{
  "abstract": "Background: We evaluated whether water, sanitation, and handwashing (WASH) and nutrition interventions reduced enteric pathogen seroprevalence during the first two years of life among children in rural Kenya. Methods: We analysed the 2x2 factorial subset of the WASH Benefits Kenya cluster-randomised trial (control, WASH, nutrition, and WASH plus nutrition). Dried blood spots were collected from all children in the birth cohort after two years of intervention and at 6 and 12 months within a longitudinal substudy. Immunoglobulin G (IgG) responses were measured using a multiplex bead assay that included 12 viral, bacterial, protozoan, and helminth pathogens. The primary outcome was IgG seroprevalence at 2 years. We estimated intention-to-treat differences, comparing WASH with no WASH and nutrition with no nutrition across the factorial design. The trial is registered with ClinicalTrials.gov (NCT01704105). Findings: The primary analysis included 3030 children in 384 of 391 clusters (median age 23 months). Seroprevalence increased rapidly with age and exceeded 90% for norovirus, Campylobacter, and LT-ETEC by the final visit, with several pathogens at more moderate prevalences (24% of children were seropositive to typhoidal S. enterica HlyE). Differences between intervention groups were small: lower T. solium (-3.3 percentage points [95% CI -6.3 to -0.2]) and higher E. histolytica (3.2 [0.1 to 6.3]) with WASH versus control, and lower V. cholerae (-1.1 [-1.8 to -0.3]) and Shigella/EIEC (-2.7 [-5.5 to 0.0]) with nutrition versus no nutrition. No comparison met the 5% Benjamini-Hochberg false discovery rate threshold. Secondary analyses and age-seroprevalence curves suggested modest reductions in seroprevalence for some pathogens but an increase in norovirus at approximately 12 months when intervention adherence was highest. Interpretation: At the levels of adherence achieved, household-level WASH and nutrition interventions were insufficient to reduce widespread early-life enteric pathogen exposure in this high-transmission setting, supporting development of complementary vaccine and transmission-control strategies. Funding: National Institutes of Health (R01AI166671, R01AI106878, R01AI134814). The original WASH Benefits trial was funded by the Gates Foundation (OPPGD759).",
  "abstract_shown": true,
  "affiliations": [
    "University of California, San Francisco"
  ],
  "article_type": "PUBLISHAHEADOFPRINT",
  "arxiv": null,
  "author_total": 27,
  "authors": [
    {
      "name": "H. Kanyi"
    },
    {
      "name": "R. W. Kihoro"
    },
    {
      "name": "H. Hu"
    },
    {
      "name": "H. Emisiko"
    },
    {
      "name": "B. Goodhew"
    },
    {
      "name": "C. Coleman"
    },
    {
      "name": "R. C. Charles"
    },
    {
      "name": "E. T. Ryan"
    },
    {
      "name": "C. Munroe"
    },
    {
      "name": "R. L. Atmar"
    },
    {
      "name": "P. A. Ante-Testard"
    },
    {
      "name": "E. Kamau"
    },
    {
      "name": "S. J. Bents"
    },
    {
      "name": "B. S. Achando"
    },
    {
      "name": "A. N. Mertens"
    },
    {
      "name": "H. N. Dentz"
    },
    {
      "name": "G. Rao"
    },
    {
      "name": "M. K. Wolfe"
    },
    {
      "name": "C. P. Stewart"
    },
    {
      "name": "A. J. Pickering"
    },
    {
      "name": "C. Null"
    },
    {
      "name": "A. Lin"
    },
    {
      "name": "J. M. Colford"
    },
    {
      "name": "P. J. Lammie"
    },
    {
      "name": "J. W. Priest"
    },
    {
      "affs": [
        0
      ],
      "name": "B. F. Arnold"
    },
    {
      "name": "S. M. Njenga"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/5jamhsaszgphb.bib",
  "cited_by": 0,
  "doi": "10.64898/2026.10.30.26366882",
  "fulltext_url": "https://www.medrxiv.org/content/10.64898/2026.10.30.26366882v1.full",
  "id": "5jamhsaszgphb",
  "issns": [],
  "landing_url": "https://www.medrxiv.org/content/10.64898/2026.10.30.26366882v1",
  "language": null,
  "licence": "CC-BY",
  "licence_label": "CC BY",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "medrxiv",
      "epidemiology"
    ],
    [
      "openalex",
      "2916|Child Nutrition and Water Access"
    ]
  ],
  "openalex": "W7225057286",
  "pdf_url": "https://www.medrxiv.org/content/10.64898/2026.10.30.26366882v1.full.pdf",
  "pmcid": null,
  "pmid": null,
  "published": "2026-10-30",
  "publisher": null,
  "ris": "https://research.draconitic.com/paper/5jamhsaszgphb.ris",
  "sources": [
    {
      "first_seen": "2026-11-02T12:20:44Z",
      "native_id": "10.64898/2026.10.30.26366882",
      "source": "medrxiv",
      "url": "https://www.medrxiv.org/content/10.64898/2026.10.30.26366882v1"
    }
  ],
  "subjects": [
    {
      "field": "medicine",
      "origin": "medrxiv:epidemiology",
      "subfield": "epidemiology-public-health"
    }
  ],
  "title": "Effects of water quality, sanitation, handwashing and nutritional interventions on enteric pathogen seroconversion in rural Kenya: a cluster randomised trial",
  "title_text": "Effects of water quality, sanitation, handwashing and nutritional interventions on enteric pathogen seroconversion in rural Kenya: a cluster randomised trial",
  "type": "preprint",
  "updated_at": "2026-11-03T00:20:20Z",
  "url": "https://research.draconitic.com/paper/5jamhsaszgphb",
  "venue": "medRxiv",
  "versions": []
}