- INTRODUCTION
- MATERIALS AND METHODS
- RESULTS
- Participant characteristics.
- Bacterial contamination of bottle and hand samples.
- Bottle characteristics, usage, and hygiene practices.
- Trial of cleaning practices under controlled conditions.
- Identified barriers to optimal bottle disinfection.
- Health providers’ advice surrounding bottle hygiene.
- Uptake of practices recommended during the TIPs.
- Facilitators and challenges surrounding behavior change.
- DISCUSSION
ProCite
RefWorks
Reference Manager
BibTeX
Zotero
EndNote
-
1.
Katona P, Katona-Apte J, 2008. The interaction between nutrition and infection. Clin Infect Dis 46: 1582–1588.
-
2.
Dewey KG, Mayers DR, 2011. Early child growth: how do nutrition and infection interact? Matern Child Nutr 7 (Suppl 3): 129–142.
-
3.
Kar BR, Rao SL, Chandramouli BA, 2008. Cognitive development in children with chronic protein energy malnutrition. Behav Brain Funct 4: 31.
-
4.
Berkman DS, Lescano AG, Gilman RH, Lopez SL, Black MM, 2002. Effects of stunting, diarrhoeal disease, and parasitic infection during infancy on cognition in late childhood: a follow-up study. Lancet 359: 564–571.
-
5.
Dewey KG, Begum K, 2011. Long-term consequences of stunting in early life. Matern Child Nutr 7 (Suppl 3): 5–18.
-
6.
Victora CG, Adair L, Fall C, Hallal PC, Martorell R, Richter L, Sachdev HS; Maternal, Child Undernutrition Study Group, 2008. Maternal and child undernutrition: consequences for adult health and human capital. Lancet 371: 340–357.
-
7.
Hoddinott J, Maluccio JA, Behrman JR, Flores R, Martorell R, 2008. Effect of a nutrition intervention during early childhood on economic productivity in Guatemalan adults. Lancet 371: 411–416.
-
8.
Martorell R, Melgar P, Maluccio JA, Stein AD, Rivera JA, 2010. The nutrition intervention improved adult human capital and economic productivity. J Nutr 140: 411–414.
-
9.
INEI, 2015. Peru: Encuesta Demográfica y de Salud Familiar 2014. Lima, Peru: Instituto Nacional de Estadística e Informática.
-
10.
Behar M, 1975. The role of feeding and nutrition in the pathogeny and prevention of diarrheic processes. Bull Pan Am Health Organ 9: 1–9.
-
11.
Bullen CL, Willis AT, 1971. Resistance of the breast-fed infant to gastroenteritis. Br Med J 3: 338–343.
-
12.
Cushing AH, Anderson L, 1982. Diarrhea in breast-fed and non-breast-fed infants. Pediatrics 70: 921–925.
-
13.
Lu R, Costello A, 2000. Failure to exclusively breastfeed and the risk of early infant mortality due to infectious disease in poor communities in Lima, Peru. J Trop Pediatr 46: 309–311.
-
14.
Surjono D, Ismadi SD, Suwardji, Rohde JE, 1980. Bacterial contamination and dilution of milk in infant feeding bottles. J Trop Pediatr 26: 58–61.
-
15.
Andresen E, Rollins NC, Sturm AW, Conana N, Greiner T, 2007. Bacterial contamination and over-dilution of commercial infant formula prepared by HIV-infected mothers in a Prevention of Mother-to-Child Transmission (PMTCT) Programme, South Africa. J Trop Pediatr 53: 409–414.
-
16.
Morais TB, Morais MB, Sigulem DM, 1998. Bacterial contamination of the lacteal contents of feeding bottles in metropolitan Sao Paulo, Brazil. Bull World Health Organ 76: 173–181.
-
17.
Imong SM, Jackson DA, Rungruengthanakit K, Wongsawasdii L, Amatayakul K, Drewett RF, Baum JD, 1995. Maternal behaviour and socio-economic influences on the bacterial content of infant weaning foods in rural northern Thailand. J Trop Pediatr 41: 234–240.
-
18.
Suthienkul O, Siripanichgon K, Promachot P, Echeverria P, Lexsomboon U, Rakue Y, 1999. Bacterial contamination of bottle milk in infants under 6 months in Children’s Hospital, Bangkok, Thailand. Southeast Asian J Trop Med Public Health 30: 770–775.
-
19.
Gibson S, Sahanggamu D, Fatmaningrum D, Curtis V, White S, 2017. ‘Unfit for human consumption’: a study of the contamination of formula milk fed to young children in East Java, Indonesia. Trop Med Int Health.
