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Preventing acute respiratory infections and diarrhoea in child care centres
A J Barros1, D A Ross, W V Fonseca
1Maternal and Child Epidemiology Unit, London School of Hygiene and Tropical Medicine, UK. abarros@ufpel.tche.br
Insights
Child care hygiene practices significantly impact child health. Frequent hand washing and hygienic diaper changes in child care centers can reduce diarrhea, but modifiable factors for preventing respiratory infections remain elusive.
Area of Science:
- Pediatric Health
- Infectious Disease Epidemiology
- Child Care Environment
Background:
- Child care settings are environments where children aged 3-35 months are at risk of infections.
- Understanding risk factors within child care centers is crucial for public health interventions.
Purpose of the Study:
- To investigate physical characteristics and child care practices as risk factors for respiratory infections and diarrhea in young children.
- To identify modifiable factors in child care centers for disease prevention.
Main Methods:
- A dynamic cohort study followed 667 children across 40 child care centers in Campinas, Brazil, for 8 months.
- Direct structured observations assessed physical structure, child activities, and hygiene practices.
- Risk factors for diarrhea and respiratory infections were analyzed using relative risks.
Main Results:
- Infrequent hand washing and unhygienic diaper changes were common despite good infrastructure.
- Diarrhea risk factors included flies during meals, and infrequent child hand washing (before meals, after defecation).
- Improved diapering hygiene (soap use) reduced diarrhea by 33%; no modifiable factors were identified for respiratory infections.
Conclusions:
- Enhancing hygiene practices, particularly hand washing and diapering, is key to reducing diarrhea in child care settings.
- No specific, modifiable child care center characteristics were found to effectively prevent respiratory infections in this study.
Abstract:
This study was designed to explore the physical characteristics and child care practices of child care centres as potential risk factors for respiratory infections and diarrhoea in children 3-35 mo of age. A dynamic cohort averaging 667 children from 40 child care centres in Campinas (Brazil) was followed up for 8 mo. Direct structured observations were made to collect information on the centres' physical structure, child activities and child care practices. Despite their good infrastructures, hand washing in the centres was infrequent, and nearly 30% of diaper changes were unhygienic. Risk factors for diarrhoea included the presence of flies during meals, infrequent child hand washing before meals, and infrequent child hand washing after defecation, with relative risks of 1.33, 1.73 and 1.63, respectively. There was 33% less diarrhoea in classes where soap was frequently used during diapering. Contrary to our hypotheses, ventilation, group size and child density were not associated with respiratory infections, as was the case for most other factors studied. Only mixing of groups and a larger classroom area were found to be negatively associated with lower and upper respiratory infections, respectively. The results indicate that improving hygiene practices is the only intervention in child care centre characteristics with good potential to reduce diarrhoea among attendees. For respiratory infections, no modifiable characteristic with intervention potential was identified.