title: Formative research on hygiene behaviors and geophagy among infants and young children and implications of exposure to fecal bacteria.
abstract: 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.
authors.affiliation: 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.
authors.forename: Francis M
authors.initials: FM
authors.lastname: Ngure
authors.forename: Jean H
authors.initials: JH
authors.lastname: Humphrey
authors.forename: Mduduzi N N
authors.initials: MN
authors.lastname: Mbuya
authors.forename: Florence
authors.initials: F
authors.lastname: Majo
authors.forename: Kuda
authors.initials: K
authors.lastname: Mutasa
authors.forename: Margaret
authors.initials: M
authors.lastname: Govha
authors.forename: Exevia
authors.initials: E
authors.lastname: Mazarura
authors.forename: Bernard
authors.initials: B
authors.lastname: Chasekwa
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Prendergast
authors.forename: Valerie
authors.initials: V
authors.lastname: Curtis
authors.forename: Kathyrn J
authors.initials: KJ
authors.lastname: Boor
authors.forename: Rebecca J
authors.initials: RJ
authors.lastname: Stoltzfus
mesh_terms: D000328:Adult; D000818:Animals; D002645:Chickens; D002675:Child, Preschool; D004781:Environmental Exposure; D004783:Environmental Microbiology; D005243:Feces / Q000382:microbiology*; D005260:Female; D006801:Humans; D006920:Hygiene / Q000592:standards*; D007223:Infant; D008297:Male; D012307:Risk Factors; D012987:Soil; D012988:Soil Microbiology; D055815:Young Adult; D015030:Zimbabwe
chemical_list: D012987:Soil