Ingestion Of Feces Research Articles

Faeces of Capybara (Hydrochoerus hydrochaeris) as a Bioindicator of Contamination in Urban Environments in Central-West Brazil

Along with exposure to parasites and other biological disease vectors, animal faeces can also contain heavy metals and metalloids. We quantified metals, metalloids, and non-metals in the faeces of capybara (Hydrochoerus hydrochaeris) that live in parks in the city of Campo Grande (Brazil). Quantification of metalloids was obtained after acid digestion using an inductively coupled plasma optical emission spectrometer. Higher mean concentrations in mg/kg of aluminium (Al) (140.322), arsenic (As) (0.010), cadmium (Cd) (1.042), chromium (Cr) (26.866), cobalt (Co) (1.946), copper (Cu) (50.764), lead (Pb) (8.762), manganese (Mn) (291.469), molybdenum (Mo) (3.634), nickel (Ni) (5.475), and zinc (Zn) (100.027) were quantified in samples of faeces of capybara that live on the banks of a lagoon that receives input from streams that cross the city. According to the risk assessment, potential risks to the health of children and adults may occur due to the presence of Al, As, Cd, Co, Cu, and Mn through involuntary oral ingestion of faeces, via inhalation and dermal contact. The hazard index (HI) due to oral ingestion was greater than 1 for children and adults. Therefore, we believe that faeces of H. hydrochaeris can be considered as a bioindicator of environmental pollution in urban parks.

Coprophagia in early life tunes expression of immune genes after weaning in rabbit ileum

Coprophagia by suckling rabbits, i.e. ingestion of feces from their mother, reduces mortality after weaning. We hypothesized that this beneficial effect of coprophagia is immune-mediated at the intestinal level. Therefore, this study investigated immune development after weaning by analyzing the ileal transcriptome at day 35 and 49 in rabbits with differential access to coprophagia in early life. Rabbit pups had access between day 1 and 15 to (i) no feces (NF) or (ii) feces from unrelated does (Foreign Feces, FF) or (iii) feces from unrelated does treated with antibiotics (FFab). 350 genes were differentially expressed between day 35 and day 49 in suckling rabbits with access to coprophagia. These genes coded for antimicrobial peptides, a mucin, cytokines and chemokines, pattern recognition receptors, proteins involved in immunoglobulin A secretion and in interferon signaling pathway. Strikingly, prevention of coprophagia or access to feces from antibiotic-treated does in early life blunted immune development between day 35 et 49 in the ileum of rabbits. Thus, coprophagia might be crucial for the maturation of intestinal immunity in rabbits and could explain why this behavior improves survival.

First serological and molecular investigation of hepatitis E virus infection in dromedary camels in Algeria.

Hepatitis E is an acute self-limited or fulminant infection in humans, caused by the hepatitis E virus (HEV). This member of the Hepeviridae family has been identified in a wide range of domestic and wild animals all over the world, with a possible transmission to humans through fecal oral route, direct contact and ingestion of contaminated meat products, making it one of the global zoonotic and public health major concerns. Since there is no monitoring program and a lack of data on HEV in animals in Algeria, the current preliminary survey has been undertaken to elucidate the exposure to the virus in camels at abattoirs of six southern provinces of Algeria. Two-hundred and eight sera/plasma were collected and analyzed (by double antigen sandwich ELISA) for the presence of total anti-HEV antibodies, among which 35.1% were positive, but no HEV RNA could be isolated from them (by two pan-HEV nested RT-PCR and broad range real-time reverse transcription RT-PCR). The univariate analysis showed significant associations (p < 0.05) between HEV seroprevalence and province of origin, age, and sex of camels, whereas the multivariable logistic regression analysis revealed a negative impact of camels' age on it. The obtained results confirm that HEV infection is widespread established in the camelid population of Algeria.

Coprophagy rapidly matures juvenile gut microbiota in a precocial bird.

