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

PY - 2023/6/23

Y1 - 2023/6/23

N2 - 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 , 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 infection and to characterise the transmission mechanisms involved. 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 1400 adult 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 infection assessed through five serological measurements: one preintervention (baseline) and four postintervention. As a secondary outcome, we will assess load in soil, before and after the intervention. We will also assess 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 change following the introduction of sanitation. 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. Brazilian Clinical Trials Registry (RBR-8cjjpgm). [Abstract copyright: © Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY. Published by BMJ.]

AB - 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 , 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 infection and to characterise the transmission mechanisms involved. 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 1400 adult 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 infection assessed through five serological measurements: one preintervention (baseline) and four postintervention. As a secondary outcome, we will assess load in soil, before and after the intervention. We will also assess 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 change following the introduction of sanitation. 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. Brazilian Clinical Trials Registry (RBR-8cjjpgm). [Abstract copyright: © Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY. Published by BMJ.]

KW - General Medicine

U2 - 10.1136/bmjopen-2022-065009

DO - 10.1136/bmjopen-2022-065009

M3 - Journal article

VL - 13

JO - BMJ Open

JF - BMJ Open

SN - 2044-6055

IS - 6

M1 - e065009

ER -