Child Mouthing of Feces and Fomites and Animal Contact are Associated with Diarrhea and Impaired Growth Among Young Children in the Democratic Republic of the Congo: A Prospective Cohort Study (REDUCE Program)

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

Research output: Contribution to journalArticlepeer-review

2 Scopus citations

Abstract

Objective: To identify exposure pathways to fecal pathogens that are significant contributors to diarrheal diseases and impaired growth in young children, and to evaluate scalable interventions to reduce fecal contamination from these pathways. Study design: Reducing Enteropathy, Undernutrition, and Contamination in the Environment (REDUCE) was a prospective cohort study of 370 children <5 years of age was conducted in Walungu Territory, South Kivu, Democratic Republic of the Congo. Child mouthing behaviors were assessed through caregiver reports and 5-hour structured observations. Caregiver reports of child contact with animals and child diarrhea were also obtained. Anthropometric measurements were collected at baseline and at a 6-month follow-up. Results: Children observed putting soil in their mouth during structured observation at baseline had a significantly higher odds of diarrhea at the 6-month follow-up (OR, 1.79; 95% CI, 1.04 to 3.07). Children observed mouthing feces during structured observation had a significant reduction in height-for-age z-score (HAZ) from baseline to the 6-month follow-up (ΔHAZ, −0.69; 95% CI, −1.34 to −0.04). A significant reduction in HAZ was also observed for children with caregiver reports of touching guinea pigs (−0.33; 95% CI, −0.58 to −0.08) and rabbits (−0.34; 95% CI, −0.64 to −0.04) and children with feces in their sleeping space during unannounced spot checks (−0.41; 95% CI, −0.74 to −0.09). Conclusions: These findings emphasize the urgent need for infant water, sanitation, and hygiene interventions targeting child mouthing behaviors, fecal contamination in child living spaces, and child contact with domestic animals to reduce exposure to fecal pathogens among susceptible populations.

Original languageEnglish (US)
Pages (from-to)110-116.e1
JournalJournal of Pediatrics
Volume228
DOIs
StatePublished - Jan 2021

Keywords

  • Democratic Republic of the Congo
  • animal contact
  • child growth
  • child mouthing
  • diarrhea

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health

Fingerprint

Dive into the research topics of 'Child Mouthing of Feces and Fomites and Animal Contact are Associated with Diarrhea and Impaired Growth Among Young Children in the Democratic Republic of the Congo: A Prospective Cohort Study (REDUCE Program)'. Together they form a unique fingerprint.

Cite this