Volume 96, Issue 3
  • ISSN: 0002-9637
  • E-ISSN: 1476-1645



Diarrhea is a leading cause of mortality in children under 5 years of age. We conducted a cross-sectional study of 54 children aged 3 months to 5 years old in Kibera, an urban slum in Nairobi, Kenya, to assess the relationship between caregiver-reported soil ingestion and child diarrhea. Diarrhea was significantly associated with soil ingestion (adjusted odds ratio = 9.9, 95% confidence interval = 2.1–47.5). Soil samples from locations near each household were also collected and analyzed for and a human-associated fecal marker (HF183). was detected in 100% of soil samples (mean 5.5 log colony forming units per gram of dry soil) and the fecal marker HF183 was detected in 93% of soil samples. These findings suggest that soil ingestion may be an important transmission pathway for diarrheal disease in urban slum settings.


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  1. WHO, 2013. Diarrhoeal Disease Fact Sheet. Geneva, Switzerland: World Health Organization. Available at: http://www.who.int/mediacentre/factsheets/fs330/en/. Accessed December 15, 2015. [Google Scholar]
  2. Curtis V, Cairncross S, Yonli R, , 2000. Review: domestic hygiene and diarrhoea—pinpointing the problem. Trop Med Int Health 5: 2630.[Crossref] [Google Scholar]
  3. Kutalek R, Wewalka G, Gundacker C, Auer H, Wilson J, Haluza D, Huhulescu S, Hillier S, Sager M, Prinz A, , 2010. Geophagy and potential health implications: geohelminths, microbes and heavy metals. Trans R Soc Trop Med Hyg 104: 787795.[Crossref] [Google Scholar]
  4. Young SL, Khalfan SS, Farag TH, Kavle JA, Ali SM, Hajji H, Rasmussen KM, Pelto GH, Tielsch JM, Stoltzfus RJ, , 2010. Association of pica with anemia and gastrointestinal distress among pregnant women in Zanzibar, Tanzania. Am J Trop Med Hyg 83: 144151.[Crossref] [Google Scholar]
  5. Luoba AI, Wenzel Geissler P, Estambale B, Ouma JH, Alusala D, Ayah R, Mwaniki D, Magnussen P, Friis H, , 2005. Earth-eating and reinfection with intestinal helminths among pregnant and lactating women in western Kenya. Trop Med Int Health 10: 220227.[Crossref] [Google Scholar]
  6. Young SL, Sherman PW, Lucks JB, Pelto GH, , 2011. Why on earth?: evaluating hypotheses about the physiological functions of human geophagy. Q Rev Biol 86: 97120.[Crossref] [Google Scholar]
  7. Miao D, Young SL, Golden CD, , 2015. A meta-analysis of pica and micronutrient status: pica and micronutrient meta-analysis. Am J Hum Biol 27: 8493.[Crossref] [Google Scholar]
  8. Geissler PW, Mwaniki DL, Thiong'o F, Michaelsen KF, Friis H, , 1998. Geophagy, iron status and anaemia among primary school children in western Kenya. Trop Med Int Health 3: 529534.[Crossref] [Google Scholar]
  9. Ngure FM, Humphrey JH, Mbuya MNN, Majo F, Mutasa K, Govha M, Mazarura E, Chasekwa B, Prendergast AJ, Curtis V, Boor KJ, Stoltzfus RJ, , 2013. Formative research on hygiene behaviors and geophagy among infants and young children and implications of exposure to fecal bacteria. Am J Trop Med Hyg 89: 709716.[Crossref] [Google Scholar]
  10. George CM, Oldja L, Biswas S, Perin J, Lee GO, Kosek M, Sack RB, Ahmed S, Haque R, Parvin T, Azmi IJ, Bhuyian SI, Talukder KA, Mohammad S, Faruque AG, , 2015. Geophagy is associated with environmental enteropathy and stunting in children in rural Bangladesh. Am J Trop Med Hyg 92: 11171124.[Crossref] [Google Scholar]
  11. Pickering AJ, Julian TR, Marks SJ, Mattioli MC, Boehm AB, Schwab KJ, Davis J, , 2012. Fecal contamination and diarrheal pathogens on surfaces and in soils among Tanzanian households with and without improved sanitation. Environ Sci Technol 46: 57365743.[Crossref] [Google Scholar]
  12. Shivoga WA, Moturi WN, , 2009. Geophagia as a risk factor for diarrhoea. J Infect Dev Ctries 3: 9498. [Google Scholar]
  13. WHO/UNICEF, 2015. Progress on Sanitation and Drinking Water—2015 Update and MDG Assessment. Geneva, Switzerland and New York, NY: World Health Organization and UNICEF. [Google Scholar]
  14. Boehm AB, Griffith J, McGee C, Edge TA, Solo-Gabriele HM, Whitman R, Cao Y, Getrich M, Jay JA, Ferguson D, Goodwin KD, Lee CM, Madison M, Weisberg SB, , 2009. Faecal indicator bacteria enumeration in beach sand: a comparison study of extraction methods in medium to coarse sands. J Appl Microbiol 107: 17401750.[Crossref] [Google Scholar]