-
20.
Cherian A, Lawande RV, 1985. Recovery of potential pathogens from feeding bottle contents and teats in Zaria, Nigeria. Trans R Soc Trop Med Hyg 79: 840–842.
-
21.
Elegbe IA, Ojofeitimi EO, Elegbe I, Akinola MO, 1982. Pathogenic bacteria isolated from infant feeding teats: contamination of teats used by illiterate and educated nursing mothers in Ile-Ife, Nigeria. Am J Dis Child 136: 672–674.
-
22.
Anderson JA, Gatherer A, 1970. Hygiene of infant-feeding utensils. Practices and standards in the home. Br Med J 2: 20–23.
-
23.
Redmond EC, Griffith CJ, Riley S, 2009. Contamination of bottles used for feeding reconstituted powdered infant formula and implications for public health. Perspect Public Health 129: 85–94.
-
24.
Black RE, Lopez de Romana G, Brown KH, Bravo N, Bazalar OG, Kanashiro HC, 1989. Incidence and etiology of infantile diarrhea and major routes of transmission in Huascar, Peru. Am J Epidemiol 129: 785–799.
-
25.
INEI, 2006. Peru: Encuesta Demográfica y de Salud Familiar. ENDES Continua 2004–2005. Informe Principal. Lima, Peru: Instituto Nacional de Estadística e Informática.
-
26.
WHO, 2001. Global Strategy for Infant and Young Child Feeding. WHA54 A54/INF.DOC./4. Geneva, Switzerland: World Health Organization.
-
27.
INEI, 1988. Encuesta Demográfica y de Salud familiar (ENDES 1986). Informe General. Lima, Peru: Instituto Nacional de Estadística e Informática.
-
28.
WHO, 2013. Protecting Breastfeeding in Peru. Geneva, Switzerland: World Health Organization. Available at: http://www.who.int/features/2013/peru_breastfeeding/en/. Accessed December 10, 2018.
-
29.
INEI, 1992. Encuesta Demográfica y de Salud Familiar 1991/1992. Lima, Peru: Instituto Nacional de Estadística e Informática.
-
30.
INEI, 2007. XI Censo de Población y VI de Vivienda. Lima, Peru: Instituto Nacional de Estadistica e Informatica.
-
31.
Sandelowski M, 1995. Sample size in qualitative research. Res Nurs Health 18: 179–183.
-
32.
Doyle M, Erickson M, 2006. Closing the door on the fecal coliform assay. Microbe 1: 162–163.
-
33.
WHO and Food and Agriculture Organization of the United Nations, 2007. Safe Preparation, Storage and Handling of Powdered Infant Formula: Guidelines. Geneva, Switzerland: World Health Organization.
-
34.
Dreibelbis R, Winch PJ, Leontsini E, Hulland KR, Ram PK, Unicomb L, Luby SP, 2013. The integrated behavioural model for water, sanitation, and hygiene: a systematic review of behavioural models and a framework for designing and evaluating behaviour change interventions in infrastructure-restricted settings. BMC Public Health 13: 1015.
-
35.
Dickin K, Griffiths M, 1997. Designing by Dialogue: A Program Planners’ Guide to Consultative Research for Improving Young Child Feeding. Washington, DC: Academy for Educational Development.
-
36.
Hsieh HF, Shannon SE, 2005. Three approaches to qualitative content analysis. Qual Health Res 15: 1277–1288.
-
37.
Kim HY, Han Y, Pyun Y, Kim J, Ahn K, Lee SI, 2011. Prolonged bedtime bottle feeding and respiratory symptoms in infants. Asia Pac Allergy 1: 30–35.
-
38.
Feachem RG, Koblinsky MA, 1984. Interventions for the control of diarrhoeal diseases among young children: promotion of breast-feeding. Bull World Health Organ 62: 271–291.
-
39.
Huttly SR, Morris SS, Pisani V, 1997. Prevention of diarrhoea in young children in developing countries. Bull World Health Organ 75: 163–174.
-
40.
Kramer MS et al. 2001. Promotion of Breastfeeding Intervention Trial (PROBIT): a randomized trial in the Republic of Belarus. JAMA 285: 413–420.
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41.
Donlan RM, 2002. Biofilms: microbial life on surfaces. Emerg Infect Dis 8: 881–890.
-
42.
Watnick P, Kolter R, 2000. Biofilm, city of microbes. J Bacteriol 182: 2675–2679.
