TY - JOUR
T1 - 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
T2 - A Prospective Cohort Study (REDUCE Program)
AU - George, Christine Marie
AU - Cirhuza, Lucien Bisimwa
AU - Kuhl, Jennifer
AU - Williams, Camille
AU - Coglianese, Nicole
AU - Thomas, Elizabeth
AU - Bauler, Sarah
AU - Francois, Ruthly
AU - Saxton, Ronald
AU - Presence, Amani Sanvura
AU - Birindwa, Alves
AU - Jean Claude, Bisimwa Rusanga
AU - Perin, Jamie
AU - Mirindi, Patrick
N1 - Funding Information:
We thank USAID/Bureau for Humanitarian Assistance and Phil Moses and Amagana Togo at Food for the Hungry for their support. We also thank all the study participants and the following research supervisors and assistants who were crucial to the successful implementation of this study: Willy Mapendano, Eric-Yves Iragi, Pascal Tezangi, Blessing Muderhwa, Manu Kabiyo, Fraterne Luhiriri, Wivine Ntumba, Julienne Rushago, Pacifique Kitumaini, Freddy Endelea, Claudia Bazilerhe, Jean Claude Lunye Lunye, Adolophine F. Rugusha, Gisele N. Kasanzike, Brigitte Munyerenkana, Jessy T. Mukulikire, Dieudonné Cibinda, Jean Basimage, and Siloé Barhuze. These individuals were supported by funding from the USAID and declare no conflicts of interest. This material is based in part upon work supported by the USAID Bureau for Humanitarian Assistance (BHA), under a Development Food Security Activity (DFSA), led by Food for the Hungry in the Sud Kivu and Tanganyika provinces of DRC (Cooperative Agreement AID-FFP-A-16-00010). Any opinion, findings, and conclusions or recommendations expressed in this material are those of the author and do not necessarily reflect the views of partner organizations or the U.S. Government.
Funding Information:
Supported by the United States Agency for International Development (USAID). The contents of this study are the sole responsibility of Johns Hopkins School of Public Health and Food for the Hungry and do not necessarily reflect the views of USAID or the US Government. The authors declare no conflicts of interest.
Publisher Copyright:
© 2020 Elsevier Inc.
PY - 2021/1
Y1 - 2021/1
N2 - 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.
AB - 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.
KW - Democratic Republic of the Congo
KW - animal contact
KW - child growth
KW - child mouthing
KW - diarrhea
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U2 - 10.1016/j.jpeds.2020.09.013
DO - 10.1016/j.jpeds.2020.09.013
M3 - Article
C2 - 32918918
AN - SCOPUS:85096559336
SN - 0022-3476
VL - 228
SP - 110-116.e1
JO - Journal of Pediatrics
JF - Journal of Pediatrics
ER -