Coprophagy is a behavior where animals consume feces, and has been observed across a wide range of species, including birds and mammals. The phenomenon is particularly prevalent in juveniles, but the reasons for this remain unclear. One hypothesis is that coprophagy enables offspring to acquire beneficial gut microbes that aid development. However, despite the potential importance of this behavior, studies investigating the effects in juveniles are rare. Here we experimentally test this idea by examining how ingestion of adult feces by ostrich chicks affects their gut microbiota development, growth, feeding behavior, pathogen abundance, and mortality. We conducted extensive longitudinal experiments for 8 weeks, repeated over 2 years. It involved 240 chicks, of which 128 were provided daily access to fresh fecal material from adults and 112 were simultaneously given a control treatment. Repeated measures, behavioral observations, and DNA metabarcoding of the microbial gut community, both prior to and over the course of the experiment, allowed us to evaluate multiple aspects of the behavior. The results show that coprophagy causes (a) marked shifts to the juvenile gut microbiota, including a major increase in diversity and rapid maturation of the microbial composition, (b) higher growth rates (fecal-supplemented chicks became 9.4% heavier at 8 weeks old), (c) changes to overall feeding behavior but no differences in feed intake, (d) lower abundance of a common gut pathogen (Clostridium colinum), and (e) lower mortality associated with gut disease. Together, our results suggest that the behavior of coprophagy in juveniles is highly beneficial and may have evolved to accelerate the development of gut microbiota.

Stool culture &amp; sensitivity for vibrio cholera in acute out break of diarrhea

Background: Acute watery diarrhea is a common clinical entity encountered daily in emergency department worldwide. In adults more than 90% of cases of acute diarrhea are caused by infectious agents spread by ingestion of feces contaminated food and water. Objective: To assess the stool Culture &amp; Sensitivity for Vibrio Cholera in Acute Out Break of Diarrhea. Methodology: This study was prospective cohort study targeting all acute bacterial diarrhea cases in patients of either sex and all ages attending the emergency department of Qazi Hussain Ahmed Medical Complex, Nowshera Pakistan. The overall sample size was 86 on the basis of WHO sample size calculator. Culture and sensitivity was done for all the isolates of Vibrio cholera. All the data was documented in a special designed proforma and then analyzed by SPSS version 24. Results: In the current study, totally 86 patients were enrolled. There were 50 (58.14%) males and 36 (41.86%) females’ patients in our study. Based on identification, 11 (12.79%) samples were positive for vibrio cholera while 3 (3.49%) samples were positive for Salmonella typhi. Ampicillin was susceptible to 2 (18.18%) isolates while 3 (27.27%) isolates were resistant to ampicillin.

Evaluating the Role of Corrals and Insects in the Transmission of Porcine Cysticercosis: A Cohort Study.

The widespread dispersion of pigs infected with cysticercosis across endemic villages, low cyst burden among infected pigs, and low prevalence of taeniasis all suggest that pig ingestion of human feces is not the only mode of transmission for Taenia solium. Our objective was to evaluate the risk of porcine cysticercosis associated with exposure to human feces, dung beetles, and flies in an endemic community setting. We used a cluster-randomized cohort design to compare the risk of developing antibodies and infection among 120 piglets raised in either free-roaming (FR), standard corral (SC), or netted corral environments (NC). We collected monthly blood samples to detect serum antibodies and necropsied all pigs after 10 months to identify cysts. A total of 66 piglets developed antibodies with the relative risk of seropositivity in FR vs. all corralled pigs increasing significantly after 18 weeks. Of 108 necropsied pigs, 15 had T. solium cysts, all belonging to the FR group. Corrals were protective against infection but less so against seropositivity. NC, which did not completely exclude insects, did not provide added protection against seropositivity as compared to SC. The results of this study suggest that dung beetles and flies do not play an important role in infection.

