Children's Handwashing Research Articles

Role of Psychosocial Factors and Mental Well-Being for Baby WASH- and Nutrition-Related Behaviors in Lao PDR.

In Lao PDR, 30% of children under age 5 years are affected by stunting. Stunting in childhood is associated with poorer outcomes for both physical and cognitive development. Baby WASH is a focused approach to water supply, sanitation, and hygiene for infants and children that targets numerous contextual and psychosocial factors including child handwashing, food hygiene, clean play spaces, and management of animal feces in the household environment. Using the risks, attitudes, norms, abilities, and self-regulation approach to behavior change (BC), the objective of this study was to investigate psychosocial factors of Baby WASH and nutrition related-behaviors, considering caregivers mental well-being, to design evidence-based BC interventions. A cross-sectional survey of 616 caregivers of a child under 2 years was conducted in Lao PDR. Caregivers well-being was significantly associated with handwashing before feeding a baby, controlling "mouthing," and the intention to exclusively breastfeed for the first 6 months. All psychosocial factors of the three behaviors were correlated with mental well-being. Results suggest that attitudinal and ability factors underlying handwashing with soap before feeding a child should be the primary focus of BC interventions. For controlling mouthing factors, interventions should target attitude and norm factors. To increase the intention of exclusive breastfeeding for the first 6 months attitude, ability, and self-regulation factors should be targeted through BC interventions. The findings of this study can be used to support the inclusion of vulnerable caregivers with poor mental well-being with BC interventions designed to improve child health and prevent stunting.

Science behind children's handwashing: action study of 9- to 10-years-old elementary school students in Japan.

Hand washing instructions for children have been implemented in school education to establish good lifestyle habits. However, repeated hand washing through education from early childhood was common for both teachers and children. If this continues, children might assume they already know how to wash their hands, stop taking handwashing instructions seriously, and become increasingly lax about washing their hands. This study aimed to develop a new handwashing education method for children. We applied the adenosine triphosphate (ATP) test to health education on hand washing in elementary schools. This study was conducted as part of a class for elementary school students in October 2023, in Hokkaido, Japan. The subjects were 157 third-grade (9-10 years old) elementary school students. After excluding absent pupils, 147 were included in the analysis. Both pre- and post-education, ATP values after handwashing were lower than those before handwashing. Following the education, children's handwashing behavior improved, with an increase in the number of point washed and appropriate timing of handwashing. The new handwashing education program utilizing the ATP-test succeeded in promoting handwashing behavior among many children. Visualizing handwashing using ATP values was effective in motivating children.

Peran Orang Tua dalam Menanamkan Pembiasaan Mencuci Tangan pada Anak Usia 4-5 Tahun di BKB PAUD Kelurahan Utan Kayu Utara

This research aims to obtain data regarding the role of parents in implementing the habit of hand washing in children 4-5 years old at BKB PAUD Utan Kayu Utara Subdistrict, Jakarta. This research uses a quantitative descriptive method with a survey method. This research was conducted by distributing questionnaires to respondents. The sample in this study were parents of students aged 4-5 years at BKB PAUD, Utan Kayu Utara Subdistrict. The technique used in determining the sample in this research is cluster sampling. The results of this study show that the role of parents in implementing the habit of hand washing in children aged 4-5 years is in the high category with 88% of the respondents. It can be concluded that parents are aware of the importance of getting their children to washing their hands. Parents are the first educators for children. The role of parents towards children is as caregivers, mentors, educators and as role models in shaping the child's character. In this case, parents are role models in getting children used to washing their hands so that their hands are clean and protected from disease.

The Effect of Health Education on Knowledge and Attitudes of Hand Washing in Children at TKA-TPA Al Muhajirin Kampung Parang

Health problems in children are related to the habit of not keeping their hands clean. The lack of hand washing behavior in school age children is caused by low knowledge about hand washing. Health education is an effort to modify behavior through increasing knowledge and skills to improve healthier lifestyles. The purpose of this study was to identify the effect of health education on the level of knowledge and attitudes towards hand washing in children. This type of quantitative research with a Quasi Experiment approach. Research design one group prepost test design. The sample of this study were 20 children out of a total of 20 children at TKA-TPA Al Muhajirin Kampung Parang. The research instrument used a research questionnaire on the level of knowledge and hand washing attitudes. Statistical test using paired t test. The research results showed that the level of knowledge before the intervention was 18 and increased to 19.45 after the intervention. There was a difference in the average level of knowledge between before and after the intervention with an average difference of 1.45 and a p value = 0.000. Variable hand washing attitude, the table shows that the average hand washing attitude indicator of action before the intervention was 18 and increased to 19 after the intervention. There is a difference in the average action between before and after the intervention with a mean rank difference of 1 and a value of p = 0.001. This means that providing health education about hand washing attitudes is effective in increasing hand washing attitudes in children, where there is a significant increase

