Child hand contamination is associated with subsequent pediatric diarrhea in rural Democratic Republic of the Congo (REDUCE Program).

The objective of the Reducing Enteropathy, Undernutrition, and Contamination in the Environment (REDUCE) program is to identify exposure pathways to fecal pathogens that are significant contributors to morbidity among young children in the Democratic Republic of the Congo (DRC), and on developing and evaluating scalable interventions to reduce fecal contamination from these pathways. This prospective cohort study of 270 children under 5 years of age was conducted in rural South Kivu, DRC, to investigate the association between Escherichia coli in hand rinse, soil, food, object, surface, stored water, and water source samples and child developmental outcomes. Child developmental outcomes were assessed by communication, fine motor, gross motor, personal social, problem-solving, and combined scores measured by the Extended Ages and Stages Questionnaire (EASQ) at a 6-month follow-up. Children having E. coli present in the soil in their play spaces had significantly lower combined EASQ z scores (coefficient: -0.38 (95% CI: -0.73, -0.03)). E. coli on children's hands was associated with lower communication EASQ z scores (-0.37 (95% CI: -0.0.10, -0.01), and E. coli in stored drinking water was associated with lower gross motor EASQ z scores (-0.40 (95% CI: -0.68, -0.12). In the REDUCE cohort study, E. coli in child play spaces, on children's hands, and in stored drinking water was associated with lower developmental outcome scores (communication, gross motor, fine motor, and problem-solving skills). These results suggest the need for interventions to reduce fecal contamination in the household environment to protect the cognitive development of susceptible pediatric populations in rural DRC.

Exposure to fecal contamination continues to be a major public health concern for low-income households in sub-Saharan Africa. Drinking water and hands are known transmission routes for pathogens in household environments. In an effort to identify explanatory variables of water and hand contamination, a variety of analytical approaches have been employed that model variation in E. coli contamination as a function of behaviors and household characteristics. Using data collected from 1217 households in Bagamoyo, Tanzania, this investigation compares the explanatory variables identified in the three different modeling methods to explain hand and water contamination: ordinary least squares regression, logistic regression, and classification tree. Although the modeling approaches varied, there were some similarities in the results, with certain explanatory variables being consistently identified as being related to hand and water contamination (e.g., water source type for the water models and activity prior to sampling for the hand models). At the same time, there were also marked differences across the models. In sum, these results suggest there are benefits to using multiple analysis methods to assess relationships in complex systems. The models were also characterized by low explanatory power, suggesting that variation in hand and water contamination is difficult to capture when analyzing one-time water and hand rinse samples. For improved model performance, future studies could explore modeling of repeat measures of water quality and hand contamination.

The aim of this study was to identify the exposure pathways of fecal pathogens for a pediatric population living in the urban slums of Bangladesh. A total of 252 soil, food, surface, and hand rinse samples were collected from the pilot households with children less than 5 years of age. All samples were analyzed using the IDEXX Quanti-Tray System (Colilert-18) to enumerate fecal indicator bacteria Escherichia coli. Escherichia coli was detected in all soil samples collected from children play spaces (N = 46), 35% of objects and surfaces children frequently put in their mouths, and 31% of child food samples. Thirty-three percent of hand samples from the child and 46% of hand samples from the caregiver had detectable E. coli. These findings showed high fecal contamination of soil, food, and on hands and surfaces in households with young children and demonstrate the need for interventions reducing these exposure pathways for susceptible pediatric populations.

Fecal-oralpathogens are transmitted through complex, environmentallymediated pathways. Sanitation interventions that isolate human fecesfrom the environment may reduce transmission but have shown limitedimpact on environmental contamination. We conducted a study in ruralBangladesh to (1) quantify domestic fecal contamination in settingswith high on-site sanitation coverage; (2) determine how domesticanimals affect fecal contamination; and (3) assess how each environmentalpathway affects others. We collected water, hand rinse, food, soil,and fly samples from 608 households. We analyzed samples with IDEXXQuantitray for the most probable number (MPN) of E. coli. We detected E. coli in source water (25%), storedwater (77%), child hands (43%), food (58%), flies (50%), ponds (97%),and soil (95%). Soil had >120 000 mean MPN E. coli per gram. In compounds with vs without animals, E. coli was higher by 0.54 log10 in soil, 0.40 log10 in stored water and 0.61 log10 in food (p < 0.05). E. coli in stored water and food increasedwith increasing E. coli in soil, ponds, source waterand hands. We provide empirical evidence of fecal transmission inthe domestic environment despite on-site sanitation. Animal fecescontribute to fecal contamination, and fecal indicator bacteria donot strictly indicate human fecal contamination when animals are present.

