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Int. J. Environ. Res. Public Health 2018, 15(2), 192; https://doi.org/10.3390/ijerph15020192

Oral Contact Events and Caregiver Hand Hygiene: Implications for Fecal-Oral Exposure to Enteric Pathogens among Infants 3–9 Months Living in Informal, Peri-Urban Communities in Kisumu, Kenya

1
Department of International Health—Social and Behavioral Interventions, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA
2
Department of Disease Control, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK
3
Department of Community Health and Development, Great Lakes University of Kisumu, Kisumu 40100, Kenya
4
Department of Occupational and Environmental Health, College of Public Health, University of Iowa, Iowa City, IA 52333, USA
5
Nutrition Department, School of Public Health, Great Lakes University of Kisumu, Kisumu 40100, Kenya
*
Author to whom correspondence should be addressed.
Received: 11 December 2017 / Revised: 18 January 2018 / Accepted: 22 January 2018 / Published: 24 January 2018
(This article belongs to the Section Environmental Health)
Full-Text   |   PDF [309 KB, uploaded 24 January 2018]

Abstract

Childhood diarrhea is one of the leading causes of morbidity and mortality in children under five in low and middle-income countries, second only to respiratory illness. The mouthing behavior that is common in children exposes them to fecal-orally transmitted pathogens that can result in diarrhea; however, there is a need for further evidence on specific exposure routes. This study describes the frequency and diversity of two important routes of enteric pathogen exposure among infants 3–9 months of age: infant oral contact behavior and caregiver handwashing behavior. Data were collected through structured observations of 25 index infants for the oral contact data and 25 households for the caregiver handwashing data in a peri-urban setting in Kisumu (Obunga), Kenya. Breast was the most common type of oral contact event with an average of 3.00 per observation period and 0.5 events per hour. This was followed by a range of physical objects with an average of 2.49 per observation and 0.4 events per hour. The “infant’s own hands” was the third most common oral contact, with an average of 2.16 events per hour, and 0.4 oral contact events per hour. Food and liquids were the 4th and 5th most common oral contact events with an average of 1.64 food contacts and 0.52 liquid oral contact events per observation period. Feeding events, including breastfeeding, were the most commonly observed key juncture—71% of total junctures observed were caregivers feeding children. This was followed by child cleaning (23%), caregiver toilet uses at (4%), and lastly food preparation at 2%. HWWS was observed only once before a feeding event (1%), twice after cleaning a child (9%), and twice after caregiver toilet use (40%). The combined implication of data from observing oral contact behavior in children and hand hygiene of caregivers suggests that caregiver hand hygiene prior to feeding events and after cleaning a child are priority interventions. View Full-Text
Keywords: pathogen exposure; caregiver handwashing; direct observation; enteric infection; childhood diarrhea pathogen exposure; caregiver handwashing; direct observation; enteric infection; childhood diarrhea
This is an open access article distributed under the Creative Commons Attribution License which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. (CC BY 4.0).
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Davis, E.; Cumming, O.; Aseyo, R.E.; Muganda, D.N.; Baker, K.K.; Mumma, J.; Dreibelbis, R. Oral Contact Events and Caregiver Hand Hygiene: Implications for Fecal-Oral Exposure to Enteric Pathogens among Infants 3–9 Months Living in Informal, Peri-Urban Communities in Kisumu, Kenya. Int. J. Environ. Res. Public Health 2018, 15, 192.

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