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Quantifying Contact with the Environment: Behaviors of Young Children in Accra, Ghana
Insights
Young children in urban Africa engage in behaviors that increase fecal-oral exposure risks. Critical hygiene practices like handwashing are infrequent, highlighting the need for targeted interventions to reduce disease transmission.
Area of Science:
- Environmental health
- Pediatric epidemiology
- Behavioral science
Background:
- Young children in low-income urban settings face significant risks from environmental fecal contamination.
- Understanding children's daily behaviors is crucial for assessing exposure pathways.
Purpose of the Study:
- To systematically characterize and quantify the behaviors of young children (0-5 years) in Accra, Ghana.
- To estimate the frequency of specific activities and location combinations relevant to fecal-oral exposure.
Main Methods:
- Conducted structured observations of 154 children across four neighborhoods, collecting approximately 500 hours of data.
- Utilized a competing hazards model to estimate hazard rates for different activity/compartment states.
- Simulated daily behavior sequences to describe child routines.
Main Results:
- Children under 1 year primarily played/slept off the ground; older children played on floors.
- Time spent in high-risk areas like drains or wet trash was minimal.
- Essential hygiene behaviors, such as handwashing after defecation or before eating, occurred infrequently.
Conclusions:
- Quantitative behavioral data can inform risk assessments for fecal-oral disease transmission in urban settings.
- Identified specific behavioral patterns that may increase or decrease exposure risk.
- Findings highlight the importance of promoting critical hygiene practices in vulnerable populations.
Abstract:
To better understand the risks of exposure for young children to fecal contamination in their environment, we systematically characterized and quantified behaviors of 154 children, 0-5 years old, in four high-density, low-income neighborhoods in Accra, Ghana. A repertoire of six different activities and five different compartments (categories of locations within the household) was developed, and about 500 hours of ordered structured observations of activities and locations of individual children were collected. These records were analyzed using a competing hazards model, estimating (Weibull) hazard rates for each state (activity/compartment combination), dependent on the present state and the preceding state. The estimated rates were used to simulate sequences of behavior and describe days in the life of a child in low-income, urban Africa. Children younger than 1 year spent most time playing or sleeping off the ground, older children frequently played on floors. Relatively little time was spent in drains or wet trash areas. Critical combinations of activities, like handwashing after defecation or before eating were estimated to occur rarely. These quantitative behavior estimates can inform future risk assessments that examine the relative roles of various fecal-oral exposure pathways in low-income urban settings.
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