Maternal and Child Health Commons^™

Effect Of Intrauterine Smoke Exposure On Microrna-15a Expression In Human Lung Development And Subsequent Asthma Risk., Sunita Sharma, Alvin T. Kho, Divya Chhabra, Kathleen Haley, Carrie A. Vyhlidal, R Gaedigk, J Steven Leeder, Kelan G. Tantisira, Benjamin Raby, Scott T. Weiss

Manuscripts, Articles, Book Chapters and Other Papers

Background: In utero smoke (IUS) exposure is associated with asthma susceptibility.

Objective: We sought to test the hypothesis that changes in miRNA expression by IUS exposure during human lung development is associated with asthma susceptibility.

Methods: Gene expression was profiled from 53 IUS unexposed and 51 IUS exposed human fetal lung tissues. We tested for the differential expression of miRNAs across post-conception age and by IUS using linear models with covariate adjustment. We tested the IUS-associated miRNAs for association with their gene expression targets using pair-wise inverse correlation. Using our mouse model, we investigated the persistence of the IUS-associated miRNA …

The Role Of Prenatal Food Insecurity On Breastfeeding Behaviors: Findings From The United States Pregnancy Risk Assessment Monitoring System, Lauren Dinour, Elizabeth I. Rivera Rodas, Ndidiamaka Amutah-Onukagha, Laurén A. Doamekpor

Department of Nutrition and Food Studies Scholarship and Creative Works

Background

In addition to its health and nutritional benefits, breastfeeding can save low-income, food insecure mothers the cost of infant formula so that money can be spent on food and other necessities. Yet breastfeeding may exacerbate food insecurity by negatively affecting maternal employment. The relationship between food insecurity and breastfeeding has been explored previously, with varying results. The purpose of this study was to determine the relationship between prenatal food insecurity and breastfeeding initiation and early cessation (< 10 weeks) among U.S. mothers.

Methods

Data were pooled from 2012 to 2013 (Phase 7) of the Pregnancy Risk Assessment Monitoring System, a population-based cross-sectional survey of …

Early Marriage And Early Childbearing In South Asia: Trends, Inequalities, And Drivers From 2005 To 2018, Samuel Scott, Phuong Hong Nguyen, Sumanta Neupane, Priyanjana Pramanik, Priya Nanda, Zulfiqar Ahmed Bhutta, Kaosar Afsana, Purnima Menon

Woman and Child Health

Early marriage (EM) and early childbearing (ECB) have far-reaching consequences. This study describes the prevalence, trends, inequalities, and drivers of EM and ECB in South Asia using eight rounds of Demographic and Health Survey data across 13 years. We report the percentage of ever-married women aged 20-24 years (n = 105,150) married before 18 years (EM) and with a live birth before 20 years (ECB). Relative trends were examined using average annual rate of reduction (AARR). Inequalities were examined by geography, marital household wealth, residence, and education. Sociodemographic drivers of changes for EM were assessed using regression decomposition analyses. We …

Prevention Of Pediatric Mortality Associated With Malaria: An Exhaustive Literature Review, Taylor Mosley

The Eleanor Mann School of Nursing Undergraduate Honors Theses

Malaria, a disease that is preventable yet frequently fatal, disproportionately affects pediatric African populations at a rate that results in a child under the age of 5 dying every two minutes. Since 1955, the World Health Organization has contributed to a significant reduction in the morbidity and mortality of malaria; however, progress has stalled in recent years. In some countries, particularly those in sub-Saharan Africa, cases have increased since 2015. This literature review seeks to identify factors associated with this incline, as well as what interventions can have the greatest impact to prevent pediatric mortality in areas with the largest …

J Mich Dent Assoc December 2020

The Journal of the Michigan Dental Association

Every month, The Journal of the Michigan Dental Association brings news, information, and features about Michigan dentistry to our state's oral health community and the MDA's 6,200+ members. No publication reaches more Michigan dentists!

In this issue, the reader will find the following original content:

• A cover story on “The Dentist’s Role in Recognizing Sleep-Related Breathing Disorders: A Two-Part Series”.
• The “2020 Author/Title Index to the Journal of the Michigan Dental Association”.
• News you need, Editorial and regular department articles on MDA Foundation activities, Dentistry and the Law, Staff Matters, and component news.