-
43.
Kuan WH, Chen YL, 2016. Bottle material and cleansing procedures of infant feeding bottles. Southeast Asian J Trop Med Public Health 47: 142–151.
-
44.
Spinks AT, Dunstan RH, Harrison T, Coombes P, Kuczera G, 2006. Thermal inactivation of water-borne pathogenic and indicator bacteria at sub-boiling temperatures. Water Res 40: 1326–1332.
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45.
Devine J, 2010. Beyond tippy-taps: the role of enabling products in scaling up and sustaining handwashing. Waterlines 29: 304.
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46.
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-
47.
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48.
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-
49.
Clasen T, McLaughlin C, Nayaar N, Boisson S, Gupta R, Desai D, Shah N, 2008. Microbiological effectiveness and cost of disinfecting water by boiling in semi-urban India. Am J Trop Med Hyg 79: 407–413.
-
50.
Oswald WE, Lescano AG, Bern C, Calderon MM, Cabrera L, Gilman RH, 2007. Fecal contamination of drinking water within peri-urban households, Lima, Peru. Am J Trop Med Hyg 77: 699–704.
-
51.
Psutka R, Peletz R, Michelo S, Kelly P, Clasen T, 2011. Assessing the microbiological performance and potential cost of boiling drinking water in urban Zambia. Environ Sci Technol 45: 6095–6101.
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52.
Delgado J, Ramirez-Cardich ME, Gilman RH, Lavarello R, Dahodwala N, Bazan A, Rodriguez V, Cama RI, Tovar M, Lescano A, 2002. Risk factors for burns in children: crowding, poverty, and poor maternal education. Inj Prev 8: 38–41.
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53.
Donroe J, Gilman RH, Brugge D, Mwamburi M, Moore DA, 2009. Falls, poisonings, burns, and road traffic injuries in urban Peruvian children and adolescents: a community based study. Inj Prev 15: 390–396.
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Household Contamination of Baby Bottles and Opportunities to Improve Bottle Hygiene in Peri-Urban Lima, Peru
Jessica D. Rothstein
Jessica D. Rothstein
Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland;
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Alejandra Llican Mendoza
Alejandra Llican Mendoza
Laboratorio de Investigación en Enfermedades Infecciosas, Universidad Peruana Cayetano Heredia, Lima, Peru;
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Lilia Z. Cabrera
Lilia Z. Cabrera
Asociación Benéfica Proyectos en Informática, Salud, Medicina, y Agricultura (PRISMA), Lima, Peru
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Jessica Pachas
Jessica Pachas
Asociación Benéfica Proyectos en Informática, Salud, Medicina, y Agricultura (PRISMA), Lima, Peru
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Maritza Calderón
Maritza Calderón
Laboratorio de Investigación en Enfermedades Infecciosas, Universidad Peruana Cayetano Heredia, Lima, Peru;
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Mónica J. Pajuelo
Mónica J. Pajuelo
Laboratorio de Investigación en Enfermedades Infecciosas, Universidad Peruana Cayetano Heredia, Lima, Peru;
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Laura E. Caulfield
Laura E. Caulfield
Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland;
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Peter J. Winch
Peter J. Winch
Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland;
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Robert H. Gilman
Robert H. Gilman
Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland;
Laboratorio de Investigación en Enfermedades Infecciosas, Universidad Peruana Cayetano Heredia, Lima, Peru;
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Laboratorio de Investigación en Enfermedades Infecciosas, Universidad Peruana Cayetano Heredia, Lima, Peru;
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Feeding of infant formula using contaminated bottles may be an important transmission pathway of enteric pathogens during early life. Determinants of suboptimal bottle hygiene and the feasibility and acceptability of intervention strategies have not been well assessed. We evaluated the extent of bottle contamination, its contributing factors, and options for promoting improved bottle hygiene in a Peruvian shantytown. During Phase 1, we sampled from bottles and caregiver hands (n = 48) and processed for enumeration of total coliform and Escherichia coli colony-forming units. A semi-structured questionnaire captured bottle use and hygiene practices. Phase 2 involved the identification of candidate practices to recommend to caregivers. Phase 3 consisted of a behavioral trial in which 14 caregivers were educated about improved practices for bottle disinfection and later reported on their experiences implementing them. Fecal bacteria were detected in 43.8% of bottles sampled during Phase 1 and in 21.7% of hands. Caregivers overall did not use effective methods for disinfecting bottles, displayed misunderstandings surrounding hygienic practices, and few had ever discussed bottle hygiene with a health provider. Findings from the behavioral trial indicated that the improved practice of brushing the bottle with dish detergent for 30 seconds after every use is preferable to boiling the bottle for several minutes daily as caregivers reported that the brush was simple to use, efficient, and practical. The promotion of a bottle brush and detergent is a feasible and acceptable intervention strategy in peri-urban settings, and future research should evaluate its long-term effectiveness for reducing bottle contamination.