The Effect of Media Edutainment Education on Hand washing Accuracy in Grades 4 – 6 Students

Children in school age are a period of acquiring the basics of knowledge. Various diseases that attack school-age children such as diarrhea, ARI, hepatitis, typhoid and bird flu, are generally related to daily behavior. To avoid sickness in youngsters, it is vital to carry out health education on hand washing. Health education in delivered through entertaining and engaging media prevent disease in children, it is necessary to carry out health education on hand washing. Health education is provided in the form of interesting and not boring media, like edutainment. The purpose of this study is to ascertain the impactelementary school pupils in grades 4 – 6. This research method uses pre-experimental design with One group pre post test design. This research was conducted at SDN Banjarsawah 1. The population was 30 respondents. The sampling technique used Total Sampling with 30 sampleof 30 respondents. The research instrument used an observation sheet. Analysis of the data used in this study using the Wilcoxon test.According to the findings, up to 25 respondents (83,3%) were determined to fall into the incorrect category of hand washing before receining edutainment media education. As many as 28 respondents (93,3%) were categorizet as practicing proper hand washing after receiving edutainment media education. The results of the analysis test showed that there was an effect of edutainment media education on the accuracy of hand washing with r-value = 0.000 <α = 0.05. It can be concluded that there is an effect of edutainment media education on the accuracy of hand washing in school children.Edutainment media can increase the accuracy of hand washing in children, so that further research can be carried out in other fields of study with the abilities possessed by various ages and characters.

Effect of handwashing on the reduction of Escherichia coli on children's hands in an urban slum Indonesia.

Poor hand hygiene practice has been linked to an increase in the number of infections among children in urban slums. Hands are considered an intersection for bacterial transmission, but it is unclear whether the handwashing technique affects bacteria elimination. This study investigated the effect of handwashing on the concentration of Escherichia coli (E. coli) and factors related to its reduction among children in an urban slum in Bandung, Indonesia. We observed handwashing and conducted repeated hand swabs before and after handwashing among 137 participants. The mean E. coli concentration on the hands decreased after handwashing, with a higher reduction in E. coli count among students who used soap and had soap contact for more than 10 s during handwashing. Cleaning in-between fingers, using soap, soap contact for more than 10 s, and drying hands with a single-use towel were effective factors for reducing E. coli concentration after handwashing (p < 0.05). More than half of the swab samples (59%) tested positive for E. coli after handwashing, indicating that the children's handwashing technique was not effective in completely removing E. coli from the hands. Moreover, sustained and consistent handwashing practice as a daily behavior in children would maximize the effect.

Investigation on children's handwashing behaviour and contamination levels in rural Cambodia

Abstract The present study aimed to investigate children's handwashing behaviour, contamination levels and qualities of water sources used for handwashing in rural Cambodia. A field survey was conducted by simple random sampling in Kandal Leu village of Kandal Province in 2014. Only 23 children were interviewed with the informed consent of their guardians, limiting our data analysis as descriptive. Concurrently, an adenosine triphosphate test kit was used to assess their hands' contamination levels. Their water sources for handwashing were also tested for Escherichia coli and coliform. As a result, approximately 27% of children in the study areas were found not to wash their hands and 17.2% of children washed their hands more than four times a day before and after eating, after touching dirt and after toileting. Approximately 74% of the dirt could be removed from hands by washing with water. Concurrently, approximately 96% of water from traditional rainwater jars (Pieng) used for handwashing was contaminated with coliform, while 65% was contaminated with E. coli. Cambodian children in our study area used polluted rainwater for handwashing in the rainy season. This study suggests that appropriate handwashing requires safe water and educational programs on environmental and personal hygiene for parents and children.

Prevalence and Associated Risk Factors of Intestinal Parasites among Children under Five Years of Age Attended at Bachuma Primary Hospital, West Omo Zone, Southwest Ethiopia: A Cross-Sectional Study.

