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      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

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          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).


          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.


          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.


          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.

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          Author and article information

          UCL Open: Environment Preprint
          UCL Press
          23 December 2020
          [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

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

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

          Life sciences, Public health, Infectious disease & Microbiology

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


          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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