Assessing the Infection Burden and Associated Risk Factors in Children under 5 Across Jaipur's Urban Slums: A Feasibility Study Using a One Health Approach

Purpose: Infectious diseases are one of the leading causes of death among children under five (U5s) both in India and globally. This is worse in slum environments with poor access to water, sanitation and hygiene (WASH), good nutrition and a safe built environment. Globally, a One Health (i.e. human, animal and environment) approach is increasingly advocated for by the WHO-FAO-OIE tripartite to reduce infections and antimicrobial resistance. As under-5s living in peri-urban slums are exposed to household- and community-owned companion and livestock animals and pests, the CHIP consortium hypothesised that employing a One Health approach to co-produce behavioural change and slum upgrading interventions may reduce this burden where other WASH and nutrition interventions have failed. This study aimed to assess the feasibility of employing a One Health approach to assess under-5 infection and risk factor prevalence in Jaipurs peri-urban slums, prior to undertaking prospective cohort studies involving culture and culture-independent sampling of under-5s and animals across our study sites in Jaipur (Rajasthan, India), Jakarta (Indonesia) and Antofagasta (Chile). Methods: We administered a rapid household survey to 25 purposively selected households across six slums in Jaipur. The questionnaire used evaluated infection prevalence, healthseeking behaviours, the built environment, the presence of companion and livestock animals and pests, and individual- and household-level demographics. We displayed the correlations between infection incidence and a range of factors in our sample, and displayed the portion of children under 5 who experienced one or multiple episodes of ill health, categorised by a range of One Health factors. Results: Parents reported at least one recent episode of ill health for a large portion (40%) of under-5s within the last 30 days. 80% of under-5s had no access to safe drinking water; every household reported the presence of at least one kind of pest within the respondents own home; and 20% of under-5s feeding equipment was cleaned with water only. Only one household reported owning a companion or livestock animal, potentially reflecting confusion about the definition of these animals. The incidence of infection appeared to be related to WASH and socio-economic factors as expected. Conclusion: Safe drinking water, pest control and behavioural change surrounding the cleaning of under-5 feeding equipment should be given consideration in future research in this locale. Future studies should not rely solely on parent reporting of childrens symptoms cross referencing symptom reporting from multiple household members should be combined with culture and culture-independent sampling. Where possible, researchers should measure the presence of companion and livestock animals directly to avoid misinterpretation and to observe practices rather than relying on reporting alone.

Content

Author and article information

Journal

Title: UCL Open: Environment Preprint

Publisher: UCL Press

Publication date (Electronic preprint): 23 December 2020

Affiliations

[1 ] Department of Epidemiology and Public Health, UCL

[2 ] Population, Policy and Practice Department, UCL

[3 ] Freetown City Council, Freetown, Sierra Leone

[4 ] Jeevan Ashram Sanstha

[5 ] Indonesia One Health University Network

[6 ] Health and Wellbeing Department, Southwark Council

[7 ] Bartlett School of Environmental Design and Engineering, UCL

[8 ] Institute for Global Health, UCL

[9 ] Jawaharlal Nehru University

[10 ] Department of Geography, UCL

Author information

Logan Manikam https://orcid.org/0000-0001-5288-3325

Spencer Rutherford https://orcid.org/0000-0001-8923-9373

Article

DOI: 10.14324/111.444/000032.v2

SO-VID: f96d2328-0bd1-4367-a7d7-c367d39497cc

License:

This is an open access article distributed under the terms of the Creative Commons Attribution License (CC BY) 4.0 https://creativecommons.org/licenses/by/4.0/, which permits unrestricted use, distribution and reproduction in any medium, provided the original author and source are credited.

History

Date received : 3 May 2020

Data availability: The datasets generated during and/or analysed during the current study are available from the corresponding author on reasonable request.

ScienceOpen disciplines: Life sciences,Public health,Infectious disease & Microbiology

Keywords: One Health, Infectious Diseases, Children Under Five, Slum, India,Pollution and health

Comments

UCL Open: Environment Editorial Office wrote:

Date: 29 November 2021

Handling Editor: Carla-Leanne Washbourne and Dan Osborn

Editorial decision: This article has been mutually declined for further publication in the journal by the Editors of UCL Open: Environment and the Authors and the article is now considered withdrawn from submission. This preprint (and all other versions of it) will remain online on the preprint server with its registered DOI, but the article is no longer under consideration for peer review at UCL Open: Environment and the authors are free to submit this manuscript to any other relevant journal of their choice. For more information about this please read the journal’s Editorial Policy online at https://ucl-about.scienceopen.com/publishing-policies.

Additional notes from the Editors

The paper in its current form presents material that is too preliminary in nature. More data and additional material is needed to provide a fuller context and framing for the work.

The intention to produce a preliminary set of results that would be supplemented by more data later is appreciated but we feel at present the paper lacks the following specifics and until these issues have been dealt with the paper is not suitable for full publication:

The paper contains a very limited set of data from only a few samples and the sample size is thought inadequate for a study with the number of complexities this one inevitably faces. Sample size would have to be at least double to reach the minimum required in social science-based approaches where standard methodologies are not always used or usable.
There needs to be a wider context provided for the work. There have been numerous studies of child health in India and in Jaipur district. This study needs placing in that context. Jaipur is a bustling mixed city with many poorer areas facing health challenges. Although various areas are mentioned as providing samples the information provided on these areas is very limited. There is too little here to help put the study and the results in any kind of context. Important factors to set out about each area would include social, economic environmental and cultural/religious ones. Given the preliminary nature of the work done, having this context would provide a reader with a better way of interpreting the results.
The framing of the work is unclear. Although the One Health approach is a very promising way of positioning the paper the references to the One Health initiative seem to have been added in retrospect rather than being part of the design of the study from the outset. As it stands, the paper does not demonstrate how the work as presented, and as it might develop, is related to the One Health framework.
Also with respect to framing, it is unclear how the data was gathered by what appear to be local health workers or how ethical permissions were gathered from subjects who may have not realised there was involvement of UCL authors in interpreting results.

2021-11-29 10:59 UTC

UCL Open: Environment Editorial Office wrote:

Date: 06 January 2021

Handling Editor: Carla-Leanne Washbourne

The article has been revised, this article remains a preprint article and peer-review has not been completed. It is under consideration following submission to UCL Open: Environment Preprint for open peer review.

2021-01-06 17:19 UTC

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