Where Children Play: Young Child Exposure to Environmental Hazards during Play in Public Areas in a Transitioning Internally Displaced Persons Community in Haiti

Abstract

Globally, gastrointestinal (GI) infections by enteric pathogens are the second-leading cause of morbidity and mortality in children under five years of age (≤5 years). While GI pathogen exposure in households has been rigorously examined, there is little data about young children’s exposure in public domains. Moreover, public areas in low-income settings are often used for other waste disposal practices in addition to human feces, such as trash dumping in areas near households. If young children play in public domains, they might be exposed to interrelated and highly concentrated microbial, chemical, and physical hazards. This study performed structured observations at 36 public areas in an internally displaced persons community that has transitioned into a formal settlement in Haiti. We documented how often young children played in public areas and quantified behaviors that might lead to illness and injury. Children ≤5 years played at all public sites, which included infants who played at 47% of sites. Children touched and mouthed plastic, metal and glass trash, food and other objects from the ground, ate soil (geophagia) and drank surface water. They also touched latrines, animals, animal feces and open drainage canals. Hand-to-mouth contact was one of the most common behaviors observed and the rate of contact significantly differed among developmental stages (infants: 18/h, toddlers: 11/h and young children: 9/h), providing evidence that children could ingest trace amounts of animal/human feces on hands that may contain GI pathogens. These findings demonstrate that water, sanitation and hygiene interventions could be more effective if they consider exposure risks to feces in public domains. Furthermore, this research highlights the need for waste-related interventions to address the broader set of civil conditions that create unsafe, toxic and contaminated public environments where young children play.

The Landscape of Enteric Pathogen Exposure of Young Children in Public Domains of Low-Income, Urban Kenya: The Influence of Exposure Pathway and Spatial Range of Play on Multi-Pathogen Exposure Risks

“…During rapid observation at least one child was observed to play at 54% of public residential sites and engaged in behaviors such as hand contact with soil and surface water, hand-to-mouth contact, and geophagy, validating that observed behaviors in Kisumu neighborhoods are consistent with extant literature (25–27, 32, 33, 35, 36) and are relevant pathways for pathogen exposure. Of all public sites where children <5 yrs were observed in Kisumu, 93% of these sites were residential areas with mostly permeable or unpaved surfaces, versus non-residential sites.…”

“…(12, 25, 26) Some exposure differences may be related to child behavior. Young children typically have high rates of contact with soil and objects,(27–31) and occasionally surface water,(32, 33) and frequently place their hands in their mouth with no handwashing in between. (33, 34) This results in frequent indirect ingestion of trace amounts of soil, and perhaps surface water.…”

“…Young children typically have high rates of contact with soil and objects,(27–31) and occasionally surface water,(32, 33) and frequently place their hands in their mouth with no handwashing in between. (33, 34) This results in frequent indirect ingestion of trace amounts of soil, and perhaps surface water. Geophagia (direct ingestion of handfuls of soil) among young children(25, 26, 33, 35) and drinking from surface water also occur, (33) albeit less frequently than hand-to-mouth behaviors.…”

“…(33, 34) This results in frequent indirect ingestion of trace amounts of soil, and perhaps surface water. Geophagia (direct ingestion of handfuls of soil) among young children(25, 26, 33, 35) and drinking from surface water also occur, (33) albeit less frequently than hand-to-mouth behaviors. Yet, the greater volume of material ingested by these infrequent behaviors could result in greater pathogen doses than what is ingested via hand-to-mouth behaviors.…”

“…Many children play outside the household unattended, while others have self-or guardian-driven limitations that restrict distance away from the household and acceptable areas for play. (33) In settings where the landscape is often contaminated by feces from many humans and animals, the children who play in a constrained spatial area (i.e. near their household) may experience lower risks for feces exposure than children who roam across a larger spatial area and play at a variety of locations throughout the course of a day, especially if those locations are public areas used for feces disposal.…”