Microbiological Quality and Safety of Ready-to-Eat Street-Vended Foods in Johannesburg, South Africa

Microbial assessment of water, sanitation, and hygiene (WaSH) in temporary and permanent settlements two years after Nepal 2015 earthquake

The popularity of small-scale and local fruit and vegetable production has increased in recent years due to perceived economic, environmental, and social benefits. However, these operations face contamination risks that both consumers and small-scale producers may underestimate. The present study aimed to assess the microbiological and chemical hazards on fruit, vegetables, soil, and water samples from small-scale farms in north-western Portugal during pre-harvest activities. Additionally, the study investigated farmers' non-compliance with food safety regulations and good agricultural practices (GAPs), exploring how their behaviour might contribute to the identified hazards. A before-and-after analysis of non-compliant behaviours was conducted to determine the impact of training on improving food safety practices. The analysis identified the presence of pathogenic bacteria, pesticides, flame retardant residues, nitrates, and heavy metals. Lead (Pb) concentrations exceeded EU limits in organic carrots from one producer (0.156 ± 0.043 mg/kg) and in chard from another (0.450 ± 0.126 mg/kg). Cadmium (Cd) levels were also above regulatory thresholds in bell peppers (0.023 ± 0.009 mg/kg) and organic tomatoes (0.026 ± 0.015 mg/kg) from two different producers. Elevated levels of heavy metals were detected in irrigation water from two sites, with zinc (Zn) at 0.2503 ± 0.0075 mg/L and Pb at 0.0218 ± 0.0073 mg/L. Among food samples, the most prevalent microorganisms were Pseudomonas spp. (88.2%), Bacillus cereus (76.5%), and aerobic mesophilic bacteria (100%). Phosphorus flame retardants (PFRs), particularly tris(2-butoxyethyl) phosphate (TBEP), were detected in all food and soil samples. Some EU-banned pesticides were detected in food and soil samples, but at levels below the maximum residue limits (MRLs). Chlorpyrifos (35.3%) and p,p'-DDD (23.5%) were the most detected pesticides in food samples. After the training, GAP behaviour improved, particularly that related to hygiene. However, issues related to record-keeping and soil and water analyses persisted, indicating ongoing challenges in achieving full compliance.

BackgroundResearch exploring the unique exposure pathways to fecal pathogens for young children and innovative water, sanitation, and hygiene (WASH) interventions for susceptible pediatric populations is needed to reduce the burden of diarrheal diseases and stunting globally. The Reducing Enteropathy, Diarrhea, Undernutrition, and Contamination in the Environment (REDUCE) program seeks to 1) identify exposure pathways to fecal pathogens that are significant contributors to morbidity for young children in South Kivu, Democratic Republic of the Congo, and 2) develop and evaluate scalable interventions that reduce fecal contamination and exposure from these pathways. The formative research portion of the project sought to identify feasible and acceptable WASH interventions to modify behaviors found to be associated with diarrheal disease and impaired growth in our REDUCE cohort study.MethodsNinety-one semi-structured interviews, 6 focus group discussions, and a pilot study of 102 households were conducted during 24 months of formative research. Thirty-one interviews and six focus group discussions were conducted with caregivers, community health workers, and village leaders to explore existing WASH practices and to identify barriers and facilitators to WASH behaviors. Findings were organized using the Integrated Behavioral Model for Water, Sanitation and Hygiene to facilitate interpretation and identify determinants to Baby WASH behaviors in this setting. Care Group modules and enabling technology were developed based on exploratory findings and then revised during a two-part, iterative pilot study. Sixty interviews were conducted with participants in a pilot study of the REDUCE Baby WASH Care Group modules to learn about their experiences with the intervention.ResultsSix REDUCE Baby WASH Care Group modules were developed based on formative research findings and covered the following topics: 1) living with animals; 2) child mouthing of fomites and feces; 3) composting animal feces; 4) child feces disposal; 5) handwashing with soap; and 6) water treatment.ConclusionThis study took a theory-driven and evidence-based approach to formative research and the development of the REDUCE Baby WASH Care Group modules. Intervention design focused on interrupting the exposure routes for infants and young children to fecal pathogens in the environment and promoting low-cost, low-burden Baby WASH behavioral recommendations and enabling technology. These developed REDUCE Baby WASH Care Group modules are currently being rolled out to over 1,000,000 beneficiaries in Democratic Republic of the Congo.

