Child Mouthing of Feces and Fomites and Animal Contact are Associated with Diarrhea and Impaired Growth Among Young Children in the Democratic Republic of the Congo: A Prospective Cohort Study (REDUCE Program)

George, Christine Marie; Cirhuza, Lucien Bisimwa; Kuhl, Jennifer; Williams, Camille; Coglianese, Nicole; Thomas, Elizabeth; Bauler, Sarah; François, Ruthly; Saxton, Ronald; Presence, Amani Sanvura; Birindwa, Alves; Claude, Bisimwa Rusanga Jean; Perin, Jamie; Mirindi, Patrick

doi:10.1016/j.jpeds.2020.09.013

Cited by 18 publications

(15 citation statements)

References 30 publications

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“…36,57 The association identified in our present study is likely because feces on the household compound contributed to fecal contamination of drinking water sources that are often illegal connections to the municipal water supply [58][59][60][61] and contributed to pediatric exposure to fecal pathogens through child mouthing behaviors. [13][14][15][16] High E. coli (> 100 CFU/100 mL) in source water was a significant risk factor for diarrhea in young children in this study. This finding are also consistent with previous studies that have found unimproved and unprotected water sources, which are more prone to fecal contamination, to be associated with pediatric diarrhea.…”

Section: Discussionmentioning

confidence: 50%

“…[9][10][11][12] Geophagy, the consumption of soil, dirt, or mud, and child mouthing of feces and fomites have been associated with environmental enteropathy, diarrhea, and growth faltering in young children. [13][14][15][16][17] Previous studies have also identified unimproved drinking water sources, poor water storage practices, not treating drinking water in the home, lack of caregiver handwashing with soap, lack of caregiver awareness of hygiene practices,…”

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confidence: 99%

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Fecal Contamination on the Household Compound and in Water Sources are Associated with Subsequent Diarrhea in Young Children in Urban Bangladesh (CHoBI7 Program)

Parvin

Thomas

Bhuyian

et al. 2021

The American Journal of Tropical Medicine and Hygiene

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We investigated the environmental and individual-level risk factors for diarrheal disease among young children in slum areas of Dhaka, Bangladesh. A prospective cohort study was conducted among 884 children under 5 years of age. Caregiver reports were collected on sociodemographic factors and hygiene behaviors. Diarrhea surveillance data was collected monthly based on caregiver-reported diarrhea for children in the past 2 weeks during the 12-month study period. Unannounced spot checks of the household compound were performed at 1, 3, 6, 9, and 12 months after enrollment to check for the presence of feces (animal or human) and the presence of animals in the child’s sleeping space, to assess child and caregiver hands for the presence of dirt, and to collect samples of the household’s source and stored drinking water. Children with feces found on the household compound during spot checks had a significantly higher odds of diarrhea (odds ratio: 1.71; 95% confidence interval: 1.23–2.38). Children residing in households with > 100 colony forming units/100 mL Escherichia coli in source drinking water had a significantly higher odds of diarrhea (OR: 1.43; 95% CI: 1.06–1.92). The presence of feces on the household compound and source drinking water with > 100 colony forming units/100 mL E. coli were significant risk factors for diarrheal disease for children < 5 years of age in slum areas of Dhaka, Bangladesh. These findings demonstrate the urgent need for comprehensive interventions to reduce fecal contamination on the household compound to protect the health of susceptible pediatric populations.

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Section: Discussionmentioning

confidence: 50%

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confidence: 99%

Fecal Contamination on the Household Compound and in Water Sources are Associated with Subsequent Diarrhea in Young Children in Urban Bangladesh (CHoBI7 Program)

Parvin

Thomas

Bhuyian

et al. 2021

The American Journal of Tropical Medicine and Hygiene

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“…21,22 Spot checks are another widely used observational method used for assessing a predetermined list of conditions. [23][24][25][26][27] Spot checks can be used to evaluate inadequate environmental conditions surrounding infants, such as the absence of sanitation facilities, 28 poor household cleanliness (presence of feces on the floor, stagnant wastewater), 23,[28][29][30] and hand cleanliness, 27,31 all of which are associated with enteric outcomes. Hour-to-hour spot check results can estimate the short-term variability of certain behaviors.…”

Section: Introductionmentioning

confidence: 99%

Characterizing Behaviors Associated with Enteric Pathogen Exposure among Infants in Rural Ecuador through Structured Observations

