Where children play: young child exposure to environmental hazards during play in public areas in a transitioning internally displaced persons community in Haiti

Globally, gastrointestinal (GI) infections by enteric pathogens are the second leading cause of morbidity and mortality in children under the age of five (≤5). While GI pathogen exposure in households has been rigorously examined, there is little data about young children’s exposure in public domains. Public areas in low-income settings are often used for waste disposal practices beyond human feces disposal, including trash dumping in open drainage canals and unused lots. If young children play in public domains unattended, they might be exposed to interrelated and highly concentrated microbial, chemical, and physical hazards. This study performed structured observations at 36 public areas in a transitioning internally displaced persons community in Haiti, to document how often young children play in public areas and to quantify behaviors that might lead to illness and injury. Children ≤5 yrs played at all public sites, including toddlers (92%/sites) and infants (44%/sites). Children touched and mouthed trash (metal, glass, plastic), food and other objects from the ground, ate soil (geophagia), drank surface water; as well as touched latrines, animals, animal feces, and open drainage canals. Hand-to-mouth contact was frequent and significantly different among developmental stages (infants: 18/hr, toddlers: 11/hr, and young children: 9/hr), providing evidence that children could ingest trace amounts of GI pathogens and other contaminants on hands. These findings demonstrate that water, sanitation, and hygiene interventions need to consider the unique risks posed by public domains that contribute to GI infection in young children. Furthermore, this 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.