Faecal contamination is a major causative factor for incidence of water borne infectious diseases. Certain hydrogen sulfide (H(2)S) producing enteric bacteria such as Salmonella sp. and Citrobacter sp., associated with coliforms, have been considered for rapid detection of recent faecal contamination in water. The basic H(2)S test medium, modified by adding 0.25 gm/L of L-cystine HCl, was examined for its efficiency with 90 water samples collected from 40 pipe supplies, 20 open wells, 15 hand pumps and 15 different surface water bodies (river, streams and ponds). Sterilized modified culture medium in glass vials was inoculated with 100 mL of each sample and incubated at 20, 25, 30, 35 and 44 degrees C for 18, 24, 42, 48, 66 and 72 h. Blackening of content in incubated vials was considered positive. For comparison, most probable number (MPN) of coliform and faecal coliform per 100 mL was also estimated in each sample by multiple tube fermentation (MTF) method. H(2)S positive result was exhibited by 78% of samples. Coliform (> 10) and faecal coliform/100 mL were also detected in 59% of samples. Maximum H(2)S positive results (100%) were found with well and surface water samples incubated at 30, 35 and 44 degrees C for 18 h. Coliform (> 10) and faecal coliform/100 mL were also detected in most of these samples. Pipe supplies (60%) and hand pumps (73%) also exhibited considerable H(2)S production. Coliforms and faecal coliforms were also found in significant number of these samples. Thus, the modified H(2)S test may prove a useful alternative indicator of faecal contamination for water quality surveillance and screening of large number of water samples in short duration, particularly during any outbreak of water borne disease among rural population.

Sixty–six (66) food and ten (10) water samples from Nsukka metropolis were screened for the presence of coliforms using the Most probable number (MPN) technique and direct plate count on MacConkey agar/broth and Eosin Methylene Blue (EMB) agar for isolating those from both faecal and human origin. The isolates were characterized biochemically analysed using standard conventional methods. The geometric mean counts (GMC) using MPN ranged from 1-180 faecal coliforms per 100 ml for both food and water samples. However, food samples (66.7%) served in plates and water sources (83.3%) showed apparent signs of contamination probably from the human and water sources, handling and storage unlike foods from the pots that had no trace of contamination. Faecal coliforms were E. coli (42.4%) and Klebsiella pneumonia (37.4%) and others(20.20%)of non-human origin. The E. coli count ranged between 22.2% (“abacha”) and 83.3% (beans ,rice, yam) as well as water(50.0% ).Thus, there was no significant difference (p>0.05) between the indicator organisms (E. coli) in the food, storage vats and water sources. The faecal and human coliforms in foods and water were indications of foodborne diseases Keywords: Food, Water, Coliforms, Vending, Contamination

An earthquake of magnitude 7.8 MW and 6.8 MW struck Nepal on 25 April and 12 May, 2015, respectively, which caused massive damage. In such crises, understanding the water, sanitation, and hygiene (WASH) situation is of paramount importance. Therefore, we aimed to assess the WASH situation and its impact on health, particularly in the Sindhupalchowk district. A questionnaire survey and microbial analysis of water samples were conducted. Descriptive statistics and parametric and non-parametric statistical tests were employed. The results revealed that 97.1% of water samples from the source during the pre-monsoon season and 98.5% during the monsoon season had fecal contamination. Similarly, 92.8% of water samples during the pre-monsoon season and 96.7% during the monsoon season at point of use (PoU) had fecal contamination. Furthermore, water consumption was comparatively less during the pre-monsoon season. The increase in water consumption improved hygiene behavior and lowered the prevalence of waterborne diseases. Similarly, less water consumption affected water handling behavior; for example, the cleaning interval of storage vessels was less frequent. An increase in cleaning interval resulted in fecal contamination of water at PoU. The findings of this study can be useful in the review of existing WASH policy and plans and integration with the disaster management plan for disaster risk reduction.

Reliable access to water, sanitation, and hygiene (WASH) services is a critical component of child health and development. However, as piped water systems with taps conveniently close to households are rare in rural, sub-Saharan Africa, there is limited evidence of their impact. We conducted a quasi-experimental study in four rural villages of southern Zambia between April 2018 and May 2019 in which we measured the impact of installing on-premises piped water systems on fecal contamination of stored water and caregivers’ hands. Gaining access to piped water was associated with a 0.5 log10 reduction of E. coli concentration in drinking water (p < 0.05) but no changes in hand contamination. The piped water systems in this study reduced the median distance to a safe drinking water source by over 90%, but we measured only small improvements in microbiological outcomes and no changes in the duration of self-reported, in-home water storage. These findings emphasize the need for future impact assessments of piped water systems to measure a comprehensive set of indicators directly linked to human well-being such as time savings.

