Formative Research on Hygiene Behaviors and Geophagy among Infants and Young Children and Implications of Exposure to Fecal Bacteria

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Abstract

We conducted direct observation of 23 caregiver–infant pairs for 130 hours and recorded wash-related behaviors to identify pathways of fecal–oral transmission of bacteria among infants. In addition to testing fingers, food, and drinking water of infants, three infants actively ingested 11.3 ± 9.2 (mean ± SD) handfuls of soil and two ingested chicken feces 2 ± 1.4 times in 6 hours. Hand washing with soap was not common and drinking water was contaminated with Escherichia coli in half (12 of 22) of the households. A one-year-old infant ingesting 1 gram of chicken feces in a day and 20 grams of soil from a laundry area of the kitchen yard would consume 4,700,000–23,000,000 and 440–4,240 E. coli, respectively, from these sources. Besides standard wash and nutrition interventions, infants in low-income communities should be protected from exploratory ingestion of chicken feces, soil, and geophagia for optimal child health and growth.

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Most cited references 16

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Hygiene: new hopes, new horizons

Val Curtis, Wolf G. Schmidt, Stephen Luby … (2011)

Summary Although promotion of safe hygiene is the single most cost-effective means of preventing infectious disease, investment in hygiene is low both in the health and in the water and sanitation sectors. Evidence shows the benefit of improved hygiene, especially for improved handwashing and safe stool disposal. A growing understanding of what drives hygiene behaviour and creative partnerships are providing fresh approaches to change behaviour. However, some important gaps in our knowledge exist. For example, almost no trials of the effectiveness of interventions to improve food hygiene in developing countries are available. We also need to figure out how best to make safe hygiene practices matters of daily routine that are sustained by social norms on a mass scale. Full and active involvement of the health sector in getting safe hygiene to all homes, schools, and institutions will bring major gains to public health.

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Intestinal permeability, mucosal injury, and growth faltering in Gambian infants.

R Downes, Nicole Northrop, Michael P Lunn (1991)

There is controversy over whether children in developing countries can catch up on their growth rates after bouts of diarrhoea. A factor influencing catch-up growth is the extent and duration of mucosal injury. To explore the relation between intestinal disease and growth performance, a non-invasive test of intestinal integrity, the lactulose:mannitol permeability test, was done regularly on children aged 2-15 months, whose growth was monitored over a mean of 7.5 months. The study revealed persistent abnormalities in the small bowel mucosa of 2-15 month old Gambian infants and a negative correlation between these abnormalities and growth. Up to 43% of observed growth faltering can be explained on the basis of these long-term intestinal lesions.

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Hands, water, and health: fecal contamination in Tanzanian communities with improved, non-networked water supplies.

Joshua Chynoweth, Lynette Rogers, S Walters … (2010)

Almost half of the world's population relies on non-networked water supply services, which necessitates in-home water storage. It has been suggested that dirty hands play a role in microbial contamination of drinking water during collection, transport, and storage. However, little work has been done to evaluate quantitatively the association between hand contamination and stored water quality within households. This study measured levels of E. coli, fecal streptococci, and occurrence of the general Bacteroidales fecal DNA marker in source water, in stored water, and on hands in 334 households among communities in Dar es Salaam, Tanzania, where residents use non-networked water sources. Levels of fecal contamination on hands of mothers and children were positively correlated to fecal contamination in stored drinking water within households. Household characteristics associated with hand contamination included mother's educational attainment, use of an improved toilet, an infant in the household, and dissatisfaction with the quantity of water available for hygiene. In addition, fecal contamination on hands was associated with the prevalence of gastrointestinal and respiratory symptoms within a household. The results suggest that reducing fecal contamination on hands should be investigated as a strategy for improving stored drinking water quality and health among households using non-networked water supplies.

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Author and article information

Journal

Journal ID (nlm-ta): Am J Trop Med Hyg

Journal ID (iso-abbrev): Am. J. Trop. Med. Hyg

Journal ID (publisher-id): tpmd

Title: The American Journal of Tropical Medicine and Hygiene

Publisher: The American Society of Tropical Medicine and Hygiene

ISSN (Print): 0002-9637

ISSN (Electronic): 1476-1645

Publication date (Print): 09 October 2013

Publication date PMC-release: 09 October 2013

Volume: 89

Issue: 4

Pages: 709-716

Affiliations

Division of Nutritional Sciences, Cornell University, Ithaca, New York; Department of International Health, Johns Hopkins Bloomberg School of Public Health, Johns, Baltimore, Maryland; Zvitambo Project, Harare, Zimbabwe; Centre for Pediatrics, Queen Mary University of London, London, United Kingdom; The Hygiene Centre, London School of Hygiene and Tropical Medicine, London, United Kingdom

Author notes

*Address correspondence to Francis M. Ngure, Division of Nutritional Sciences, Cornell University, 118 Savage Hall, Ithaca, NY 14853. E-mail: fmn9@ 123456cornell.edu

Article

DOI: 10.4269/ajtmh.12-0568

PMC ID: 3795101

PubMed ID: 24002485

SO-VID: 99185d0f-1ee4-4ca3-a3c6-fa7a825d70c3

License:

This is an Open Access article distributed under the terms of the American Society of Tropical Medicine and Hygiene's Re-use License which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Formative Research on Hygiene Behaviors and Geophagy among Infants and Young Children and Implications of Exposure to Fecal Bacteria

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Abstract

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Bacterial extracellular vesicles

Most cited references 16

Hygiene: new hopes, new horizons

Intestinal permeability, mucosal injury, and growth faltering in Gambian infants.

Hands, water, and health: fecal contamination in Tanzanian communities with improved, non-networked water supplies.

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