Date Published: April 28, 2019
Publisher: The American Society of Tropical Medicine and Hygiene
Author(s): Francis Ngure, Aulo Gelli, Elodie Becquey, Rasmané Ganaba, Derek Headey, Lieven Huybregts, Abdoulaye Pedehombga, Armande Sanou, Abdoulaye Traore, Florence Zongo, Amanda Zongrone.
Livestock farming is common in low-income settings as a source of income and animal-sourced food. However, there is growing evidence of the harmful health effects of proximity of animals to infants and young children, especially through exposure to zoonotic pathogens. Poultry ownership is almost universal in rural Burkina Faso. Poultry feces are a significant risk factor for enteric diseases that are associated with child undernutrition. To investigate the extent of exposure to livestock feces among young children and caregivers, we conducted direct observations of 20 caregiver–child dyads for a total of 80 hours (4 hours per dyad) and recorded water quality, sanitation, and hygiene (WASH)-related behaviors. We also undertook in-depth interviews with these caregivers and focus group discussions with separate groups of men and women who were poultry farmers. Poultry and other livestock feces were visible in all 20 and 19 households, respectively, in both kitchen areas and in the household courtyards where children frequently sit or crawl. Direct soil ingestion by young children was observed in almost half of the households (45%). Poor handwashing practices were also common among caregivers and children. Although latrines were available in almost all households, child feces disposal practices were inadequate. This body of research suggests an urgent need to adapt conventional WASH and livestock interventions to reduce the exposure of infants and young children to livestock feces.
Poor water quality, sanitation, and hygiene (WASH) conditions cause recurrent childhood infections such as diarrheal infections, soil transmitted helminthes, and trachoma. Some studies have found that diarrheal infections could increase the susceptibility to pneumonia.1–3 Diarrhea and pneumonia are among the leading causes of mortality in children aged less than 5 years in low- and middle-income contexts.4 Poor WASH conditions are also associated with child undernutrition, primarily through enteric infections.2,5 Cohort studies link stunting, a chronic and resilient form of undernutrition, to repeated childhood infections such as diarrhea.6 Besides causing diarrhea, recurrent fecal pathogen exposure is thought to contribute to a subclinical condition, environmental enteric dysfunction (EED),7 characterized by chronic inflammation of the small intestinal lining, a permeable gut, and subsequent immune system stimulation, and malabsorption of nutrients.
This mixed methods study presents a consistent picture of poor hygiene, particularly with regard to contamination of the immediate living environment with animal feces, poor child feces disposal, and handwashing practices. Poor animal husbandry practices present a pervasive health risk to vulnerable young children in the study area in rural Burkina Faso, especially in the context of poor general hygiene. Domestic animals were observed roaming freely in most of the households and chicken feces were observed in the kitchen areas and courtyards of all 20 households. Moreover, although all households reported access to a toilet, and human feces were not observed within children’s reach, poor disposal of children’s feces was common and presents an additional source of fecal contamination. Handwashing practices were also poor, and many mothers’ and children’s hands were visibly dirty. Respondents were generally aware of the health risks of poor hygiene, but this awareness did not translate into better hygiene practices.
Livestock husbandry, handwashing, and child feces disposal practices remain inadequate and provide immense opportunity for behavior change and technological approaches to reduce health risks among children and caregivers in the study context. Child-sensitive WASH practices are underemphasized in conventional WASH interventions, as are the problems of fecal contamination by livestock. Innovative interventions to address the gaps in conventional WASH could be critical to breaking fecal–oral pathways such as direct ingestion of contaminated soil.