This issue also includes three articles reprinted …

“We Have A Lot Of Home Deliveries” A Qualitative Study On The Impact Of Covid-19 On Access To And Utilization Of Reproductive, Maternal, Newborn And Child Health Care Among Refugee Women In Urban Eastleigh, Kenya, Adelaide Lusambili, Michela Martini, Faiza Abdirahman, Abena Asante, Sharon Ochieng, Joseph N. Guni, Rose Maina, Stanley Luchters

Population Health, East Africa

Background: Little is known about how pregnant refugee women, and the frontline health care workers who serve them, are affected by the COVID-19 pandemic in terms of health, and health service access. Women refugees are classified as a vulnerable group with regard to pregnancy outcomes and access to maternal care, and may be disproportionally at risk for COVID-19 infection as they are likely to face unique barriers to information and access to reproductive health services during the pandemic. Few studies identify gaps that could inform potential interventions to improve service uptake for refugee women, particularly in the context of …

Typhoid And Paratyphoid Cost Of Illness In Pakistan: Patient And Health Facility Costs From The Surveillance For Enteric Fever In Asia Project Ii, Nelly Mejia, Farah Naz Qamar, Mohammad Tahir Yousafzai, Jamal Raza, Denise O. Garrett, Kashmira Date, Taiwo Abimbola, Sarah W. Pallas

Department of Paediatrics and Child Health

Background: The objective of this study was to estimate the cost of illness from enteric fever (typhoid and paratyphoid) at selected sites in Pakistan.
Methods: We implemented a cost-of-illness study in 4 hospitals as part of the Surveillance for Enteric Fever in Asia Project (SEAP) II in Pakistan. From the patient and caregiver perspective, we collected direct medical, nonmedical, and indirect costs per case of enteric fever incurred since illness onset by phone after enrollment and 6 weeks later. From the health care provider perspective, we collected data on quantities and prices of resources used at 3 of the hospitals, …

Diagnostic Value Of Clinical Features To Distinguish Enteric Fever From Other Febrile Illnesses In Bangladesh, Nepal, And Pakistan, Kristen Aiemjoy, Dipesh Tamrakar, Shampa Saha, Shiva R. Naga, Alexander T. Yu, Ashley Longley, Kashmira Date, Caitlin Hemlock, Farah Naz Qamar, Samir K. Saha

Department of Paediatrics and Child Health

Background: Enteric fever, a bacterial infection caused by Salmonella enterica serotypes Typhi and Paratyphi A, frequently presents as a nonlocalizing febrile illness that is difficult to distinguish from other infectious causes of fever. Blood culture is not widely available in endemic settings and, even when available, results can take up to 5 days. We evaluated the diagnostic performance of clinical features, including both reported symptoms and clinical signs, of enteric fever among patients participating in the Surveillance for Enteric Fever in Asia Project (SEAP), a 3-year surveillance study in Bangladesh, Nepal, and Pakistan.
Methods: Outpatients presenting with ≥3 consecutive days …

Frequency Of Hypocalcemic Fits In Children 2 Months To 2 Years Of Age, Presenting With The First Episode Of Afebrile Seizures At Hospital Settings In Urban Pakistan: A Cross-Sectional Study, Waseem Rahman, Heeramani Lohana, Sarwat Urooj, Sheraz Ahmed, Abdul Moeed, Khadija Nuzhat Humayun

Department of Paediatrics and Child Health

Introduction: Seizures are common in the pediatric age group, occurring approximately 10% of children. Hypocalcemia is one of the most common metabolic causes of afebrile seizures. The objective of the study was to determine the frequency of hypocalcemic fits in children presenting with the first episode of afebrile seizures from 2 months to 2 years of age.
Methods: The study was conducted at the Aga Khan hospital Karachi and its three secondary hospitals including the following sites of Kharadar, Hyderabad, and garden. It was a cross-sectional study. The duration of the study was of 6 months from 18th July 2017 …

Maternal Risk Factors And Short Term Outcome Of Prematurity: A Descriptive Study At A Secondary Care Hospital, Heeramani Lohana, Shakeel Ahmed, Nigar Jabeen, Farida Karim, Sarwat Urooj, Ayesha Ahmed

Department of Paediatrics and Child Health

Background: Approximately 15 million babies are born premature (before 37 weeks of gestation) and 1 million babies die due to prematurity complications every year. Less is known about risk factors of prematurity in middle and low-income countries. The prevalence of prematurity ranges from 5% - 18%.
Objective: To determine the prevalence of premature births and to assess the rate of survival, along with the morbidity, among preterm newborns. Furthermore, to document our experience with different gestational age groups of preterm births; and to analyze the association among these strata and their clinical outcomes.
Study Design: A descriptive study.
Place …

