Environmental and behavioural exposure pathways associated with diarrhoea and enteric pathogen detection in 5-month-old, periurban Kenyan infants: a cross-sectional study

Abstract

ObjectivesThe aim of this study was to test whether household environmental hygiene and behavioural conditions moderated associations between diarrhoea and enteric pathogen detection in infants 5 months of age in Kenya and pathogen sources, including latrine access, domestic animal co-habitation and public food sources.DesignCross-sectional study utilising enrolment survey data of households participating in the Safe Start cluster-randomised controlled trial .SettingKisumu, Kenya.ParticipantsA total of 898 caregivers with 5-month (22 week ± 1 week) aged infants were enrolled in the study and completed the enrolment survey.Primary and secondary outcome measuresOutcomes were (1) caregiver-reported 7-day diarrhoea prevalence and (2) count of types of enteric viruses, bacteria and parasites in infant stool. Exposures and effect modifiers included water access and treatment, cohabitation with domestic animals, sanitation access, handwashing practices, supplemental feeding, access to refrigeration and flooring.ResultsReported handwashing after handling animals (adjusted odds ratio (aOR)=0.20; 95% CI=0.06 to 0.50) and before eating (aOR=0.44; 95% CI=0.26 to 0.73) were strongly associated with lower risk of caregiver-reported diarrhoea, while cohabitation with animals (aOR=1.54; 95% CI=1.01 to 2.34) living in a household with vinyl-covered dirt floors (aOR=0.60; 95% CI=0.45 to 0.87) were strongly associated with pathogen codetection in infants. Caregiver handwashing after child (p=0.02) or self-defecation (p=0.03) moderated the relationship between shared sanitation access and infant exposure to pathogens, specifically private latrine access was protective against pathogen exposure of infants in households, where caregivers washed hands after defecation. In the absence of handwashing, access to private sanitation posed no benefits over shared latrines for protecting infants from exposure.ConclusionOur evidence highlights eliminating animal cohabitation and improving flooring, postdefecation and food-related handwashing, and safety and use of cow milk sources as interventions to prevent enteric pathogen exposure of young infants in Kenya.Trial registration numberNCT03468114

WASH Levels and Associated Human Health Risks in War-Prone West African Countries: A Global Indicators Study (2015 to 2021)

“…For this reason, men have less access to WASH services than women, increasing their susceptibilities to pathogens like bacteria, viruses and parasites. 32 , 33 This finding supports Kayser et al 35 who found that there are disparities in access to WASH between males and females. These disparities are problematic because Conflict Theory holds that conflicts and wars affect human health as well as access to WASH levels.…”

Protocol for the PATHOME study: a cohort study on urban societal development and the ecology of enteric disease transmission among infants, domestic animals and the environment

“…DNA and RNA from infant and animal faeces is analysed as previously described using microfluidic TaqMan Array cards containing primers and probes for Norovirus GI and GII, adenovirus 40/41, Sapovirus , Enterovirus , Rotavirus, Salmonella enterica , Shigella/EIEC backbone, Shigella/EIEC plasmid, Campylobacter jejuni/coli, Listeria monocytogenes, Clostridium difficile , Helicobacter pylori , enterotoxigenic Escherichia coli LT/ST, enteropathogenic E. coli , enteroaggregative E. coli and Shiga-like toxin-producing E. coli stx1/stx2, Enterocytozoon bieneasi , Giardia , Cryptosporidium spp., Entamoeba histolytica and the MS2 extrinsic control. Most of these pathogens were selected based on prior evidence that they are commonly transmitted in Kenya, with a few like H. pylori and L. monocytogenes being selected based on potential of transmission 68–70. The TaqMan assays are run on a QuantiStudio 12K Flex Real-Time PCR System (ThermoFisher, Chicago, Illinois).…”

Spatial Distributions of Diarrheal Cases in Relation to Housing Conditions in Informal Settlements: A Cross-Sectional Study in Abidjan, Côte d’Ivoire

“…The international literature has extensively assessed the relationship between diarrhea and WASH services [ 2 , 7 , 8 ]. Additionally, previous studies have focused on factors other than WASH that might govern contamination pathways, notably poor housing conditions and cohabitation with animals [ 9 ], food handling [ 10 ], and exposure to environmental sources of pathogens in public spaces [ 11 ]. These studies reflect a renewed interest in environmental health determinants and raise the need for a broader approach to address variations in morbidity and mortality patterns across populations based on socioeconomic and housing conditions [ 12 ].…”

“…Our study is inscribed within this broader approach by looking at specific housing deprivation characteristics as environmental exposures of interest and confronting the latter’s spatial distribution to that of diarrheal cases (health outcomes of interest). Although previous studies have already assessed relations between housing deprivation and diarrheal diseases in SSA [ 9 , 13 ], besides a few exceptions [ 14 , 15 ], there is a paucity of empirical evidence elaborated on a cartographic basis and at a high spatial resolution (i.e., with precise maps of the built environment, housing characteristics, and cases of diarrhea). This “spatially explicit” approach is critical for urban planners to assess disease risk factors related to the built environment and plan tailored interventions.…”