Enrichment-ELISA for Detection of Salmonella typhi From Food and Water Samples

BackgroundMalaria is one of the most prevalent and deadliest illnesses in sub-Saharan Africa. Despite recent gains made towards its control, many African countries still have endemic malaria transmission. This study aimed to assess malaria burden at household level in Kongo central province, Democratic Republic of Congo (DRC), and the impact of community participatory Water, Sanitation and Hygiene (WASH) Action programme.MethodsMixed method research was conducted in two semi-rural towns, Mbanza-Ngungu (a WASH action site) and Kasangulu (a WASH control site) in DRC between 1 January 2017 through March 2018, involving 625 households (3,712 household members). Baseline and post-intervention malaria surveys were conducted with the use of World Bank/WHO Malaria Indicator Questionnaire. An action research consisting of a six-month study was carried out which comprised two interventions: a community participatory WASH action programme aiming at eliminating mosquito breeding areas in the residential environment and a community anti-malaria education campaign. The latter was implemented at both study sites. In addition, baseline and post-intervention malaria rapid diagnostic test (RDT) was performed among the respondents. Furthermore, a six-month hospital-based epidemiological study was conducted at selected referral hospitals at each site from 1 January through June 2017 to determine malaria trend.ResultsLong-lasting insecticide-treated net (LLIN) was the most commonly used preventive measure (55%); 24% of households did not use any measures. Baseline malaria survey showed that 96% of respondents (heads of households) reported at least one episode occurring in the previous six months; of them only 66.5% received malaria care at a health setting. In the Action Research, mean incident household malaria cases decreased significantly at WASH action site (2.3 ± 2.2 cases vs. 1.2 ± 0.7 cases, respectively; p < 0.05), whereas it remained unchanged at the Control site. Similar findings were observed with RDT results. Data collected from referral hospitals showed high malaria incidence rate, 67.4%. Low household income (ORa = 2.37; 95%CI: 1.05–3.12; p < 0.05), proximity to high risk area for malaria (ORa = 5.13; 95%CI: 2–29-8.07; p < 0.001), poor WASH (ORa = 4.10; 95%CI: 2.11–7.08; p < 0.001) were predictors of household malaria.ConclusionThis research showed high prevalence of positive malaria RDT among the responders and high household malaria incidence, which were reduced by a 6-month WASH intervention. DRC government should scale up malaria control strategy by integrating efficient indoor and outdoor preventive measures and improve malaria care accessibility.

Rapid urbanization has led to a growing sanitation crisis in urban areas of Bangladesh and potential exposure to fecal contamination in the urban environment due to inadequate sanitation and poor fecal sludge management. Limited data are available on environmental fecal contamination associated with different exposure pathways in urban Dhaka. We conducted a cross-sectional study to explore the magnitude of fecal contamination in the environment in low-income, high-income, and transient/floating neighborhoods in urban Dhaka. Ten samples were collected from each of 10 environmental compartments in 10 different neighborhoods (4 low-income, 4 high-income and 2 transient/floating neighborhoods). These 1,000 samples were analyzed with the IDEXX-Quanti-Tray technique to determine most-probable-number (MPN) of E. coli. Samples of open drains (6.91 log10 MPN/100 mL), surface water (5.28 log10 MPN/100 mL), floodwater (4.60 log10 MPN/100 mL), produce (3.19 log10 MPN/serving), soil (2.29 log10 MPN/gram), and street food (1.79 log10 MPN/gram) had the highest mean log10 E. coli contamination compared to other samples. The contamination concentrations did not differ between low-income and high-income neighborhoods for shared latrine swabs, open drains, municipal water, produce, and street foodsamples. E. coli contamination levels were significantly higher (p <0.05) in low-income neighborhoods compared to high-income for soil (0.91 log10 MPN/gram, 95% CI, 0.39, 1.43), bathing water (0.98 log10 MPN/100 mL, 95% CI, 0.41, 1.54), non-municipal water (0.64 log10 MPN/100 mL, 95% CI, 0.24, 1.04), surface water (1.92 log10 MPN/100 mL, 95% CI, 1.44, 2.40), and floodwater (0.48 log10 MPN/100 mL, 95% CI, 0.03, 0.92) samples. E. coli contamination were significantly higher (p<0.05) in low-income neighborhoods compared to transient/floating neighborhoods for drain water, bathing water, non-municipal water and surface water. Future studies should examine behavior that brings people into contact with the environment and assess the extent of exposure to fecal contamination in the environment through multiple pathways and associated risks.