Multiomics Characterization Of Preterm Birth In Low- And Middle-Income Countries, Fyezah Jehan, Muhammad Imran Nisar, Muhammad Ilyas, Usma Mehmood, Aneeta Hotwani, Ambreen Nizar, Sajid Muhammad, Waqasuddin Khan, Javairia Khalid, Furqan Kabir

Department of Paediatrics and Child Health

Importance: Worldwide, preterm birth (PTB) is the single largest cause of deaths in the perinatal and neonatal period and is associated with increased morbidity in young children. The cause of PTB is multifactorial, and the development of generalizable biological models may enable early detection and guide therapeutic studies.
Objective: To investigate the ability of transcriptomics and proteomics profiling of plasma and metabolomics analysis of urine to identify early biological measurements associated with PTB.
Design, setting, and participants: This diagnostic/prognostic study analyzed plasma and urine samples collected from May 2014 to June 2017 from pregnant women in 5 biorepository cohorts in …

The Cortico-Limbo-Thalamo-Cortical Circuits: An Update To The Original Papez Circuit Of The Human Limbic System, Jochen Profit, Paul J Sharek, Xin Cui, Courtney C Nisbet, Eric J Thomas, Daniel S Tawfik, Henry C Lee, David Draper, J Bryan Sexton

Faculty, Staff and Student Publications

OBJECTIVES: Key validated clinical metrics are being used individually and in aggregate (Baby-MONITOR) to monitor the performance of neonatal intensive care units (NICUs). The degree to which perceptions of key components of safety culture, safety climate, and teamwork are related to aspects of NICU quality of care is poorly understood. The objective of this study was to test whether NICU performance on key clinical metrics correlates with caregiver perceptions of safety culture.

STUDY DESIGN: Cross-sectional study of 6253 very low-birth-weight infants in 44 NICUs. We measured clinical quality via the Baby-MONITOR and its nine risk-adjusted and standardized subcomponents (antenatal corticosteroids, …

Long-Term Neurocognitive And Educational Outcomes Of Neonatal Insults In Kilifi, Kenya, Dorcas N. Magai, Hans M. Koot, Paul Mwangi, Esther Chongwo, Charles R. Newton, Amina Abubakar

Institute for Human Development, East Africa

Background: There is little data on the long-term neurocognitive and educational outcomes among school-aged survivors of neonatal jaundice (NNJ) and hypoxic-ischemic encephalopathy (HIE) in Africa. This study investigates the long-term neurocognitive and educational outcomes and the correlates of these outcomes in school-aged survivors of NNJ or HIE in Kilifi, Kenya.

Methods: We conducted a cross-sectional study on neurocognitive and educational outcomes among school-aged survivors (6–12 years) of NNJ (n = 134) and HIE (n = 107) and compared them to a community comparison group (n = 134). We assessed nonverbal intelligence, planning, working memory, attention, syntax, pragmatics, wordfinding, …

Developing A Program Evaluation Plan For Medicaid Prenatal Care Management Programs, Shardae Sims

Capstone Experience: Master of Public Health

Prenatal care management (PNCM) is an intervention that targets women during the perinatal period to improve birth outcomes. PNCM has the potential to address social determinants of health issues and gaps or barriers to care that could lower incidences of adverse birth outcomes in Nebraska. There is currently a gap in the literature for studies that fully assess the impact of prenatal care management programs and the program’s ability to reach set goals. The purpose of this research is to develop an evaluation plan and potential implementation strategies that can be utilized by the Medicaid PNCM program in Nebraska. The …

Loss To Follow Up Of Pregnant Women With Hiv And Infant Hiv Outcomes In The Prevention Of Maternal To Child Transmission Of Hiv Programme In Two High-Burden Provinces In Papua New Guinea: A Retrospective Clinical Audit, Angela Kelly-Hanku, Claire Elizabeth Nightingale, Minh Duc Pham, Agnes Mek, Primrose Homiehombo, Mary Bagita, Justine Nankinga, Andrew Vallely, Lisa Vallely, Stanley Luchters

Population Health, East Africa

Introduction Despite early adoption of the WHO guidelines to deliver lifelong antiretroviral (ARV) regimen to pregnant women on HIV diagnosis, the HIV prevention of mother to child transmission programme in Papua New Guinea remains suboptimal. An unacceptable number of babies are infected with HIV and mothers not retained in treatment. This study aimed to describe the characteristics of this programme and to investigate the factors associated with programme performance outcomes.