Copepod Feeding Responses to Changes in Coccolithophore Size and Carbon Content

Phytoplankton stoichiometry and cell size could result from both phenology and environmental change. Zooplankton graze on primary producers, and this drives both the balance of the ecosystem and the biogeochemical cycles. In this study, we performed incubations with copepods and coccolithophores including different prey sizes and particulate carbon contents by considering phytoplankton biovolume concentration instead of chlorophyll a level (Chl a) as is usually performed in such studies. The egestion of fecal pellet and ingestion rates were estimated based on a gut fluorescence method. The latter was calibrated through the relationship between prey Chl a level and the biovolume of the cell. Chl a/biovolume ratio in phytopkanton has to be considered in the copepod gut fluorescent content method. Both coccolithophore biovolume and particulate inorganic/organic carbon ratios affect the food foraging by copepods. Finally, we observed a non-linear relationship between ingestion rates and fecal pellet egestion, due to the presence of calcite inside the copepod’s gut. These results illustrate that both prey size and stoichiometry need to be considered in copepod feeding dynamics, specifically regarding the process leading to the formation of fecal pellets.

Cysticercosis of Cheek - A Rare Site

Cysticercosis caused by Taenia solium is a helminthic infection. It usually resides in animals and humans to complete its life cycle and cause the disease within it. Cysticercosis in humans is acquired by ingestion of eggs or its larvae form. It is caused due to improper sanitation, fecal ingestion by the pigs which is infected with larvae of cysticercus, improper vaccination of pigs and ingestion of raw or uncooked pork and meat by the humans. Most commonly it involves the brain, heart, liver, muscles, lungs and the peritoneal cavity. When there is involvement of the mouth, frequently occurring sites include the tongue, buccal mucosa and rarely floor of mouth. Likewise, most commonly, the skeletal muscle involvement is noted.&#x0D; It is usually diagnosed by radiological and pathological investigations. Radiologically, USG and MRI characteristically reveals the lesion caused by cysticercosis. Pathologically, the biopsy done of the affected area shows the inhabited cysticercus along with its causative changes in the tissue like edema, congestion and infiltration of Inflammatory infiltrates. Being a parasitic infestation, eosinophilic infiltration around the membrane of cysticercus is commonly noted in the biopsy. This is the presentation of the case report, where there is an occurrence of Cysticercosis in the muscles of cheek, a site with rare occurrence.

Non bulimic shitty meal

IntroductionCoprophagia is a relatively rare phenomenon characterized by the ingestion of feces, and it is usually classified as a rare form of pica. It has been associated with multiple organic causes or mental disorders such as brain tumors, alcoholism, mental retardation, dementia, schizophrenia, depressive disorders or fetishism.ObjectivesCase report and reflection on its etiologyMethodsA Pubmed search was performed with the MeSH terms “Coprophagy” and “pica”. Relevant articles obtained from the respective bibliographic references were also consulted.Results A 56-year-old man with a history of psychiatric follow-up with a diagnosis of schizophrenia and cognitive impairment, assessed for behavioral changes such as cat feces intake. After possible organic causes were excluded, treatment with supportive psychotherapy and pharmacologically began with a selective serotonin reuptake inhibitor, fluoxetine, along with treatment for schizophrenia.ConclusionsAccording to literature, coprophagia often occurs associated with other medical or neuropsychiatric conditions. Although the etiology, pathophysiology and management remains unclear, several pharmacologic treatments have been attempted with some degree of success. We describe a case of unusual behavior, coprophagia, associated with cognitive impairment and schizophrenia that responded favorably to fluoxetine although without complete remission, in order to contribute to a future nosological redefinition.DisclosureNo significant relationships.

