Child hand contamination is associated with subsequent pediatric diarrhea in rural Democratic Republic of the Congo (REDUCE Program)
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Published on: August 22, 2012
Christine Marie George1, Lucien Bisimwa Cirhuza2,3, Alves Birindwa2
1Department of International Health, Johns Hopkins School Bloomberg of Public Health, Baltimore, Maryland, USA.
Insights
Child hand contamination is linked to diarrhea in young children in the Democratic Republic of Congo (DRC). High levels of fecal contamination were found in play areas and food, highlighting the need for hygiene interventions.
Area of Science:
- Environmental health
- Pediatric infectious diseases
- Global public health
Background:
- Young children in the Democratic Republic of Congo (DRC) face significant risks from enteropathy, undernutrition, and environmental contamination.
- The Reducing Enteropathy, Undernutrition, and Contamination in the Environment (REDUCE) program aims to identify and mitigate exposure pathways of fecal pathogens in young children.
Purpose of the Study:
- To investigate the association between fecal contamination on hands, food, and the environment and the prevalence of diarrheal disease in young children in Walungu Territory, South Kivu, DRC.
- To identify key exposure pathways for fecal pathogens affecting children under five.
Main Methods:
- A prospective cohort study involving 690 participants was conducted.
- 1923 environmental samples (hand rinses, soil, food, objects, surfaces, water) were analyzed for Escherichia coli (E. coli).
- Caregiver reports of diarrhea in children under five were collected at a 6-month follow-up.
Main Results:
- E. coli was detected in a high percentage of samples: 73% of hand-rinses, 69% of play soil, 54% of food, 74% of stored water, and 40% of source water.
- Children under five with E. coli on their hands had double the odds of experiencing diarrhea (OR: 2.03).
- Significant fecal contamination was prevalent in children's play spaces and food.
Conclusions:
- Child hand contamination is significantly associated with diarrheal disease in rural DRC.
- High levels of fecal contamination in children's play spaces and food underscore the urgent need for targeted interventions.
- Findings support the necessity of providing clean play environments and promoting hand hygiene to reduce pediatric exposure to fecal pathogens.
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.
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