Methods We conducted a retrospective analysis of clinical records of HIV-positive pregnant women at two hospitals providing prevention of mother to child transmission services. All women enrolled in the prevention …

Neonatal Deaths In Infants Born Weighing ≥ 2500 G In Low And Middle-Income Countries, Sarah Saleem, Farnaz Naqvi, Elizabeth M. Mcclure, Kayla J. Nowak, Shiyam Sunder Tikmani, Ana L. Garces, Patricia L. Hibberd, Janet L. Moore, Tracy L. Nolen, Sameen Siddiqi

Community Health Sciences

Background: Babies born weighing ≥ 2500 g account for more than 80% of the births in most resource-limited locations and for nearly 50% of the 28-day neonatal deaths. In contrast, in high-resource settings, 28-day neonatal mortality among this group represents only a small fraction of the neonatal deaths. Yet mortality risks for birth weight of ≥ 2500 g is limited. Knowledge regarding the factors associated with mortality in these babies will help in identifying interventions that can reduce mortality.
Methods: The Global Network's Maternal Newborn Health Registry (MNHR) is a prospective, population-based observational study that includes all pregnant women and …

The Global Network Maternal Newborn Health Registry: A Multi-Country, Community-Based Registry Of Pregnancy Outcomes, Elizabeth M. Mcclure, Ana L. Garces, Patricia L. Hibberd, Janet L. Moore, Shivaprasad S. Goudar, Sarah Saleem, Fabian Esamai, Archana Patel, Elwyn Chomba, Adrien Lokangaka

Community Health Sciences

Background: The Global Network for Women's and Children's Health Research (Global Network) conducts clinical trials in resource-limited countries through partnerships among U.S. investigators, international investigators based in in low and middle-income countries (LMICs) and a central data coordinating center. The Global Network's objectives include evaluating low-cost, sustainable interventions to improve women's and children's health in LMICs. Accurate reporting of births, stillbirths, neonatal deaths, maternal mortality, and measures of obstetric and neonatal care is critical to determine strategies for improving pregnancy outcomes. In response to this need, the Global Network developed the Maternal Newborn Health Registry (MNHR), a prospective, population-based registry …

Evaluating The Effect Of Care Around Labor And Delivery Practices On Early Neonatal Mortality In The Global Network's Maternal And Newborn Health Registry, Archana B. Patel, Elizabeth M. Simmon, Sowmya R. Rao, Janet Moore, Tracy L. Nolen, Robert L. Goldenberg, Shivaprasad S. Goudar, Manjunath S. Somannavar, Sarah Saleem, Farnaz Naqvi

Community Health Sciences

Background: Neonatal deaths in first 28-days of life represent 47% of all deaths under the age of five years globally and are a focus of the United Nation's (UN's) Sustainable Development Goals. Pregnant women are delivering in facilities but that does not indicate quality of care during delivery and the postpartum period. The World Health Organization's Essential Newborn Care (ENC) package reduces neonatal mortality, but lacks a simple and valid composite index that measures its effectiveness.
Methods: Data on 5 intra-partum and 3 post-partum practices (indicators) recommended as part of ENC, routinely collected in NICHD's Global Network's (GN) Maternal Newborn …

The Relationship Between Birth Intervals And Adverse Maternal And Neonatal Outcomes In Six Low And Lower-Middle Income Countries, Melissa Bauserman, Kayla Nowak, Tracy L. Nolen, Jackie Patterson, Adrien Lokangaka, Antoinette Tshefu, Archana B. Patel, Patricia L. Hibberd, Sarah Saleem, Saleem Jessani

Community Health Sciences

Background: Due to high fertility rates in some low and lower-middle income countries, the interval between pregnancies can be short, which may lead to adverse maternal and neonatal outcomes.
Methods: We analyzed data from women enrolled in the NICHD Global Network Maternal Newborn Health Registry (MNHR) from 2013 through 2018. We report maternal characteristics and outcomes in relationship to the inter-delivery interval (IDI, time from previous delivery [live or stillborn] to the delivery of the index birth), by category of 6-17 months (short), 18-36 months (reference), 37-60 months, and 61-180 months (long). We used non-parametric tests for maternal characteristics, and …

