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Child hand contamination is associated with subsequent pediatric diarrhea in rural Democratic Republic of the Congo (REDUCE Program)
Author(s) -
George Christine Marie,
Cirhuza Lucien Bisimwa,
Birindwa Alves,
Williams Camille,
Beck Sara,
Julian Timothy,
Kuhl Jennifer,
Coglianese Nicole,
Thomas Elizabeth,
Bauler Sarah,
François Ruthly,
Saxton Ronald,
Presence Amani Sanvura,
Rusanga Jean Claude Bisimwa,
Perin Jamie,
Mirindi Patrick
Publication year - 2021
Publication title -
tropical medicine and international health
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.056
H-Index - 114
eISSN - 1365-3156
pISSN - 1360-2276
DOI - 10.1111/tmi.13510
Subject(s) - medicine , environmental health , odds ratio , diarrhea , hand washing , contamination , diarrhoeal disease , cohort , confidence interval , pediatrics , hygiene , biology , ecology , pathology
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.