Fecal indicator bacteria along multiple environmental exposure pathways (water, food, and soil) and intestinal parasites among children in the rural northwest Ethiopia

Abstract

Background Children in low-resource settings are exposed to multiple risk factors for enteropathogens. However, the probability of exposures may be different across exposure pathways. Accordingly, this study was conducted to assess environmental exposures of children to intestinal parasites in the east Dembiya district of Ethiopia. Methods A cross-sectional study was conducted for 372 households with children aged 24–59 months. The potential for external exposure of children to intestinal parasites was assessed by determining the presence of fecal indicator organism (Escherichia coli (E. coli)) in drinking water at point of use, ready-to-eat foods, and courtyard soil from children’s outdoor play areas. For internal exposure assessment, ova of parasites in stool samples was detected using wet mount and Kato-Katz techniques to estimate exposure to intestinal parasites. The external and internal exposure assessments were also complemented using questionnaire and spot-check observations to assess behaviors that result in high risk of exposure. Individual and community-level predictors of intestinal parasites were identified using a multilevel logistic regression model. Statistically significant variables were identified on the basis of adjusted odds ratio (AOR) with 95% confidence interval (CI) and p-value < 0.05. Results Ova of one or more intestinal parasites was detected among 178 (47.8%) (95% CI 42.8, 52.6%) of the children. The most common intestinal parasites were A. lumbricoides (20.7%) and S. mansoni (19.1%). Furthermore, E. coli was detected in 69.1% of drinking water samples at point of use, 67.5% of ready-to-eat food samples, and 83.1% of courtyard soil samples from children’s outdoor play areas. Exposure of children to intestinal parasites among children in the studied region was associated with poor hand hygiene of mothers (AOR 1.98, 95% CI (1.07, 3.66), poor hand hygiene of children (AOR 3.20, 95% CI (1.77, 5.77), mouthing of soil contaminated materials (AOR 2.31, 95% CI (1.26, 4.24), open defecation practices (AOR 2.22, 95% CI (1.20, 4.10), limited access to water (AOR 2.38, 95% CI (1.13, 5.01), water contamination (AOR 2.51, 95% CI (1.31, 4.80), food contamination (AOR 3.21, 95% CI (1.69, 6.09), and soil contamination (AOR 2.56, 95% CI (1.34, 4.90). Conclusion An extensive E. coli contamination of water, foods, and courtyard soil was found in the studied region and the potential sources of contamination were open defecation practices, unhygienic disposal of wastes, poor animal husbandry and keeping practices, and poor water and food safety measures at household level. Moreover, fecal contamination of water, foods, and soil linked to exposure of children to intestinal parasites in the studied region. Thus, it is critical to implement individual-level interventions (such as latrine utilization, hand hygiene promotion, food safety, home-based water treatment, and containment of domestic animals), plus community-level interventions (such as protecting water sources from contamination, source-based water treatment, and community-driven sanitation).

Stunting among children aged 24–59 months and associations with sanitation, enteric infections, and environmental enteric dysfunction in rural northwest Ethiopia

“…This community-based cross-sectional study is part of a large-scale study conducted in rural northwest Ethiopia during May–June 2021 to assess environmental exposures of children to enteric infections and fecal biomarkers of EED in children aged 24–59 months. The method has been described in more detail elsewhere 38 , 39 . The sample size was determined using double proportion population formula with the following assumptions: proportion of stunting with enteric infection (p 1 ) = 38.5%, proportion of stunting with no enteric infection (p 2 ) = 61.5% 40 , Z α/2 at type I error of 5% = 1.96, Z β at 80% power = 0.842, and an allocation ratio of 1:1.…”

“…Fecal contamination of the living environment (drinking water, ready-to-eat foods, and courtyard soil) was measured by detection of fecal indicator bacteria, i.e., Escherichia coli ( E. coli ) using membrane filter technique 46 . Sampling procedures of environmental samples and E. coli detection procedures are described elsewhere in more detail 38 . Intestinal parasites in children were measured by detecting ova of one or more intestinal parasites in stool samples of children using wet mount and Kato-Katz techniques 47 .…”

“…Intestinal parasites in children were measured by detecting ova of one or more intestinal parasites in stool samples of children using wet mount and Kato-Katz techniques 47 . The detailed procedures of stool sample collection and investigation of ova of parasites are described elsewhere in more detail 38 . Geophagy or mouthing of soil-contaminated materials is a repeated ingestion of nonfood substances (such as clays, yard soil), or large quantities of certain particular foods contaminated with soil 48 .…”

How much spatial and temporal variation in groundwater microbiology can occur following open dumping of municipal solid waste?

“…Several water-borne diseases due to contaminated groundwater are constantly being reported across the globe irrespective of the economic status of the region (Zhang et al 2014;Andrade et al 2018). E. coli is regularly used as an indicator organism to check faecal discharges and ensure biological safety of water sources (Navab-Daneshmand et al 2018;Gizaw et al 2022).…”

Development and validation of questionnaire to assess exposure of children to enteric infections in the rural northwest Ethiopia

“…A study done to measure child exposure to enteric infection in the rural northwest Ethiopia showed that contamination of water, food, and soil with fecal matter due to open defecation practice and poor animal keeping practice was common. Moreover, mouthing of soil or soil contaminated materials is commonly practiced among children in the rural Ethiopia 3 .…”