  15. Jenkins MW, Tiwari S, Lorente M, Gichaba CM, Wuertz S, , 2009. Identifying human and livestock sources of fecal contamination in Kenya with host-specific Bacteroidales assays. Water Res 43: 49564966.[Crossref] [Google Scholar]
  16. Seurinck S, Defoirdt T, Verstraete W, Siciliano SD, , 2005. Detection and quantification of the human-specific HF183 Bacteroides 16S rRNA genetic marker with real-time PCR for assessment of human faecal pollution in freshwater. Environ Microbiol 7: 249259.[Crossref] [Google Scholar]
  17. Layton BA, Cao Y, Ebentier DL, Hanley K, Ballesté E, Brandão J, Byappanahalli M, Converse R, Farnleitner AH, Gentry-Shields J, Gidley ML, Gourmelon M, Lee CS, Lee J, Lozach S, Madi T, Meijer WG, Noble R, Peed L, Reischer GH, Rodrigues R, Rose JB, Schriewer A, Sinigalliano C, Srinivasan S, Stewart J, Van De Werfhorst LC, Wang D, Whitman R, Wuertz S, Jay J, Holden PA, Boehm AB, Shanks O, Griffith JF, , 2013. Performance of human fecal anaerobe-associated PCR-based assays in a multi-laboratory method evaluation study. Water Res 47: 68976908.[Crossref] [Google Scholar]
  18. Bustin SA, Benes V, Garson JA, Hellemans J, Huggett J, Kubista M, Mueller R, Nolan T, Pfaffl MW, Shipley GL, Vandesompele J, Wittwer CT, , 2009. The MIQE guidelines: minimum information for publication of quantitative real-time PCR experiments. Clin Chem 55: 611622.[Crossref] [Google Scholar]
  19. Cao Y, Griffith JF, Dorevitch S, Weisberg SB, , 2012. Effectiveness of qPCR permutations, internal controls and dilution as means for minimizing the impact of inhibition while measuring Enterococcus in environmental waters. J Appl Microbiol 113: 6675.[Crossref] [Google Scholar]
  20. Heinze G, Puhr R, , 2010. Bias-reduced and separation-proof conditional logistic regression with small or sparse data sets. Stat Med 29: 770777.[Crossref] [Google Scholar]
  21. Heinze G, Schemper M, , 2002. A solution to the problem of separation in logistic regression. Stat Med 21: 24092419.[Crossref] [Google Scholar]
  22. Zambrano LD, Levy K, Menezes NP, Freeman MC, , 2014. Human diarrhea infections associated with domestic animal husbandry: a systematic review and meta-analysis. Trans R Soc Trop Med Hyg 108: 313325.[Crossref] [Google Scholar]
  23. Katukiza AY, Ronteltap M, van der Steen P, Foppen JWA, Lens PNL, , 2014. Quantification of microbial risks to human health caused by waterborne viruses and bacteria in an urban slum. J Appl Microbiol 116: 447463.[Crossref] [Google Scholar]
  24. Juberg DR, Alfano K, Coughlin RJ, Thompson KM, , 2001. An observational study of object mouthing behavior by young children. Pediatrics 107: 135142.[Crossref] [Google Scholar]
  25. Jamieson RC, Gordon RJ, Sharples KE, Stratton GW, Madani A, , 2002. Movement and persistence of fecal bacteria in agricultural soils and subsurface drainage water: a review. Can Biosyst Eng 44: 19. [Google Scholar]
  26. Savichtcheva O, Okayama N, Okabe S, , 2007. Relationships between Bacteroides 16S rRNA genetic markers and presence of bacterial enteric pathogens and conventional fecal indicators. Water Res 41: 36153628.[Crossref] [Google Scholar]
  27. Howard G, Pedley S, Tibatemwa S, , 2006. Quantitative microbial risk assessment to estimate health risks attributable to water supply: can the technique be applied in developing countries with limited data? J Water Health 4: 4965. [Google Scholar]
  28. Humphrey JH, Jones AD, Manges A, Mangwadu G, Maluccio JA, Mbuya MN, Moulton LH, Ntozini R, Prendergast AJ, Stoltzfus RJ, Tielsch JM, SHINE Trial Team; , 2015. The Sanitation Hygiene Infant Nutrition Efficacy (SHINE) trial: rationale, design, and methods. Clin Infect Dis 61: S685S702.[Crossref] [Google Scholar]
  29. Grusec JE, Danyliuk T, , 2014. Parents' Attitudes and Beliefs: Their Impact on Children's Development. Encyclopedia on early childhood development. Montreal, Quebec: Centre of Excellence for Early Childhood Development and Strategic Knowledge Cluster on Early Child Development. [Google Scholar]

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  • Received : 01 Jul 2016
  • Accepted : 27 Nov 2016
  • Published online : 16 Jan 2017

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