Molecular Detection of Norwalk Virus in Carp Fish and Shrimp Ponds in Khuzestan Province, Iran by RT-PCR Method

Background: Norwalk virus is one of the most common causes of viral gastroenteritis. The aquatic products are potential sources of contamination with this virus. Objectives: The main objective of the study was to investigate the presence of the Norwalk virus in different aquatic animals in Khuzestan provinces, Iran. Materials and Methods: A total of 40 pieces of fish (silver carp, common carp, big head, and grass carp species) and 10 pieces of shrimps were caught from ponds, and the samples were transferred to the laboratory in ice bags. After the separation of the intestine, the content of the intestine was extracted using two sterile filters. Then, the supernatant was used for reverse transcription polymerase chain reaction (RT-PCR) using Calicivirus-specific primers (p289/ p290). Then, Norwalk virus-specific primers (NVp36/NVp35) were detected in Calicivirus positive samples. Results: The results showed 8% (4 samples) and 6% (3 samples) of the samples were infected with Calicivirus (p289/p290 genes) and Norwalk virus (NVp36/NVp35 genes), respectively. Calicivirus positive samples included 2 common carp, 1 silver carp, and 1 shrimp. Norwalk virus-positive samples included 2 common carp and 1 shrimp. In other words, the highest prevalence of virus was observed in aquatic fish feeding from the bottom of the pool. Due to the fact that this species is bred with other species and considering that this virus lives in the gastrointestinal tract, the ingestion of feces of other infected organisms can lead to the increase of this virus in the digestive system of carp. Conclusion: Therefore, due to the importance of Norwalk as a zoonotic agent and the possibility of human infection through consumption of aquatic products, preventive measures such as not using animal manure for fertilization and preventing the growth of phytoplankton in aquaculture ponds and cooking meat properly are suggested.

Impact of Plastic Debris on the Gut Microbiota of Caretta caretta From Northwestern Adriatic Sea

Plastic pollution is nowadays a relevant threat for the ecological balance in marine ecosystems. Small plastic debris (PD) can enter food webs through various marine organisms, with possible consequences on their physiology and health. The loggerhead sea turtle (Caretta caretta), widespread across the whole Mediterranean Sea, is a “flagship species,” useful as indicator of the general pollution level of marine ecosystems. Ingested PD accumulate in the final section of turtles’ digestive tract before excretion. During their transit and accumulation, PD also interact with the residing microbial community, with possible feedback consequences on the host’s health. To explore the possible relationship between fecal microbial composition and PD ingestion, we collected fecal samples from 45 turtles rescued between 2017 and 2019 in the Northwestern Adriatic Sea (Italy), assessing occurrence and content of PD in the samples and in parallel the microbiome structure by 16S rRNA gene sequencing. According to our findings, almost all samples contained PD, mirroring the high level of plastic pollution in the area. We identified phylotypes associated to a high amount of PD, namelyCetobacterium someraeand other taxa, possibly responding to contamination by plastic-associated chemicals. Furthermore, putative marine pathogens were found associated to higher plastic contamination, supporting the hypothesis that PD can act as a carrier for environmental pathogenic bacteria into marine organisms. Besides confirming the role of the sea turtle as relevant flagship species for plastic pollution of the marine environment, our study paves the way to the exploration of the impact that PD ingestion can have on the microbial counterpart of large marine organisms, with potential feedback consequences on the animal and ecosystem health.

Exploring the Use and Appeal of Playpens to Protect Infants from Exposure to Animals, Animal Feces, and Dirt in Rural Ethiopia.

.The persistence and pervasiveness of growth stunting in low- and middle-income countries spur reexamination of disease transmission pathways related to water, sanitation, and hygiene. Animal feces constitute a more important reservoir of enteric pathogens in homes in low-income countries than previously recognized, and exploratory object mouthing and direct ingestion of soil and animal feces represent underexplored exposure pathways. The effectiveness, adoption, constraints, and scale-up potential of measures for reducing infant and young children’s exposure to fecal pathogens are recently beginning to be systematically explored. This mixed methods study tested the feasibility and appeal of using playpens to establish a hygienic “safe zone” for infants in rural Ethiopia. We conducted home trials of three playpen designs, including two models made from locally available materials through user-centered design. After using playpens for several weeks, caregivers reported extensive benefits, ranging from perceived safety to developmental and hygiene benefits for infants and relief from physical stress and worry for caregivers. We observed many playpens contaminated with Escherichia coli after weeks of use, though at concentrations below those of the common room floor on which infants might otherwise have played. Caregivers reported daily playpen use, but for intervals likely insufficient to protect infants from pathogen exposure affecting growth. We determine that playpens alone cannot plausibly protect infants from environmental contamination, but our results support further exploration of the potential benefits and commercial viability of scaling up use of playpens in rural, agricultural households as part of a comprehensive approach to child development and women’s empowerment.