In regions of the world with low resources, such as Ethiopia, intestinal parasite diseases are still highly prevalent, especially in children. Poor personal and environmental hygiene, as well as unsafe and low-quality drinking water, are the main causes of this. This investigation aimed to determine the frequency of intestinal parasites and risk factors among children under 5 years age at Bachuma Primary Hospital in 2022. : A cross-sectional study was carried out from October 2022 to December 2022 at Bachuma Primary Hospital, West Omo Zone, Southwest Ethiopia. Stool sample was collected from randomly selected children who were ordered to have their stool examined at the hospital laboratory and wet mount was prepared using normal saline to detect the different stage of intestinal parasites microscopically. Moreover, data related to the sociodemographic and associated risk factors was collected using a structured questionnaire. Descriptive statistics were computed to describe the characteristics of the study participants and determine the prevalence of intestinal parasites. Data were entered into Epi-data manager and analysed using statistical packages for social sciences (SPSS) version 25.0, respectively. Bivariate and multivariate logistic regression analyses were performed, with variables with a p value of <0.05 considered statistically significant. : Infection with at least one intestinal parasite among children was 29.4% (95% CI: 24.5-34.7). Ascaris lumbricoide and Giardia lamblia were responsible for 8% (26/323) and 4% (13/323) of the prevalence of helminth and protozoans, respectively. A multivariate logistic regression analysis revealed that children whose residence was rural had an adjusted odds ratio (AOR) of 5.048 (p=0.001), those who did not wash their hands before meals had an AOR of 7.749 (p=0.001), a child with not trimmed fingernails had an AOR of 2.752 (p=0.010), a child who frequently experienced stomach pain and whose source of water was pond had an AOR of 2.415 (p=0.028) and 3.796 (p=0.040), respectively. In this study, the prevalence of intestinal parasites recorded was low. Rural residency, absence of child hand washing practice before meal, and not trimming fingernail were among factors significantly associated with intestinal parasite infection.

Effectiveness of Health Education Using Audiovisual Media on Psychomotor Ability to Wash Hands in Children with Special Needs

This study aims to determine the effectiveness of health education using audiovisual media on the psychomotor ability of hand washing in children (with mental retardation). Children with special needs need special care and get a subject called self-development. Children are taught healthy living behaviours. This study used an experimental method with a one-group pre-test and post-test approach consisting of one intervention group. The sampling technique uses a total sampling technique: as many as 25 children were selected in the intervention class. Data analysis using the Wilcoxon Signed Rank test. The results of this study: 1) The level of psychomotor ability to wash hands before being given audiovisual media to children with special needs (Tunagrahita) at SLB Pelita Nusa in Pekanbaru 68% Incapable, 2) The level of psychomotor ability to wash hands after being given audiovisual media to children with special needs (Tunagrahita) at SLB Pelita Nusa in Pekanbaru increased to Independent with 80% of respondents, 3) Audiovisual media learning is effective for improving psychomotor handwashing skills in children with special needs (Tunagrahita) at SLB Pelita Nusa in Pekanbaru, Riau. Based on the study's results, it can be concluded that audiovisual media effectively improves the psychomotor ability of hand washing in children with special needs (Tunagrahita) at SLB Pelita Nusa in Pekanbaru, Riau.

Evaluating Health Education Module on Hand, Food, and Mouth Diseases Among Preschoolers in Malacca, Malaysia.

This study aims to improve parents' perceptions of susceptibility, severity, benefits, and barriers to children's handwashing practice by utilizing the Health Belief Model. In Alor Gajah, Melaka, a parallel cluster-randomized controlled study was conducted over 26 months. Parents who agreed to participate completed pre-test (t0) questionnaires. Data analysis used IBM SPSS version 25. The descriptive analysis described the baseline data pre-intervention. Chi-square and T-test or Mann-Whitney U test for non-parametric analysis assessed baseline data comparability between intervention and control groups. Generalized Estimating Equation (GEE) analyzed between and within-group comparison of the outcomes, and multivariate analysis determined the effectiveness of the intervention with clustered data. The individual participation rate was 86%. Parents who followed up immediately had higher perceived susceptibility, perceived severity, and perceived barriers (p < 0.001). Each unit increment in parents' practice score was 0.02-unit higher preschool children's hand hygiene practice score (p = 0.045). The intervention effectively improved parents' perceived susceptibility and benefits at immediate follow-up compared to baseline. However, there were no significant intervention effects on parents' perceived severity and barriers and preschool children's handwashing practices. The follow-up time significantly affected each outcome. There were significant covariates as the outcome predictors in this study, besides intervention groups and follow-up time. Parents' knowledge and age of the youngest child were significant predictors of parents' perceived susceptibility, besides parents' knowledge and perceived susceptibility being the predictors of parents' practice score. As a result, parents, teachers, and communities can implement this intervention in other schools with susceptible children.