Author Notes
Financial support: The “Natural infection of norovirus and sapovirus in a birth cohort in a Peruvian peri-urban community” is funded by the National Institute of Allergy and Infectious Diseases. J. R. received the Fulbright–Fogarty Fellowship in Public Health (co-sponsored by the Fulbright Program and the Fogarty International Center at the National Institutes of Health) and a Procter and Gamble Fellowship.
Authors’ addresses: Jessica D. Rothstein, Laura E. Caulfield, and Peter J. Winch, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, E-mails: jrothstein@jhu.edu, lcaulfi1@jhu.edu, and pwinch@jhu.edu. Alejandra Llican Mendoza, Maritza Calderón, and Mónica J. Pajuelo, Laboratorio de Investigación en Enfermedades Infecciosas, Universidad Peruana Cayetano Heredia, Lima, Perú, E-mails: maria.llican.m@upch.pe, mmcalderons@yahoo.es, and monica.pajuelo.t@upch.pe. Lilia Z. Cabrera and Jessica Pachas, Asociación Benéfica Proyectos en Informática, Salud, Medicina, y Agricultura (PRISMA), Lima, Perú, E-mails: lzcabrera28@gmail.com and jessica_pachas@yahoo.es. Robert H. Gilman, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, and Laboratorio de Investigación en Enfermedades Infecciosas, Universidad Peruana Cayetano Heredia, Lima, Perú, E-mail: gilmanbob@gmail.com.
- INTRODUCTION
- MATERIALS AND METHODS
- RESULTS
- Participant characteristics.
- Bacterial contamination of bottle and hand samples.
- Bottle characteristics, usage, and hygiene practices.
- Trial of cleaning practices under controlled conditions.
- Identified barriers to optimal bottle disinfection.
- Health providers’ advice surrounding bottle hygiene.
- Uptake of practices recommended during the TIPs.
- Facilitators and challenges surrounding behavior change.
- DISCUSSION
ProCite
RefWorks
Reference Manager
BibTeX
Zotero
EndNote
-
1.
Katona P, Katona-Apte J, 2008. The interaction between nutrition and infection. Clin Infect Dis 46: 1582–1588.
-
2.
Dewey KG, Mayers DR, 2011. Early child growth: how do nutrition and infection interact? Matern Child Nutr 7 (Suppl 3): 129–142.
-
3.
Kar BR, Rao SL, Chandramouli BA, 2008. Cognitive development in children with chronic protein energy malnutrition. Behav Brain Funct 4: 31.
-
4.
Berkman DS, Lescano AG, Gilman RH, Lopez SL, Black MM, 2002. Effects of stunting, diarrhoeal disease, and parasitic infection during infancy on cognition in late childhood: a follow-up study. Lancet 359: 564–571.
-
5.
Dewey KG, Begum K, 2011. Long-term consequences of stunting in early life. Matern Child Nutr 7 (Suppl 3): 5–18.
-
6.
Victora CG, Adair L, Fall C, Hallal PC, Martorell R, Richter L, Sachdev HS; Maternal, Child Undernutrition Study Group, 2008. Maternal and child undernutrition: consequences for adult health and human capital. Lancet 371: 340–357.
-
7.
Hoddinott J, Maluccio JA, Behrman JR, Flores R, Martorell R, 2008. Effect of a nutrition intervention during early childhood on economic productivity in Guatemalan adults. Lancet 371: 411–416.
-
8.
Martorell R, Melgar P, Maluccio JA, Stein AD, Rivera JA, 2010. The nutrition intervention improved adult human capital and economic productivity. J Nutr 140: 411–414.
-
9.
INEI, 2015. Peru: Encuesta Demográfica y de Salud Familiar 2014. Lima, Peru: Instituto Nacional de Estadística e Informática.
-
10.
Behar M, 1975. The role of feeding and nutrition in the pathogeny and prevention of diarrheic processes. Bull Pan Am Health Organ 9: 1–9.
-
11.
Bullen CL, Willis AT, 1971. Resistance of the breast-fed infant to gastroenteritis. Br Med J 3: 338–343.
