• 1.

    Victora CG, Adair L, Fall C, Hallal PC, Martorell R, Richter L, Sachdev HS, 2008. Maternal and child undernutrition: consequences for adult health and human capital. Lancet 371: 340357.

    • Search Google Scholar
    • Export Citation
  • 2.

    Black RE, Allen LH, Bhutta ZA, Caulfield LE, Onis M, Ezzati M, Mathers C, Rivera J, 2008. Maternal and child undernutrition: global and regional exposures and health consequences. Lancet 371: 243260.

    • Search Google Scholar
    • Export Citation
  • 3.

    Dewey KG, Adu-Afarwuah S, 2008. Systematic review of the efficacy and effectiveness of complementary feeding interventions in developing countries. Matern Child Nutr 4: 2485.

    • Search Google Scholar
    • Export Citation
  • 4.

    Solomons NW, 2003. Environmental contamination and chronic inflammation influence human growth potential. J Nutr 13: 1237.

  • 5.

    Black RE, Morris SS, Bryce J, 2003. Where and why are 10 million children dying every year? Lancet 361: 22262234.

  • 6.

    Briend A, Hasan KZ, Aziz KMA, Hoque BA, 1989. Are diarrhoea control programmes likely to reduce childhood malnutrition observations from rural Bangladesh? Lancet 2: 319322.

    • Search Google Scholar
    • Export Citation
  • 7.

    Humphrey JH, 2009. Child undernutrition, tropical enteropathy, toilets, and hand washing. Lancet 374: 10321035.

  • 8.

    Lunn PG, Northrop-Clewes CA, Downes RM, 1991. Intestinal permeability, mucosal injury and growth faltering in Gambian infants. Lancet 338: 907910.

    • Search Google Scholar
    • Export Citation
  • 9.

    Wagner EG, Lanoix J, 1958. Excreta Disposal for Rural Areas and Small Countries. WHO Monograph Series No. 39. Geneva: World Health Organization.

    • Search Google Scholar
    • Export Citation
  • 10.

    Curtis V, Cairncross S, Yonli R, 2000. Domestic hygiene and diarrhea: pinpointing the problem. Trop Med Int Health 5: 2232.

  • 11.

    Simango C, 2006. Prevalence of Clostridium difficile in the environment in a rural community in Zimbabwe. Trans R Soc Trop Med Hyg 100: 11461150.

    • Search Google Scholar
    • Export Citation
  • 12.

    Marquis GS, Ventura G, Gilman RH, Porras E, Miranda E, Carbajal L, Pentafiel M, 1990. Fecal contamination of shanty town toddlers in households with non-corralled poultry, Lima, Peru. Am J Public Health 80: 146149.

    • Search Google Scholar
    • Export Citation
  • 13.

    Young SL, Sherman PW, Lucks JB, Pelto GH, 2011. Why on earth? Evaluating hypothesis about the physiological functions of human geophagy. Q Rev Biol 86: 97120.

    • Search Google Scholar
    • Export Citation
  • 14.

    Kabuki DY, Kuaye AY, Wiedmann M, Boor KJ, 2004. Molecular subtyping and tracking of Listeria monocytogenes in Latin-style fresh-cheese processing plants. J Dairy Sci 87: 28032812.

    • Search Google Scholar
    • Export Citation
  • 15.

    Kung'u JK, Boor KJ, Ame SM, Ali NS, Jackson AE, Stoltzfus RJ, 2009. Bacterial populations in complementary foods and drinking-water in households with children aged 10–15 months in Zanzibar, Tanzania. J Health Popul Nutr 27: 4152.

    • Search Google Scholar
    • Export Citation
  • 16.

    Halder AK, Tronchet C, Akhter S, Bhuiya A, Johnston R, Luby SP, 2010. Observed hand cleanliness and other measures of hand washing behaviour in rural Bangladesh. BMC Public Health 10: 545.

    • Search Google Scholar
    • Export Citation
  • 17.

    Luby SP, Halder AK, Tronchet C, Akhtar S, Bhuiya A, Johnston R, 2009. Household characteristics associated with hand washing with soap in rural Bangladesh. Am J Trop Med Hyg 81: 882887.

    • Search Google Scholar
    • Export Citation
  • 18.

    Curtis VA, Danquah LO, Aunger RV, 2009. Planned, motivated and habitual hygiene behaviour: an eleven country review. Health Educ Res 24: 655673.

    • Search Google Scholar
    • Export Citation
  • 19.

    Curtis V, Schmidt W, Luby S, Florez R, Touré O, Biran A, 2011. Hygiene: new hopes, new horizons. Lancet Infect Dis 11: 312321.

  • 20.

    Pickering AJ, Davis J, Walters SP, Horak HM, Keymer DP, Mushi D, Strickfaden R, Chynoweth JS, Liu J, Blum A, Rogers K, Boehm AB, 2010. Hands, water and health: fecal contamination in Tanzanian communities with improved non-networked water supplies. Environ Sci Technol 40: 32673272.

    • Search Google Scholar
    • Export Citation
  • 21.

    Gundry SW, Wright JA, Conroy MR, Preez MD, Genthe B, Moyo S, Mutisi C, Potgieter N, 2009. Child dysentery in the Limpopo Valley: a cohort study of water, sanitation and hygiene risk factors. J Water and Health 7: 259266.

    • Search Google Scholar
    • Export Citation
  • 22.

    Pickering AJ, Julian TR, Mamuya S, Boehm AB, Davis J, 2011. Bacterial hand contamination among Tanzanian mothers varies temporally and following household activities. Trop Med Int Health 16: 233239.

    • Search Google Scholar
    • Export Citation
  • 23.

    Harvey SA, Winch PJ, Leontsini E, Gayoso CT, Romero SL, Gilman RH, Oberhelman RA, 2003. Domestic poultry-raising practices in a Peruvian shantytown: implications for control of Campylobacter jejuni-associated diarrhea. Acta Trop 86: 4154.

    • Search Google Scholar
    • Export Citation
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

 

 

 

Formative Research on Hygiene Behaviors and Geophagy among Infants and Young Children and Implications of Exposure to Fecal Bacteria

View More View Less
  • Division of Nutritional Sciences, Cornell University, Ithaca, New York; Department of International Health, Johns Hopkins Bloomberg School of Public Health, Johns, Baltimore, Maryland; Zvitambo Project, Harare, Zimbabwe; Centre for Pediatrics, Queen Mary University of London, London, United Kingdom; The Hygiene Centre, London School of Hygiene and Tropical Medicine, London, United Kingdom
Restricted access

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

* Address correspondence to Francis M. Ngure, Division of Nutritional Sciences, Cornell University, 118 Savage Hall, Ithaca, NY 14853. E-mail: fmn9@cornell.edu

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.

Save