Sosa-Moreno

Lee

Engen

et al. 2022

The American Journal of Tropical Medicine and Hygiene

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The relative importance of environmental pathways that results in enteropathogen transmission may vary by context. However, measurement of contact events between individuals and the environment remains a challenge, especially for infants and young children who may use their mouth and hands to explore their environment. Using a mixed-method approach, we combined 1) semistructured observations to characterize key behaviors associated with enteric pathogen exposure and 2) structured observations using Livetrak, a customized software application, to quantify the frequency and duration of contacts events among infants in rural Ecuador. After developing and iteratively piloting the structured observation instrument, we loaded the final list of prompts onto a LiveTrak pallet to assess environmental exposures of 6-month infants (N = 19) enrolled in a prospective cohort study of diarrheal disease. Here we provide a detailed account of the lessons learned. For example, in our field site, 1) most mothers reported washing their hands after diaper changes (14/18, 77.8%); however only a third (4/11, 36.4%) were observed washing their hands; 2) the observers noted that animal ownership differed from observed animal exposure because animals owned by neighboring households were reported during the observation; and 3) using Livetrak, we found that infants frequently mouthed their hands (median = 1.9 episodes/hour, median duration: 1.6 min) and mouthed surroundings objects (1.8 episodes/hour, 1.9 min). Structured observations that track events in real time, can complement environmental sampling, quantitative survey data and qualitative interviews. Customizing these observations enabled us to quantify enteric exposures most relevant to our rural Ecuadorian context.

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“…The main pathways through which exposure to animal contamination can harm child nutritional status are through the transmission of zoonotic pathogens that cause diarrhea, through parasitic infections such as worms, and through a subclinical condition known as environmental enteric dysfunction (EED), which triggers low-level inflammation and poor nutrient absorption [ 7 , 9 , 10 ]. Thus, increased ownership of animals may be associated with increased exposure to fecal matter [ 11 ] which has been associated with a higher prevalence of child growth faltering [ 10 – 13 ].…”

Section: Introductionmentioning

confidence: 99%

“…Recent research has attempted to address these concerns of animal ownership and contamination by conducting observational, experimental, and qualitative studies. Some methods to explore these relationships have included “spot checks” of cleanliness around a household [ 11 ]; direct observations of infants and young children to document instances of exposure to contamination [ 13 , 14 ]; direct measurement of pathogens and their transmission to humans, animals, and objects [ 14 – 17 ]; measurement of biomarkers of EED [ 18 ]; randomized trials to limit exposure to contamination [ 19 – 21 ]; description of the factors predicting chicken corralling practices by households [ 22 ]; qualitative research to understand perceptions surrounding the adoption of animal corrals [ 23 , 24 ]; and a combination of these methods [ 14 , 25 ]. However, we are not aware of any studies that quantitatively describe the chicken management practices used by households and then assess them qualitatively for ground-truthing purposes, especially in the context of Ethiopia.…”

Section: Introductionmentioning

confidence: 99%

The role of chicken management practices in children’s exposure to environmental contamination: a mixed-methods analysis

et al. 2021

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Background Household chicken production presents an opportunity to promote child nutrition, but the benefits might be offset by increased environmental contamination. Using household surveys, direct observations, and in-depth interviews with woman caregivers, we sought to describe the relationship between chicken management practices and household exposure to environmental contamination, and assess barriers to adopting improved husbandry practices. Methods First, we analyzed baseline data from 973 households raising chickens in the two interventions arms from the Agriculture-to-Nutrition (ATONU) study in Ethiopia to assess the relationship between animal management practices and environmental exposures. Second, we conducted six-hour direct observations of children’s environmental exposures in 18 households. Among these households, we analyzed in-depth interviews with child caregivers. Results Quantitative analyses showed that households raised approximately 11 chickens, had animal feces visible on the property 67% of the time, and children’s hands were visibly dirty 38% of the time. Households with more chickens had lower exposure to animal feces. Having a chicken coop increased the risk of observing animal feces on the property by 30%, but among those with a coop, having an enclosed coop reduced that risk by 83%. Coops that were enclosed, had fencing, and were located further from homes were associated with a reduced risk of observing animal feces and an increased likelihood of children having clean hands. Direct observations showed that chicken coops were often poorly designed or not used. On average, 3 to 5 chickens were inside homes at a time, and livestock and domestic animals were frequently inside of houses and interacting with young children. In-depth interviews revealed that protection of animals, maintenance of household cleanliness and health, type of chicken (local versus improved) and resource constraints influenced management decisions. Conclusions Improvements in chicken management practices could mitigate the exposure of household members to environmental contamination. Our findings highlight the need for training and resources to promote safe animal husbandry practices and optimal child health in nutrition-sensitive livestock projects. Trial registration Clinical trials number: NCT03152227; Retrospectively registered at ClinicalTrials.gov on May 12, 2012.

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Child Mouthing of Feces and Fomites and Animal Contact are Associated with Diarrhea and Impaired Growth Among Young Children in the Democratic Republic of the Congo: A Prospective Cohort Study (REDUCE Program)

Cited by 18 publications

References 30 publications

Fecal Contamination on the Household Compound and in Water Sources are Associated with Subsequent Diarrhea in Young Children in Urban Bangladesh (CHoBI7 Program)

Fecal Contamination on the Household Compound and in Water Sources are Associated with Subsequent Diarrhea in Young Children in Urban Bangladesh (CHoBI7 Program)

Characterizing Behaviors Associated with Enteric Pathogen Exposure among Infants in Rural Ecuador through Structured Observations

The role of chicken management practices in children’s exposure to environmental contamination: a mixed-methods analysis

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