TY - JOUR
T1 - Simplified sewerage to prevent urban leptospirosis transmission
T2 - a cluster non-randomised controlled trial protocol in disadvantaged urban communities of Salvador, Brazil
AU - Cremonese, Cleber
AU - Souza, Fabio Neves
AU - Palma, Fabiana Almerinda Gonçalves
AU - Sodré, Jonatas Fernandes Araújo
AU - Brito, Ricardo Lustosa
AU - Ribeiro, Priscyla dos Santos
AU - Santana, Juliet Oliveira
AU - Coelho, Rachel Helena
AU - Ticona, Juan P Aguilar
AU - Nazaré, Romero J
AU - De Oliveira, Daiana
AU - Silva, Cainã Queiroz
AU - Eyre, Max T
AU - Mendes, Vinícius De Araújo
AU - Knee, Jackie
AU - Ristow, Paula
AU - Stauber, Christine E
AU - López, Yeimi Alexandra Alzate
AU - Giorgi, Emanuele
AU - Diggle, Peter J
AU - Reis, Mitermayer Galvão G
AU - Cumming, Oliver
AU - Ko, Albert
AU - Costa, Federico
N1 - Publisher Copyright: © Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY. Published by BMJ.
PY - 2023/6/23
Y1 - 2023/6/23
N2 - Introduction Leptospirosis is a globally distributed zoonotic and environmentally mediated disease that has emerged as a major health problem in urban slums in developing countries. Its aetiological agent is bacteria of the genus Leptospira, which are mainly spread in the urine of infected rodents, especially in an environment where adequate sanitation facilities are lacking, and it is known that open sewers are key transmission sources of the disease. Therefore, we aim to evaluate the effectiveness of a simplified sewerage intervention in reducing the risk of exposure to contaminated environments and Leptospira infection and to characterise the transmission mechanisms involved.Methods and analysis This matched quasi-experimental study design using non-randomised intervention and control clusters was designed to assess the effectiveness of an urban simplified sewerage intervention in the low-income communities of Salvador, Brazil. The intervention consists of household-level piped sewerage connections and community engagement and public involvement activities. A cohort of 1400adult participants will be recruited and grouped into eight clusters consisting of four matched intervention-control pairs with approximately 175 individuals in each cluster in baseline. The primary outcome is the seroincidence of Leptospira infection assessed through five serological measurements: one preintervention (baseline)and four postintervention. As a secondary outcome, we will assess Leptospira load in soil, before and after the intervention. We will also assess Leptospira exposures before and after the intervention, through transmission modelling, accounting for residents' movement, contact with flooding, contaminated soil and water, and rat infestation, to examine whether and how routes of exposure for Leptospira change following the introduction of sanitation.Ethics and dissemination This study protocol has been reviewed and approved by the ethics boards at the Federal University of Bahia and the Brazilian National Research Ethics Committee. Results will be disseminated through peer-reviewed publications and presentations to implementers, researchers and participating communities.Trial registration number Brazilian Clinical Trials Registry (RBR-8cjjpgm).
AB - Introduction Leptospirosis is a globally distributed zoonotic and environmentally mediated disease that has emerged as a major health problem in urban slums in developing countries. Its aetiological agent is bacteria of the genus Leptospira, which are mainly spread in the urine of infected rodents, especially in an environment where adequate sanitation facilities are lacking, and it is known that open sewers are key transmission sources of the disease. Therefore, we aim to evaluate the effectiveness of a simplified sewerage intervention in reducing the risk of exposure to contaminated environments and Leptospira infection and to characterise the transmission mechanisms involved.Methods and analysis This matched quasi-experimental study design using non-randomised intervention and control clusters was designed to assess the effectiveness of an urban simplified sewerage intervention in the low-income communities of Salvador, Brazil. The intervention consists of household-level piped sewerage connections and community engagement and public involvement activities. A cohort of 1400adult participants will be recruited and grouped into eight clusters consisting of four matched intervention-control pairs with approximately 175 individuals in each cluster in baseline. The primary outcome is the seroincidence of Leptospira infection assessed through five serological measurements: one preintervention (baseline)and four postintervention. As a secondary outcome, we will assess Leptospira load in soil, before and after the intervention. We will also assess Leptospira exposures before and after the intervention, through transmission modelling, accounting for residents' movement, contact with flooding, contaminated soil and water, and rat infestation, to examine whether and how routes of exposure for Leptospira change following the introduction of sanitation.Ethics and dissemination This study protocol has been reviewed and approved by the ethics boards at the Federal University of Bahia and the Brazilian National Research Ethics Committee. Results will be disseminated through peer-reviewed publications and presentations to implementers, researchers and participating communities.Trial registration number Brazilian Clinical Trials Registry (RBR-8cjjpgm).
KW - BACTERIOLOGY
KW - EPIDEMIOLOGY
KW - Public health
UR - https://www.scopus.com/pages/publications/85162772649
U2 - 10.1136/bmjopen-2022-065009
DO - 10.1136/bmjopen-2022-065009
M3 - Article
C2 - 37355266
AN - SCOPUS:85162772649
SN - 2044-6055
VL - 13
JO - BMJ open
JF - BMJ open
IS - 6
M1 - e065009
ER -
