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

Abstract

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.

Food Hygiene and Fecal Contamination on the Household Compound are Associated with Increased Pediatric Diarrhea in Urban Bangladesh (CHoBI7 Program)

“…57,58 In our study, the presence of feces on the ground of the household compound was associated with diarrhea in young children. This finding is consistent with that of our previous study in urban Bangladesh 17 and from a study in rural Ethiopia, 26 which found that presence of feces around the household compound was associated with greater odds of diarrhea. A previous study in Mozambique 59 also found that the presence of feces or soiled diapers on the household compound was associated with greater protozoan infections.…”

“…61 The association observed in our study is likely because feces in the household compound contaminated cooked food and drinking water. 17,23 Uncovered cooked food stored without refrigeration was associated significantly with subsequent diarrhea in young children. This is likely because uncovered food can be contaminated through flies and rodents.…”

“…13,14 In many LMICs, young children are often exposed to animal and human feces and contaminated soil while crawling and playing both inside and outdoors. [15][16][17] Young children often put surfaces and objects from their environment in their mouth; this is a normal part of their development. 18 Several studies have demonstrated that geophagy-the consumption of soil, dirt, or mud-and child mouthing of feces, fomites, and contaminated hands, have been associated with EE, diarrhea, and growth faltering in young children 16,[19][20][21][22][23] The presence of feces on the household compound and improper waste disposal has been associated with childhood diarrhea.…”

Knowledge and Practices on the Prevention and Management of Diarrhea in Children Under-2 Years Among Women Dwelling in Urban Slums of Karachi, Pakistan

“…Various studies reported a high prevalence of diarrhea in children of families with a low socio-economic status because of a reduced access to safe drinking water or proper toilets and sanitation facilities (Hubbard et al, 2020;Soboksa et al, 2021). The inaccessibility to safe drinking water refers to drinking water contamination with the fecal material, and the presence of fecal material in the drinking water reflects the presence of enteropathogens, which are responsible for various types of enteric diseases, including diarrhea, typhoid, cholera, and others (Loyola et al, 2020;Parvin et al, 2021). Similarly, the use of shared toilet facilities and unimproved toilet facilities also increased the odds of diarrheal and enteric diseases in children (Hubbard et al, 2020;Ishimwe et al, 2020).…”

Risk Assessment Study of Domestic Wastewater Pollution in Kolaka Utara Regency: Geographic Information System Approach

“…Pollution due to the disposal of the contents of the feces storage tank results in the presence of feces around the house and sources of drinking water. Both of these are significant risk factors for the occurrence of infectious diseases such as diarrhea, especially in children under 5 years of age [9]. The contents of the feces storage tank pollute the environment, one of which is the water source used by the community.…”