Stillbirth 2010-2018: A Prospective, Population-Based, Multi-Country Study From The Global Network, Elizabeth M. Mcclure, Sarah Saleem, Shivaprasad S. Gouda, Ana Garces, Ryan Whitworth, Fabian Esamai, Archana B. Patel, Shiyam Sunder Tikmani, Musaku Mwenechanya, Elwyn Chomba

Community Health Sciences

Background: Stillbirth rates are high and represent a substantial proportion of the under-5 mortality in low and middle-income countries (LMIC). In LMIC, where nearly 98% of stillbirths worldwide occur, few population-based studies have documented cause of stillbirths or the trends in rate of stillbirth over time.
Methods: We undertook a prospective, population-based multi-country research study of all pregnant women in defined geographic areas across 7 sites in low-resource settings (Kenya, Zambia, Democratic Republic of Congo, India, Pakistan, and Guatemala). Staff collected demographic and health care characteristics with outcomes obtained at delivery. Cause of stillbirth was assigned by algorithm.
Results: From …

Hemoglobin Concentrations And Adverse Birth Outcomes In South Asian Pregnant Women: Findings From A Prospective Maternal And Neonatal Health Registry, Sumera Aziz Ali, Shiyam Sunder Tikmani, Sarah Saleem, Archana B. Patel, Patricia L. Hibberd, Shivaprasad S. Goudar, Sangappa Dhaded, Richard J. Derman, Janet L. Moore, Elizabeth M. Mcclure, Robert L. Goldenberg

Community Health Sciences

Background: While the relationship between hemoglobin (Hb) concentrations and pregnancy outcomes has been studied often, most reports have focused on a specific Hb cutoff used to define anemia. Fewer studies have evaluated pregnancy outcomes across the entire range of Hb values. Moreover, to date, most studies of the relationship of Hb concentrations to pregnancy outcomes have been done in high-income countries. Thus, we have sought to determine the relationship between the range of maternal Hb concentrations and adverse birth outcomes among South Asian pregnant women.
Methods: For this study, we used data collected from two South Asian countries (Pakistan - …

Looking Beyond The Numbers: Quality Assurance Procedures In The Global Network For Women's And Children's Health Research Maternal Newborn Health Registry, Ana Garces, Emily Macguire, Holly L. Franklin, Norma Alfaro, Gustavo Arroyo, Lester Figueroa, Shivaprasad S. Goudar, Sarah Saleem, Fabian Esama, Archana Patel

Community Health Sciences

Background: Quality assurance (QA) is a process that should be an integral part of research to protect the rights and safety of study participants and to reduce the likelihood that the results are affected by bias in data collection. Most QA plans include processes related to study preparation and regulatory compliance, data collection, data analysis and publication of study results. However, little detailed information is available on the specific procedures associated with QA processes to ensure high-quality data in multi-site studies.
Methods: The Global Network for Women's and Children's Health Maternal Newborn Health Registy (MNHR) is a prospective population-based registry …

Reports From The Nichd Global Network's Maternal And Newborn Health Registry: Supplement Introduction, Robert L. Goldenberg, Shivaprasad S. Goudar, Sarah Saleem, Patricia L. Hibberd, Jorge E. Tolosa, Marion Koso-Thomas, Elizabeth M. Mcclure, Global Network Investigators

Community Health Sciences

No abstract provided.

Generational Impacts Of 1930s Housing Discrimination And The Imperative Need For The Healthy Start Initiative To Address Structural Racism, Brittney Butler, Michael Outrich, Jessica Roach, Arthur James

Journal of Health Disparities Research and Practice

For nearly three decades, Healthy Start Initiative(HSI) has served communities with high rates of adverse pregnancy outcomes--with the goal to lower them by 50%. Despite a large focus on social determinants of health, HSI has narrowly addressed racism. The effects of legal housing discrimination continue to be felt and have profound implications for pregnancy. To understand the historical context of racism in these communities, we geospatially evaluated the relationship between HSI service areas and Home-Owners Loan Corporation(HOLC) graded maps. Using data from John Snow Inc, National Healthy Start Association, and Mapping Inequality we found that 73 of 100 communities served …

Mitigating Toxic Stress In Children Affected By Conflict And Displacement, Anushka Ataullahjan, Muthanna Samara, Theresa S. Betancourt, Zulfiqar Ahmed Bhutta

Woman and Child Health

Anushka Ataullahjan and colleagues describe the myriad stressors related to conflict and displacement experienced by children and how best to reduce their negative effect

Child Food Insecurity In Nevada Counties, 2018, Ally Beckwith, Caitlin J. Saladino, William E. Brown Jr.