Mytilus edulis and Styela clava assimilate picophytoplankton carbon through feces and pseudofeces ingestion

Picophytoplankton (PPP) may contribute to the bulk of primary production in nutrient-rich marine ecosystems. In this study, we quantified the capacity of blue mussels (Mytilus edulis) and clubbed tunicates (Styela clava) to exploit PPP. In the water, we introduced PPP cells that were isotopically labelled with 13C and using the same enrichment approach, we measured the secondary transfer (recycling) of carbon via the assimilation of pseudofeces and feces. Results show that both M. edulis and S. clava assimilate PPP carbon by ingesting PPP cells directly from water. In addition, PPP assimilation rates were similar in both species. Most interesting was our observation that both species assimilated PPP carbon contained in pseudofeces and feces, including large fecal pellets produced by S. clava. We conclude that within cultured and invasive filter feeders, PPP carbon is recycled via ingestion of feces and pseudofeces among individuals growing in close proximity. In aquaculture settings, cultured bivalves and fouling tunicates may provide an ecological service by removing excess PPP in nutrient-rich systems via direct and secondary ingestion.

Effect of different feeding regimes on cecotrophy behavior and retention of solute and particle markers in the digestive tract of paca (Cuniculus paca)

Many small herbivores practice cecotrophy - the ingestion of special feces enriched in microbial protein by colonic separation mechanisms (CSM). In digesta passage experiments, secondary marker excretion peaks in feces are considered indicative of marker-reingestion via cecotrophy, but corroboration by behavioral observation was lacking so far. The paca (Cuniculus paca), a Neotropical hystricomorph rodent, produces two different kinds of feces (hard and soft) and practices cecotrophy either directly (from the anus) or indirectly (from a pile of defecated feces, mostly when hard and soft feces are defecated together). To investigate effects of diet on cecotrophy, we monitored cecotrophy behavior and digesta passage marker excretion of solute and particle markers in four adult pacas, at constant food intake, on four diets varying in protein and fiber content. Marker excretion patterns suggested a ‘mucus-trap’ CSM typical for hystricomorph rodents, and showed secondary peaks of a similar time lag after cecotrophy as the primary marker peak after marker feeding. However, not every cecotrophy event was followed by a secondary marker peak. On higher fiber/lower protein diets, the number of cecotrophy bouts, the duration of cecotrophy, the number of secondary marker peaks and the difference between solute and particle marker retention increased, whereas the proportion of indirect cecotrophy decreased, indicating a higher degree of digesta phase separation on these diets. Compared to hard feces, soft feces were particularly enriched in solute marker concentration. Cecotrophy depends on a CSM that varies in its efficiency with the nutrient composition of the diet.

Dialium seed coprophagy in wild western gorillas: Multiple nutritional benefits and toxicity reduction hypotheses.

Unraveling the relationship between the unusual feeding behaviors and the nutritional intake of endangered species may provide crucial information for understanding species response to habitat unpredictable changes. Primates occasionally re-ingest fruit seeds alongside ingestion of feces, a behavior called coprophagy. The nutritional benefit is one of the several non-mutual exclusive hypotheses proposed to explain this behavior. We investigated the ecological correlates of coprophagy in wild western gorillas. We tested whether coprophagy occurred during periods of lower fruit availability and whether it led to higher nutrient intake in comparison to the other food. Data integrated phenological, fecal and nutritional analyses of gorilla food with behavioral observations collected at two sites in Central Africa (Mbeli Bai: ad libitum observations on 15 groups/solitary males, October 2002-November 2005; Bai Hokou: 5-min scan on a habituated group, December 2004-December 2005). Coprophagy occurred at the end of the high-fruiting season in association of two Dialium species. Coprophagy correlated positively with the occurrence of Dialium spp. fruit in gorilla feces and in the feeding scans, and showed a positive trend with Dialium availability but not with total fruit availability. Nutritional comparison of Dialium seeds with other important gorilla food showed higher fat and mineral content, particularly of Mg, but also of phenols and tannins in Dialium seeds. We discuss how the effect of gut processing and gut heat via coprophagy may act as cooking-like effect: increasing the ability to maximize nutrient intake by concurrently softening fibers and decreasing the toxic effect of antifeedants, like in human traditional cooking. Our results support both the multiple nutritional benefit hypothesis and the toxicity reduction hypothesis. Since Dialium is precious timber, the importance of this tree for the critically endangered western gorillas should be taken with high consideration when planning controlled logging of degraded forests or in face of habitat changes.