Effect of a comic story on orphan children's knowledge and hand washing practice about pandemic of COVID-19

World Health Organization (WHO) declared COVID-19 as a pandemic in 11th of March 2020. COVID-19 that disrupts Children’s growth and development, friendships, daily routines and has a negative consequence for their well-being, development and protection. About 1 in 3 children hospitalized with COVID-19 in the United States were admitted to the intensive care unit. Aim: The aim of this study was evaluating the effect of a comic story on children’s knowledge and hand washing practices about pandemic of COVID-19. Study design: A quasi-experimental design was used. Setting: Nour Al-Huda Charitable Society that caring males and females orphaned children in separate setting Sample: A convenient sample including all children in the orphanage, there was 41 children and their age range between 3 to less than 12 years. Tools of data collection: An interview questionnaire sheet as a tool one that had two parts first one concerned with sociodemographic data of children and second one assessed children’s knowledge about pandemic of COVID-19, an observational check list sheet as a tool two and had two parts; where part one assessed facilities required for applying precautionary measures inside the home, while part two assessed children’s hand washing practice inside the home. Results: there was a statistically significant differences between the total children’s knowledge regarding COVID-19 and total observed practice score regarding correct technique of hand washing pre/post comic story implementation. Conclusion: It was concluded that the implementation of a comic story had improved children’s total mean score of knowledge and hand washing practice regarding COVID-19 with statistically significant differences of both in relation to pre and post comic story implementation. Recommendations: The study recommended that to breakdown the ring of transmission of COVID-19; the collaboration between governmental and non-governmental agencies and stakeholders are main supporters for those children via appropriate and friendly communication tools that improve their knowledge; practice and also providing those setting by funding and resources for applying precautionary measures of COVID-19 with periodical follow up for personals, setting, services and resources.

Efektivitas promosi kesehatan pencegahan Covid-19 dengan CTPS

COVID-19, the infectious disease caused by SARS-CoV-2, has emerged as a global health crisis and pandemic. Children are very susceptible to disease transmission because their immune system is not yet perfect. To achieve the spread and transmission of this virus, interventions are needed across the population. The promotion of hand washing in children is needed to increase children's knowledge about preventing covid-19 by washing hands with soap. The purpose of this study is to give Indonesian children additional education about handwashing with soap and to make them be able to demonstrate good and correct hand washing. The health education is conducted by giving lecture to the children and showing them videos in the end of the sessions. After that, an evaluation of the health education is carried out by giving the children pre-test and post-test designs. The result of the study showed that 96% children (49 of 51) who attended the health education experienced an increase in their post-test results. This indicated that the content of the health education can be easily understood by most of the children. A good learning process requires several supporting factors such as careful preparation, interactive way of delivering instruction, and good team coordination. In order to monitor the application of the knowledge obtained in the health education, it is necessary to carry out continuous educative activities so that hopefully there will be an increase in the health quality of Indonesian children.&#x0D; Keywords : Covid-19, Education, Hand Washing Steps

PREVALENCE OF ACUTE DIARRHEAL DISEASES AND ASSOCIATED RISK FACTORS AMONG UNDER FIVE CHILDREN IN AN URBAN SLUM OF MUMBAI

Introduction: Diarrhoea is one of the single most common causes of death among children under age five worldwide. Diarrheal disorders in childhood account for a large proportion (18%) of childhood deaths, with an estimated 1.5 million deaths per year globally, making it the second most common cause of child deaths worldwide1.So the study was undertaken in order to study the prevalence and associated risk factors causing diarrhoea in urban slum of Metropolitan city. Methods- A cross sectional study was done from January 2012 to December 2012 in Cheetah Camp area. Toal 478 under five children were selected and the parent/guardian of the child was interviewed using pre-designed, semi-structured and pre-tested questionnaires. Results and Conclusion-The prevalence of diarrhoea in children under 5 years during past 2 weeks was 17.8%. Diarrheal episodes in the past 2 weeks was significantly associated with education of mother, socioeconomic status of family, type of family, source of water supply, housefly nuisance in home, child hand-washing before meals, mother hand-washing before meals and immunization status.