-
12.
Cushing AH, Anderson L, 1982. Diarrhea in breast-fed and non-breast-fed infants. Pediatrics 70: 921–925.
-
13.
Lu R, Costello A, 2000. Failure to exclusively breastfeed and the risk of early infant mortality due to infectious disease in poor communities in Lima, Peru. J Trop Pediatr 46: 309–311.
-
14.
Surjono D, Ismadi SD, Suwardji, Rohde JE, 1980. Bacterial contamination and dilution of milk in infant feeding bottles. J Trop Pediatr 26: 58–61.
-
15.
Andresen E, Rollins NC, Sturm AW, Conana N, Greiner T, 2007. Bacterial contamination and over-dilution of commercial infant formula prepared by HIV-infected mothers in a Prevention of Mother-to-Child Transmission (PMTCT) Programme, South Africa. J Trop Pediatr 53: 409–414.
-
16.
Morais TB, Morais MB, Sigulem DM, 1998. Bacterial contamination of the lacteal contents of feeding bottles in metropolitan Sao Paulo, Brazil. Bull World Health Organ 76: 173–181.
-
17.
Imong SM, Jackson DA, Rungruengthanakit K, Wongsawasdii L, Amatayakul K, Drewett RF, Baum JD, 1995. Maternal behaviour and socio-economic influences on the bacterial content of infant weaning foods in rural northern Thailand. J Trop Pediatr 41: 234–240.
-
18.
Suthienkul O, Siripanichgon K, Promachot P, Echeverria P, Lexsomboon U, Rakue Y, 1999. Bacterial contamination of bottle milk in infants under 6 months in Children’s Hospital, Bangkok, Thailand. Southeast Asian J Trop Med Public Health 30: 770–775.
-
19.
Gibson S, Sahanggamu D, Fatmaningrum D, Curtis V, White S, 2017. ‘Unfit for human consumption’: a study of the contamination of formula milk fed to young children in East Java, Indonesia. Trop Med Int Health.
-
20.
Cherian A, Lawande RV, 1985. Recovery of potential pathogens from feeding bottle contents and teats in Zaria, Nigeria. Trans R Soc Trop Med Hyg 79: 840–842.
-
21.
Elegbe IA, Ojofeitimi EO, Elegbe I, Akinola MO, 1982. Pathogenic bacteria isolated from infant feeding teats: contamination of teats used by illiterate and educated nursing mothers in Ile-Ife, Nigeria. Am J Dis Child 136: 672–674.
-
22.
Anderson JA, Gatherer A, 1970. Hygiene of infant-feeding utensils. Practices and standards in the home. Br Med J 2: 20–23.
-
23.
Redmond EC, Griffith CJ, Riley S, 2009. Contamination of bottles used for feeding reconstituted powdered infant formula and implications for public health. Perspect Public Health 129: 85–94.
-
24.
Black RE, Lopez de Romana G, Brown KH, Bravo N, Bazalar OG, Kanashiro HC, 1989. Incidence and etiology of infantile diarrhea and major routes of transmission in Huascar, Peru. Am J Epidemiol 129: 785–799.
-
25.
INEI, 2006. Peru: Encuesta Demográfica y de Salud Familiar. ENDES Continua 2004–2005. Informe Principal. Lima, Peru: Instituto Nacional de Estadística e Informática.
-
26.
WHO, 2001. Global Strategy for Infant and Young Child Feeding. WHA54 A54/INF.DOC./4. Geneva, Switzerland: World Health Organization.
-
27.
INEI, 1988. Encuesta Demográfica y de Salud familiar (ENDES 1986). Informe General. Lima, Peru: Instituto Nacional de Estadística e Informática.
-
28.
WHO, 2013. Protecting Breastfeeding in Peru. Geneva, Switzerland: World Health Organization. Available at: http://www.who.int/features/2013/peru_breastfeeding/en/. Accessed December 10, 2018.
-
29.
INEI, 1992. Encuesta Demográfica y de Salud Familiar 1991/1992. Lima, Peru: Instituto Nacional de Estadística e Informática.
-
30.
INEI, 2007. XI Censo de Población y VI de Vivienda. Lima, Peru: Instituto Nacional de Estadistica e Informatica.
-
31.
Sandelowski M, 1995. Sample size in qualitative research. Res Nurs Health 18: 179–183.
-
32.
Doyle M, Erickson M, 2006. Closing the door on the fecal coliform assay. Microbe 1: 162–163.
-
33.
