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We have previously conducted a controlled before-and-after trial (Maputo Sanitation trial) to evaluate the impact of an onsite urban sanitation intervention on the prevalence of bacterial and protozoan infection (primary outcome), soil-transmitted helminth (STH) re-infection, and seven-day period prevalence of diarrhea among children living in informal neighborhoods of Maputo city, Mozambique (clinicaltrials.gov: NCT02362932). We will conduct a cross-sectional survey of Maputo Sanitation (MapSan) trial compounds (clusters of households sharing sanitation and outdoor living space) at least 60-months post-intervention to evaluate the impact of the sanitation intervention on child health outcomes, specifically in children born after implementation of the sanitation intervention. Hypotheses H1. The risk of stool-based enteric pathogen detection among children 29 days – 60 months old is reduced for children born into households that previously received the sanitation intervention. H2. Children born into households that previously received the sanitation intervention experience delayed exposure to enteric pathogens relative to comparably aged children from non-intervention households, reflected in a greater reduction in the risk of enteric pathogen detection among younger age groups and attenuated reduction in risk among older children. Study Design We will revisit both the intervention and control compounds from the MapSan trial to cross-sectionally assess enteric pathogen detection, growth, and seven-day period prevalence of diarrhea in the children born into the study compounds after the sanitation intervention was delivered in 2015-2016.
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