Characterizing Potential Risks of Fecal–Oral Microbial Transmission for Infants and Young Children in Rural Zambia

Undernourished children in low-income contexts often suffer from environmental enteric disorder-damage to the intestines probably caused by chronic exposure to bacterial pathogens from feces. We aimed to identify strategies for reducing infants and young children's (IYC) exposure to human and animal feces in rural farming families by conducting direct observation of 30 caregiver-infant dyads for 143 hours and recording water, sanitation, and hygiene (WASH)-related behaviors to identify possible pathways of fecal-oral transmission of bacteria among IYC in rural Zambia. In addition to mouthing visibly dirty hands, toys, sibling's body parts, and food, 14 IYC actively ingested 6.1 ± 2.5 (mean ± standard deviation [SD]) pieces of soil and stones and one ingested animal feces 6.0 ± 0 times in the span of 5 hours. Ninety-three percent (21 of 30) of mothers reported observing the index-child eating soil and 17% (5 of 30) of mothers reported observing the index-child eating chicken feces. Adult and child handwashing was uncommon, and even though 70% (28 of 30) of households had access to a latrine, human feces were found in 67% of homestead yards. Most animals present in the household were un-corralled, and the highest observable counts of feces came from chickens, pigs, and cattle. To protect IYC in low-income communities from the exploratory ingestion of feces and soil, Baby WASH interventions will need to interrupt fecal-oral microbial transmission vectors specific to IYC with a focus on feasibility, caregiver practices, and local perceptions of risk.

An audit of Cryptosporidium and Giardia detection in Scottish National Health Service Diagnostic Microbiology Laboratories.

Giardia duodenalis and Cryptosporidium species are protozoan parasites capable of causing gastrointestinal disease in humans and animals through the ingestion of infective faeces. Whereas Cryptosporidium species can be acquired locally or through foreign travel, there is the mis-conception that giardiasis is considered to be largely travel-associated, which results in differences in laboratory testing algorithms. In order to determine the level of variation in testing criteria and detection methods between diagnostic laboratories for both pathogens across Scotland, an audit was performed. Twenty Scottish diagnostic microbiology laboratories were invited to participate with questions on sample acceptance criteria, testing methods, testing rates and future plans for pathogen detection. Reponses were received from 19 of the 20 laboratories representing each of the 14 territorial Health Boards. Detection methods varied between laboratories with the majority performing microscopy, one using a lateral flow immunochromatographic antigen assay, another using a manually washed plate-based enzyme immunoassay (EIA) and one laboratory trialling a plate-based EIA automated with an EIA plate washer. Whereas all laboratories except one screened every stool for Cryptosporidium species, an important finding was that significant variation in the testing algorithm for detecting Giardia was noted with only four laboratories testing all diagnostic stools. The most common criteria were 'travel history' (11 laboratories) and/or 'when requested' (14 laboratories). Despite only a small proportion of stools being examined in 15 laboratories for Giardia (2%-18% of the total number of stools submitted), of interest is the finding that a higher positivity rate was observed for Giardia than Cryptosporidium in 10 of these 15 laboratories. These findings highlight that the underreporting of Giardia in Scotland is likely based on current selection and testing algorithms.

