Effects of water quality, sanitation, handwashing and nutritional interventions on enteric pathogen seroconversion in rural Bangladesh: a cluster randomised trial

In a 2x2 cluster-randomized trial in rural Bangladesh, WASH interventions modestly reduced IgG against Shigella (-4.5%, 95% CI -7.6% to -1.5%) by 24 months.

• Why it matters: Randomized evidence on pathogen-specific effects of WASH and nutrition in early childhood is limited, especially in high-exposure settings where transmission is intense.
• What they did: Children in 450 clusters provided dried blood spot samples tested by multiplex IgG for 12 enteric pathogens, with primary analysis at ~24 months and secondary at ~14 months.
• The result: Seroprevalence rose with age and >94% seroconverted for norovirus, LT-ETEC, and Campylobacter by 12–18 months; WASH was generally protective but modest, while nutrition showed limited effects, including reduced non-typhoidal S. enterica at 14 months (-6.4%, 95% CI -9.8% to -3.0%).

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