Health

This fact sheet synthesizes data on the child hunger discrepancies in Nevada counties from the Feeding America 2018 Map the Meal Gap Study. The information focuses on food insecurity experienced by children, and the food budget shortfall in Nevada.

The Rural-Urban Divide In Tanzania: Residential Context And Socioeconomic Inequalities In Maternal Health Care Utilization, Neema Langa, Tirth Bhatta

Sociology Faculty Research

Background Existing studies in Tanzania, based mostly on rural samples, have primarily focused on individual behaviors responsible for the lower utilization of maternal health care. Relatively less attention had been paid to inequalities in structural circumstances that contribute to reduced utilization of maternal health care. More importantly, scholarship concerning the impact of the rural-urban divide on socioeconomic disparities in the utilization of maternal health care is virtually nonexistent in Tanzania. Methods Drawing from the Demographic Health Survey (2015-2016) conducted in Tanzania, our study includes a total of 3,595 women aged between 15-49 years old, who had given birth in five …

Simulator-Based Ultrasound Training For Identification Of Endotracheal Tube Placement In A Neonatal Intensive Care Unit Using Point Of Care Ultrasound, Khushboo Qaim Ali, Sajid Bashir Soofi, Ali Shabbir Hussain, Uzair Ansari, Shaun Morris, Mark Oliver Tessaro, Shabina Ariff, Hasan Merali

Department of Paediatrics and Child Health

Background: Simulators are an extensively utilized teaching tool in clinical settings. Simulation enables learners to practice and improve their skills in a safe and controlled environment before using these skills on patients. We evaluated the effect of a training session utilizing a novel intubation ultrasound simulator on the accuracy of provider detection of tracheal versus esophageal neonatal endotracheal tube (ETT) placement using point-of-care ultrasound (POCUS). We also investigated whether the time to POCUS image interpretation decreased with repeated simulator attempts.
Methods: Sixty neonatal health care providers participated in a three-hour simulator-based training session in the neonatal intensive care unit (NICU) …

Predictive Modeling For Perinatal Mortality In Resource-Limited Settings, Vivek V. Shukla, Barry Eggleston, Namasivayam Ambalavanan, Elizabeth M. Mcclure, Musaku Mwenechanya, Elwyn Chomba, Carl Bose, Melissa Bauserman, Antoinette Tshefu, Sarah Saleem

Community Health Sciences

Importance: The overwhelming majority of fetal and neonatal deaths occur in low- and middle-income countries. Fetal and neonatal risk assessment tools may be useful to predict the risk of death.
Objective: To develop risk prediction models for intrapartum stillbirth and neonatal death.
Design, setting, and participants: This cohort study used data from the Eunice Kennedy Shriver National Institute of Child Health and Human Development Global Network for Women's and Children's Health Research population-based vital registry, including clinical sites in South Asia (India and Pakistan), Africa (Democratic Republic of Congo, Zambia, and Kenya), and Latin America (Guatemala). A total of 502 …

Associations Between Household-Level Exposures And All-Cause Diarrhea And Pathogen-Specific Enteric Infections In Children Enrolled In Five Sentinel Surveillance Studies, Josh M. Colston, Abu S G. Faruque, M Jahangir Hossain, Debasish Saha, Suman Kanungo, Inácio Mandomando, Muhammad Imran Nisar, Anita K. M. Zaidi, Richard Omore, Zulfiqar Ahmed Bhutta

Department of Paediatrics and Child Health

Diarrheal disease remains a major cause of childhood mortality and morbidity causing poor health and economic outcomes. In low-resource settings, young children are exposed to numerous risk factors for enteric pathogen transmission within their dwellings, though the relative importance of different transmission pathways varies by pathogen species. The objective of this analysis was to model associations between five household-level risk factors-water, sanitation, flooring, caregiver education, and crowding-and infection status for endemic enteric pathogens in children in five surveillance studies. Data were combined from 22 sites in which a total of 58,000 stool samples were tested for 16 specific enteropathogens using …