Child Hand Washing Intervention (Age < 5 Years) Against The Risk of Infection in Child Care: Systematic Review

The risk of infection experienced by children (age < 5 years) who do not wash their hands properly becomes a serious threat to the health. Purpose: The study aims to explain handwashing interventions in child care facilities against the risk of infection. A systematic review was obtained from Scopus, PubMed, Science Direct, SAGE and ProQuest database, published between 2010-2020. The study design; Narrative analysis of the study's findings has been conducted. A total of 25 studies covered about comprehensive handwashing interventions (n=18) and behavior (n=7). The average number of participants more than one hundred respondents. Dealing with hand washing is essential in first aid to prevent the risk of infection in children aged < 5 years. Various interventions can have a significant effect on reducing the risk of infection although other interventions provide different successes.

Duration or technique to improve the effectiveness of children' hand hygiene: A randomized controlled trial

How to wash hands is as important as when and how often to wash hands for acquiring proper hand hygiene habits. The study aimed to compare the effect of education based on technique or duration for developing children's handwashing skills. The double-blind randomized controlled study was conducted in a primary school between the 10th and 28th of December, 2018 with 155 children who were divided into Group-I, Group-II, and Control groups. One group was taught by a multi-stage technique, the other was by duration-based teaching, and the control group was provided with usual training. Handwashing efficacy was assessed by variance analysis on fluorescent residue after using glo-germ. The students' mean age was 9.74 ± 0.69 years, 53.6% of them were girls. Effective handwashing was highest in the Group-I. There was a difference between Group-I and Group-II, and Group-I and Control group in terms of hand cleanness. The frequently missed areas when cleaning hands were palmar surface, dorsal metacarpal area, and fingertips. Teaching hand hygiene to children by multi-step technique may increase the handwashing effectiveness. Conducting comparative studies with new techniques including fewer stages is recommended.

Impact of hand hygiene intervention on hand washing ability of school-aged children.

Background:To assess the current knowledge related to hand washing and efficiency of intervention on hand washing techniques amongst school children.Methodology:A randomized control trial was conducted amongst class II students of a private school in Korangi, Karachi. Pre-intervention assessment including baseline knowledge and observed practices of hand washing in comparison with World Health Organization (WHO) standard hand washing techniques was done. This was followed by education and demonstration of proper hand washing steps by principal investigator utilizing visual aids. Participants were then randomized into two group: Group A (education only group) and Group B (education along with glow gel application group). First post-intervention assessment was conducted on same day where both groups were observed for the hand washing steps and scored for hand washing technique. In addition, participants of group B were shown germs under Ultraviolet (UV) light. School was revisited after 1 week later and participants were reassessed for their hand washing technique along with cleanliness grade after applying glow gel and observing under UV light. Data was entered and analyzed using SPSS version 21.0.Result:No significant differences were found in median hand washing scores pre-intervention between both the groups (Group A vs B: 4 vs 5, P value = 0.659), while significant improvement in median hand washing scores was seen post intervention in group B as compared to group A (7 vs 6, P value = 0.011). However, no significant differences were seen in median hand washing scores at follow-up between both the groups (Group A vs B: 9 vs 8.5, P value = 0.715) but a significant improvement was observed in both the groups in the hand washing practices from baseline (P-value = 0.000). On the contrary, no significant differences were found in median cleanliness grade between both the groups (Median for both the groups was 5, P value = 0.695).Conclusions:Hand washing education utilizing various aids is an effective method to improve children's hand washing capability. This short-term intervention was effective even in absence of glow gel, but no cleanliness of hands was observed in both the groups.

A pilot project: handwashing educational intervention decreases incidence of respiratory and diarrheal illnesses in a rural Malawi orphanage.

