Child hand contamination is associated with subsequent pediatric diarrhea in rural Democratic Republic of the Congo (REDUCE Program)

Christine Marie George, Lucien Bisimwa Cirhuza, Alves Birindwa, Camille Williams, Sara Beck, Timothy Julian, Jennifer Kuhl, Nicole Coglianese, Elizabeth Thomas, Sarah Bauler, Ruthly François, Ronald Saxton, Amani Sanvura Presence, Jean Claude Bisimwa Rusanga, Jamie Perin, Patrick Mirindi

Research output: Contribution to journalArticlepeer-review


Objective: The Reducing Enteropathy, Undernutrition, and Contamination in the Environment (REDUCE) program focuses on identifying exposure pathways to faecal pathogens for young children in the Democratic Republic of the Congo (DRC) and on developing scalable interventions to reduce faecal contamination from these pathways. Methods: A prospective cohort study of 690 participants was conducted to investigate the association between hand, food, and environmental faecal contamination and diarrhoeal disease prevalence among young children in Walungu Territory, South Kivu, DRC. A total of 1923 hand rinse, soil, food, object, surface, stored water and water source samples were collected during unannounced spot checks after baseline enrolment and analysed for Escherichia coli. Caregiver reports of diarrhoea were obtained from children < 5 years at a 6-month follow-up. Results: E.coli was detected in 73% of child and caregiver hand-rinse samples, 69% of soil samples from child play spaces, 54% of child food samples, 38% of objects and surfaces children were observed putting in their mouths, 74% of stored water samples, and 40% of source water samples. Children < 5 years with E. coli on their hands had significantly higher odds of diarrhoea at the 6-month follow-up (odds ratio: 2.03 (95% confidence interval: 1.05, 3.92)). Conclusion: The cohort study findings from the REDUCE program have shown that child hand contamination is associated with diarrhoeal disease in rural DRC, and that there is high faecal contamination in child plays spaces and food. These findings provide evidence demonstrating the urgent need to provide clean play spaces for young children and interventions targeting hand hygiene to reduce paediatric exposure to faecal pathogens.

Original languageEnglish (US)
Pages (from-to)102-110
Number of pages9
JournalTropical Medicine and International Health
Issue number1
StatePublished - Jan 2021


  • Democratic Republic of the Congo
  • Escherichia coli
  • child health
  • diarrhoea
  • faecal contamination

ASJC Scopus subject areas

  • Parasitology
  • Public Health, Environmental and Occupational Health
  • Infectious Diseases


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