Journal article
Environmental and behavioural exposure pathways associated with diarrhoea and enteric pathogen detection in 5-month-old, periurban Kenyan infants: a cross-sectional study
BMJ open, Vol.12(10), e059878
10/31/2022
DOI: 10.1136/bmjopen-2021-059878
PMCID: PMC9628658
PMID: 36316067
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
Details
- Title: Subtitle
- Environmental and behavioural exposure pathways associated with diarrhoea and enteric pathogen detection in 5-month-old, periurban Kenyan infants: a cross-sectional study
- Creators
- Kelly K Baker - University of IowaJane Awiti Odhiambo Mumma - Great Lakes University of Kisumu, Kisumu, KenyaSheillah Simiyu - African Population and Health Research CenterDaniel Sewell - University of IowaKevin Tsai - University of IowaJohn David Anderson - Consultant, Austin, Texas, USAAmy MacDougall - Department of Disease Control, London School of Hygiene & Tropical Medicine, London, UKRobert Dreibelbis - London School of Hygiene & Tropical MedicineOliver Cumming - London School of Hygiene & Tropical Medicine
- Resource Type
- Journal article
- Publication Details
- BMJ open, Vol.12(10), e059878
- DOI
- 10.1136/bmjopen-2021-059878
- PMID
- 36316067
- PMCID
- PMC9628658
- NLM abbreviation
- BMJ Open
- ISSN
- 2044-6055
- eISSN
- 2044-6055
- Publisher
- British Medical Journal Publishing Group
- Grant note
- ITDCHA2310 / Department for International Development (http://dx.doi.org/10.13039/501100000278)
- Language
- English
- Date published
- 10/31/2022
- Academic Unit
- Occupational and Environmental Health; Epidemiology; Biostatistics; Public Policy Center (Archive)
- Record Identifier
- 9984307557802771
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