Children who live in orphanages represent a population particularly vulnerable to transmissible diseases. Handwashing interventions have proven efficacy for reducing the rate of transmission of common infectious diseases. Few studies have analyzed the delivery of health interventions for children in orphanages in sub-Saharan Africa. To address this gap, we conducted an ecological assessment and piloted a handwashing intervention in an orphanage in rural Malawi, focusing on caregiver knowledge and behaviors, child handwashing behaviors, and disease incidence. A secondary study aim was to demonstrate program feasibility for a future randomized controlled trial. Orphanage caregivers participated in a three-module educational intervention on handwashing based on WHO recommendations and workshops on how to teach the curriculum to children. Seventeen orphanage caregivers and 65 children were monitored for handwashing behavior and child disease incidence. Friedman's tests were conducted to compare changes in caregiver knowledge and behaviors. Child handwashing behaviors and surveillance of child disease incidence were measured pre- and post-intervention. There were significant increases in caregiver hand hygiene knowledge. At six months post-intervention, handwashing with soap increased significantly among caregivers (p < 0.001) and was observed in children. The incidence of acute respiratory infections decreased from 30% to 6% post-intervention, resulting in an 80% decrease. The incidence of diarrhea decreased from 9.2% to 6.2% post-intervention, resulting in a 33% decrease. A brief educational intervention may improve handwashing knowledge and behaviors and help to decrease the incidence of common infectious diseases in an orphanage in rural Malawi. In addition, the caregiver uptake of the intervention demonstrated feasibility for future studies.

Increasing handwashing in young children: A brief review.

Personal hygiene is critical for preventing the spread of infection. One important component of personal hygiene is handwashing. This review summarizes research on behavioral strategies to address handwashing in children, offers areas for additional research, and suggests a treatment package to teach handwashing to young children.

Child handwashing in an internally displaced persons camp in Northern Iraq: A qualitative multi-method exploration of motivational drivers and other handwashing determinants.

BackgroundChildren in humanitarian situations are particularly vulnerable to diseases such as diarrhoea. Handwashing with soap can greatly reduce transmission but handwashing rates are often low and traditional interventions ineffective. To aid future intervention design, this study aims to understand the determinants of child handwashing and the key motivational drivers of children’s behaviour within a specific humanitarian setting.MethodsIn an internally displaced persons camp in Northern Iraq we conducted a series of 36 friendship-paired interviews with children aged 7–12 years, six semi-structured caregiver interviews, and three semi-structured hygiene promoter interviews. Perceived determinants of child handwashing were explored qualitatively, and motivational drivers were explored quantitatively with children in a rating exercise. Qualitative data were analysed thematically, using an inductive approach, and logistic regression analyses of motive rating data were performed to determine the predicted probabilities of motives being rated as important.ResultsAccess to soap and water was perceived to be high across all participant groups. Children, caregivers and hygiene promoters all perceive the determinants of child handwashing to be associated with familial role, environmental factors pertaining to location and quality of handwashing materials and facilities, and level of exposure to hygiene promotion, and children also attribute their handwashing to social norms. We find that children in this context are motived most by play and nurture.ConclusionsProvision of soap and water alone is not sufficient to encourage children to practice handwashing with soap in a humanitarian context. Our findings suggest that equal consideration should be given to the quality and location of handwashing materials and facilities and social norms could be leveraged to promote and enhance child handwashing. Motive-based interventions targeting play or nurture may be a promising approach and are likely most effective when used in conjunction, along with other motivational drivers such as affiliation and love.

Enteric pathogens from water, hands, surface, soil, drainage ditch, and stream exposure points in a low-income neighborhood of Nairobi, Kenya

Child exposure to fecal-oral pathogens occurs through several transmission pathways. However, the relative importance of different exposure points for pathogen transmission both inside and outside households is not well understood. We conducted a cross-sectional study in the urban slum of Kibera in Nairobi, Kenya, collecting 237 environmental samples from 40 households from source water, stored drinking water, caregiver hands, child hands, household surfaces, soil, standing water, open drainage ditches, and streams. We quantified the fecal indicator Escherichia coli and the enteric pathogens of adenovirus, Campylobacter jejuni, Shigella spp./enteroinvasive E. coli (EIEC), and Vibrio cholerae. At least one enteric pathogens was detected in 13% of household stored water, 47% of hand, 46% of table surface, 26% of plate surface, 75% of floor surface, 96% of soil, 56% of standing water, 77% of drainage ditch, and 100% of stream samples despite all households having access to a toilet or latrine. Our results provide evidence that children may be exposed to enteric pathogens from several exposure points, that domestic hygiene practices related to water treatment and child handwashing were associated with reduced pathogen detection in this setting, but household table and floor cleaning practices were not, that ownership or presence of chickens in the compound was associated with increased detection of C. jejuni inside households and on soil, that there were interactions among different transmission pathways for enteric pathogens, and that there were differential correlations between E. coli and enteric pathogens for different pathogens and environmental sample types. Additionally, V. cholerae was detected at several exposure points during a cholera outbreak. Overall, these results suggest that interventions that can disrupt many transmission pathways may be needed to reduce enteric pathogen exposure in this urban slum setting.