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Formative Research on Hygiene Behaviors and Geophagy among Infants and Young Children and Implications of Exposure to Fecal Bacteria
We conducted direct observation of 23 caregiver–infant pairs for 130 hours and recorded wash-related behaviors to identify pathways of fecal–oral transmission of bacteria among infants. In addition to testing fingers, food, and drinking water of infants, three infants actively ingested 11.3 ± 9.2 (mean ± SD) handfuls of soil and two ingested chicken feces 2 ± 1.4 times in 6 hours. Hand washing with soap was not common and drinking water was contaminated with Escherichia coli in half (12 of 22) of the households. A one-year-old infant ingesting 1 gram of chicken feces in a day and 20 grams of soil from a laundry area of the kitchen yard would consume 4,700,000–23,000,000 and 440–4,240 E. coli, respectively, from these sources. Besides standard wash and nutrition interventions, infants in low-income communities should be protected from exploratory ingestion of chicken feces, soil, and geophagia for optimal child health and growth.
Author Notes
Financial support: This study was supported by the Department for International Development, United Kingdom.
Authors' addresses: Francis M. Ngure, Kathyrn J. Boor, and Rebecca J. Stoltzfus, Division of Nutritional Sciences, Cornell University, Ithaca, NY, E-mails: fmn9@cornell.edu, kjb4@cornell.edu, and rjs62@cornell.edu. Jean H. Humphrey, Mduduzi N. N. Mbuya, Florence Majo, Kuda Mutasa, Margaret Govha, Exevia Mazarura, and Bernard Chasekwa, Zvitambo Project, Harare, Zimbabwe, E-mails: jhumphrey@zvitambo.co.zw, mmbuya@zvitambo.co.zw, fmajo@zvitambo.co.zw, kmutasa@zvitambo.co.zw, mgovha@zvitambo.co.zw, emazarura@zvitambo.co.zw, and bchasekwa@zvitambo.co.zw. Andrew J. Prendergast, Centre for Paediatrics, Blizard Institute, London, UK, E-mail: a.prendergast@qmul.ac.uk. Valerie Curtis, Disease Control and Vector Biology Unit, London School of Hygiene and Tropical Medicine, London, UK, E-mail: val.curtis@lshtm.ac.uk.
Reprint requests: Francis M. Ngure, Division of Nutritional Sciences, Cornell University, 118 Savage Hall, Ithaca, NY 14853, E-mail: fmn9@cornell.edu.