Water choice as a counterstrategy to faecally transmitted disease: an experimental study in captive lemurs

Abstract Many parasites and pathogens are transmitted via water, including through faecal contamination of water sources. Yet water is essential for survival, and some species gain nutritional and other benefits from coprophagy. We investigated how primates balance the risks of faecal pathogen transmission with potential benefits of faeces ingestion in their selection of water sources by conducting behavioural experiments with five species of lemurs (Family Lemuridae) in captivity. Subjects were given a choice between clean water and water ‘contaminated’ with disinfected faecal material, which contained cues associated with faecally transmitted parasites, but minimal risk. We found that lemurs exhibited strong preferences for the clean water. This pattern was supported even at low levels of faecal contamination and in species adapted to water-limited habitats, for which choosiness about water quality could present a dehydration risk. Our results strongly support the hypothesis that avoiding faecal contamination is important in water selection.

The Sanitation Hygiene Infant Nutrition Efficacy (SHINE) Trial: Rationale, Design, and Methods.

Child stunting and anemia are intractable public health problems in developing countries and have profound short- and long-term consequences. The Sanitation Hygiene Infant Nutrition Efficacy (SHINE) trial is motivated by the premise that environmental enteric dysfunction (EED) is a major underlying cause of both stunting and anemia, that chronic inflammation is the central characteristic of EED mediating these adverse effects, and that EED is primarily caused by high fecal ingestion due to living in conditions of poor water, sanitation, and hygiene (WASH). SHINE is a proof-of-concept, 2 × 2 factorial, cluster-randomized, community-based trial in 2 rural districts of Zimbabwe that will test the independent and combined effects of protecting babies from fecal ingestion (factor 1, operationalized through a WASH intervention) and optimizing nutritional adequacy of infant diet (factor 2, operationalized through an infant and young child feeding [IYCF] intervention) on length and hemoglobin at 18 months of age. Within SHINE we will measure 2 causal pathways. The program impact pathway comprises the series of processes and behaviors linking implementation of the interventions with the 2 child health primary outcomes; it will be modeled using measures of fidelity of intervention delivery and household uptake of promoted behaviors and practices. We will also measure a range of household and individual characteristics, social interactions, and maternal capabilities for childcare, which we hypothesize will explain heterogeneity along these pathways. The biomedical pathway comprises the infant biologic responses to the WASH and IYCF interventions that ultimately result in attained stature and hemoglobin concentration at 18 months of age; it will be elucidated by measuring biomarkers of intestinal structure and function (inflammation, regeneration, absorption, and permeability); microbial translocation; systemic inflammation; and hormonal determinants of growth and anemia among a subgroup of infants enrolled in an EED substudy. This article describes the rationale, design, and methods underlying the SHINE trial.Clinical Trials Registration. NCT01824940.

Hand-to-mouth contacts result in greater ingestion of feces than dietary water consumption in Tanzania: a quantitative fecal exposure assessment model.

Diarrheal diseases kill 1800 children under the age of five die each day, and nearly half of these deaths occur in sub-Saharan Africa. Contaminated drinking water and hands are two important environmental transmission routes of diarrhea-causing pathogens to young children in low-income countries. The objective of this research is to evaluate the relative contribution of these two major exposure pathways in a low-income country setting. A Monte Carlo simulation was used to model the amount of human feces ingested by children under five years old from exposure via hand-to-mouth contacts and stored drinking water ingestion in Bagamoyo, Tanzania. Child specific exposure data were obtained from the USEPA 2011 Exposure Factors Handbook, and fecal contamination was estimated using hand rinse and stored water fecal indicator bacteria concentrations from over 1200 Tanzanian households. The model outcome is a distribution of a child's daily dose of feces via each exposure route. The model results show that Tanzanian children ingest a significantly greater amount of feces each day from hand-to-mouth contacts than from drinking water, which may help elucidate why interventions focused on water without also addressing hygiene often see little to no effect on reported incidence of diarrhea.