WHO and Food and Agriculture Organization of the United Nations, 2007. Safe Preparation, Storage and Handling of Powdered Infant Formula: Guidelines. Geneva, Switzerland: World Health Organization.
-
34.
Dreibelbis R, Winch PJ, Leontsini E, Hulland KR, Ram PK, Unicomb L, Luby SP, 2013. The integrated behavioural model for water, sanitation, and hygiene: a systematic review of behavioural models and a framework for designing and evaluating behaviour change interventions in infrastructure-restricted settings. BMC Public Health 13: 1015.
-
35.
Dickin K, Griffiths M, 1997. Designing by Dialogue: A Program Planners’ Guide to Consultative Research for Improving Young Child Feeding. Washington, DC: Academy for Educational Development.
-
36.
Hsieh HF, Shannon SE, 2005. Three approaches to qualitative content analysis. Qual Health Res 15: 1277–1288.
-
37.
Kim HY, Han Y, Pyun Y, Kim J, Ahn K, Lee SI, 2011. Prolonged bedtime bottle feeding and respiratory symptoms in infants. Asia Pac Allergy 1: 30–35.
-
38.
Feachem RG, Koblinsky MA, 1984. Interventions for the control of diarrhoeal diseases among young children: promotion of breast-feeding. Bull World Health Organ 62: 271–291.
-
39.
Huttly SR, Morris SS, Pisani V, 1997. Prevention of diarrhoea in young children in developing countries. Bull World Health Organ 75: 163–174.
-
40.
Kramer MS et al. 2001. Promotion of Breastfeeding Intervention Trial (PROBIT): a randomized trial in the Republic of Belarus. JAMA 285: 413–420.
-
41.
Donlan RM, 2002. Biofilms: microbial life on surfaces. Emerg Infect Dis 8: 881–890.
-
42.
Watnick P, Kolter R, 2000. Biofilm, city of microbes. J Bacteriol 182: 2675–2679.
-
43.
Kuan WH, Chen YL, 2016. Bottle material and cleansing procedures of infant feeding bottles. Southeast Asian J Trop Med Public Health 47: 142–151.
-
44.
Spinks AT, Dunstan RH, Harrison T, Coombes P, Kuczera G, 2006. Thermal inactivation of water-borne pathogenic and indicator bacteria at sub-boiling temperatures. Water Res 40: 1326–1332.
-
45.
Devine J, 2010. Beyond tippy-taps: the role of enabling products in scaling up and sustaining handwashing. Waterlines 29: 304.
-
46.
Ma L, Zhang G, Swaminathan B, Doyle M, Bowen A, 2009. Efficacy of protocols for cleaning and disinfecting infant feeding bottles in less developed communities. Am J Trop Med Hyg 81: 132–139.
-
47.
Redmond E, Griffith CJ, 2009. Disinfection methods used in decontamination of bottles used for feeding powdered infant formula. J Fam Health Care 19: 26–31.
-
48.
Gilman RH, Skillicorn P, 1985. Boiling of drinking-water: can a fuel-scarce community afford it? Bull World Health Organ 63: 157–163.
-
49.
Clasen T, McLaughlin C, Nayaar N, Boisson S, Gupta R, Desai D, Shah N, 2008. Microbiological effectiveness and cost of disinfecting water by boiling in semi-urban India. Am J Trop Med Hyg 79: 407–413.
-
50.
Oswald WE, Lescano AG, Bern C, Calderon MM, Cabrera L, Gilman RH, 2007. Fecal contamination of drinking water within peri-urban households, Lima, Peru. Am J Trop Med Hyg 77: 699–704.
-
51.
Psutka R, Peletz R, Michelo S, Kelly P, Clasen T, 2011. Assessing the microbiological performance and potential cost of boiling drinking water in urban Zambia. Environ Sci Technol 45: 6095–6101.
-
52.
Delgado J, Ramirez-Cardich ME, Gilman RH, Lavarello R, Dahodwala N, Bazan A, Rodriguez V, Cama RI, Tovar M, Lescano A, 2002. Risk factors for burns in children: crowding, poverty, and poor maternal education. Inj Prev 8: 38–41.
-
53.
Donroe J, Gilman RH, Brugge D, Mwamburi M, Moore DA, 2009. Falls, poisonings, burns, and road traffic injuries in urban Peruvian children and adolescents: a community based study. Inj Prev 15: 390–396.
-
54.
Rosenstock IM, Strecher VJ, Becker MH, 1988. Social learning theory and the health belief model. Health Educ Q 15: 175–183.
-
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