Soil Ingestion is Associated with Child Diarrhea in an Urban Slum of Nairobi, Kenya

Abstract

Abstract. Diarrhea is a leading cause of mortality in children under 5 years of age. We conducted a crosssectional study of 54 children aged 3 months to 5 years old in Kibera, an urban slum in Nairobi, Kenya, to assess the relationship between caregiver-reported soil ingestion and child diarrhea. Diarrhea was significantly associated with soil ingestion (adjusted odds ratio = 9.9, 95% confidence interval = 2.1-47.5). Soil samples from locations near each household were also collected and analyzed for Escherichia coli and a human-associated Bacteroides fecal marker (HF183). Escherichia coli was detected in 100% of soil samples (mean 5.5 log colony forming units E. coli per gram of dry soil) and the Bacteroides fecal marker HF183 was detected in 93% of soil samples. These findings suggest that soil ingestion may be an important transmission pathway for diarrheal disease in urban slum settings.

Child soil ingestion in rural Ghana – frequency, caregiver perceptions, relationship with household floor material and associations with child diarrhoea

“…This work found evidence that children's caregiver‐reported behaviour of direct soil ingestion was associated with caregiver‐reported diarrhoea independent of whether the household had an earth floor, that children who ingest soil may ingest it every day, and that a caregiver's reported perception of soil ingestion as unsafe may not reduce the amount of soil her/his children ingest in this rural Ghanaian setting. Along with adding to the growing body of evidence that soil ingestion may be an important pathway for faecal contamination to consider in holistic WASH interventions , this study adds detailed knowledge about the prevalence, weekly frequency, and estimated quantities of direct ingestion for over 500 children in northern Ghana, including data for children over 30 months, which could be useful for future exposure and risk assessments as most past studies of soil ingestion prevalence and frequency for young children in low‐income countries have only included children up to 18 months or 30 months .…”

“…For a subset of 31 households, soil samples were collected from inside each compound (where applicable) or from the compound entrance, following the methods of Bauza et al . . Briefly, approximately 10 g of soil was collected from the ground surface using sterile polystyrene sampling spoons (Nasco, Fort Atkinson, WI) from an area approximately 10 cm by 10 cm.…”

“…Soil ingestion by young children may be an important faecal exposure route given that a growing number of studies in low‐income countries have observed a link between exploratory soil ingestion and negative health consequences (e.g. diarrhoea , environmental enteric dysfunction (EED) , stunting ) that have substantial effects on child health and survival globally. Diarrhoea is the second leading cause of death in children under five, responsible for an estimated 525 000 deaths each year .…”

“…Stunting affects over one‐fourth of children in developing countries and is estimated to be the underlying cause of approximately 15% of deaths in children under five . Faecal contamination of soil in or near households has also been documented in several low‐income countries . Given the risk of adverse health effects with which exploratory soil ingestion may be associated, its further characterisation as a potentially important faecal exposure route in children is warranted.…”

“…Although not yet directly studied, it would be a logical extension to assume floor upgrades could reduce the prevalence and frequency of direct soil ingestion, as a child with a finished floor in their household would no longer be exposed to soil within their home. However, a recent study in Kenya found a high prevalence of soil ingestion among children with finished household floors, likely due to children spending much time outside , suggesting that soil ingestion could remain an important exposure route for children living in households with finished floors. However, more research is needed to understand whether finished flooring in households reduces the prevalence or frequency of soil ingestion vs. earth flooring, which would provide insight into whether floor upgrades could be an effective means of reducing faecal exposure via direct soil ingestion.…”