Water, sanitation, and hygiene (WaSH) are foundational public health interventions for infectious disease control. Renewed efforts to end open defecation and provide universal access to safe drinking water, sanitation, and hygiene by 2030 are being enacted through the Sustainable Development Goals. However, results from clinical trials 1-3 question the efficacy of conventional rural WaSH approaches in low-income and middle-income countries (LMICs). Randomised trials in Bangladesh, 1 Kenya, 2 and Zimbabwe, 3 which introduced household pit latrines, hand-washing with soap, and point-of-use water chlorination, found no effect on child growth, and two of the three trials found no reductions in diarrhoea in children. We have, therefore, called for transformative WaSH approaches, 4 to more effectively reduce pathogen burden and promote child health and growth in LMICs. However, currently, it remains uncertain what transformative WaSH entails. We hypothesise that exposure to animal faeces is currently an under-recognised threat to human health. Estimates published in 2018 have highlighted the scale of animal faecal hazards, 5 which are not explicitly addressed by conventional WaSH strategies. Globally, 80% of the faecal load is estimated to come from livestock animals, including two-thirds of faeces at the household level. 5 Research addressing the effect of domestic and wild animal faeces on WaSH effectiveness is scarce 6,7 and collaboration between the WaSH, public health, and animal health sectors in LMICs insufficient. 6 As an interdisciplinary group of researchers, policy makers, and practitioners in One Health, epidemiology, veterinary medicine, child health, nutrition, microbiology, geography, social science, WaSH, and animal ecology, we met (on May 22-23, 2019) to focus attention on the neglected burden of domestic and wild animal faecal exposure among rural households in LMICs. We contend that without adding safe management of animal faeces to current programmes focused solely on human waste, rural WaSH programmes will insufficiently reduce faecal exposure from all sources to the extent needed to improve child health. To emphasise this, we propose a paradigm shift in WaSH terminology, by upgrading the

The number of infections caused by antibiotic resistant bacteria is rising worldwide. Fish from multisource pollution waters can harbour multidrug-resistant bacteria that can be disseminated to humans through eating or contact of contaminated fish. A cross-sectional study was carried out to (i) isolate and phenotypically identify bacteria from 36 fish samples from informal market in Mufakose, Harare, and (ii) determine the antibiotic sensitivity pattern of the isolated bacteria against ten available antibiotics (ampicillin 10 μg, gentamycin 30 μg, penicillin G 10 μg, erythromycin 15 μg, tetracycline 30 μg, kanamycin 30 μg, neomycin 10 μg, cloxacillin 5 μg, lincomycin 15 μg, and sulfamethoxazole 25 μg) using the Kirby–Bauer disk agar diffusion method. Eight bacterial genera were isolated and identified, and they were Escherichia, Aeromonas, Staphylococcus, Pseudomonas, Citrobacter, Klebsiella, Enterobacter, and Proteus. Among the isolates, Escherichia coli was isolated most frequently (44%) followed by Staphylococcus aureus (19%), Enterobacter aerogenes (7%), Aeromonas spp. (5%), Proteus mirabilis (5%), Citrobacter (5%), and coagulase-negative Staphylococci (5%) and the least frequent were Klebsiella (3%) and Pseudomonas (3%). All isolates were susceptible to gentamycin. Varying antibiotic resistance rates were observed to lincomycin (100%), ampicillin (81%), penicillin (67%), erythromycin (65%), tetracycline (63%), neomycin (61%), cloxacillin (43%), kanamycin (24%), and sulphamethoxazole (13%). All the isolates were multidrug-resistant (resistant to at 3 or more drugs tested) except Proteus mirabilis. Proteus mirabilis has multiple antibiotic resistance (MAR) index of 0.2, and the other isolated bacteria had MAR indexes greater than 0.2 ranging from 0.3 to 0.7. Those MAR indexes above 0.2 showed that the bacteria isolates are from a high risk source where antibiotics were frequently used, possibly from sewage effluents. Isolation of enteric bacteria such as Escherichia coli is an indication of faecal contamination, and this poses a high risk to animal and human health. These significant findings call for effective risk assessment models and management plans that protect human, animal, and environmental health.

Escherichia coli, mycoplasma); therefore, the role of the QX infectious bronchitis variant in causing clinical disease remains uncertain. However, this appears to be the first reported evidence of the circulation of QX-like IBV in Africa. QX IBV was described for the first time in China in 1996 (Wang and others 1998). Since then, this strain has been described in many countries in Asia and Europe, in both commercial farms and backyard chickens. These results highlight the global distribution of this pathogenic infectious bronchitis variant.

Stunting (low height for age) affects approximately one-quarter of children aged < 5 years worldwide. Given the limited impact of current interventions for stunting, new multisectoral evidence-based approaches are needed to decrease the burden of stunting in low- and middle-income countries (LMICs). Recognizing that the health of people, animals, and the environment are connected, we present the rationale and research agenda for considering a One Health approach to child stunting. We contend that a One Health strategy may uncover new approaches to tackling child stunting by addressing several interdependent factors that prevent children from thriving in LMICs, and that coordinated interventions among humans, animals, and environmental health sectors may have a synergistic effect in stunting reduction.

This study aimed to: (1) assess Escherichia coli contamination in polony, beef burgers and traditionally fermented cow milk from the formal and informal markets in Harare, Zimbabwe, (2) determine the antibiotic sensitivity of Escherichia coli isolates, and (3) identify Shiga-toxin producing Escherichia coli isolates using the presence of virulence genes, namely, intimin, enterohemolysin A and Shiga toxins 1 and 2. Ninety-six samples comprising 32 beef polony slices, 32 beef burger patties, and 32 fermented milk specimens were obtained from the informal and formal outlets of the central business district. Escherichia coli occurred in 20 (21%) of the samples, being more prevalent in the informal (29%) than in the formal (13%) market. Of the 20 E. coli isolates, 6 (30%) were Shiga-toxin producing E. coli, and the rest (70%) were negative for virulence genes. The predominance of Escherichia coli was greater in meat products (25%) than in fermented milk (13%). Total Escherichia coli counts were not substantially different between formal and informal markets (t-test: p=0.08). All the E. coli isolates were multidrugresistant with antimicrobial resistance prevalence ranging from 25% for Sulphamethoxazole to 100% for Penicillin and Erythromycin. The presence of E. coli in food indicates faecal contamination and probable existence of other enteric pathogens. The presence of virulent and antimicrobial-resistant E. coli strains in food threatens food safety and public health. We conclude that ready-to-eat animal products from both informal and formal sectors could result in the dissemination of antimicrobialresistant Escherichia coli species if corrective measures are not taken.