Exposure to animals, animal feces, and animal feces-contaminated environments for children under two years in households that own animals in Northwestern Ecuador: a qualitative research study Restricted; Files Only

Abstract

Low- and middle-income countries (LMICs) in South America, such as Ecuador, are estimated to have a high burden of child mortality from adverse health outcomes. Studies suggest that these negative health outcomes are occurring from child exposure to animal and animal feces. Existing research does not adequately explain if, how, to what extent, and what conditions children are exposed to animals and animal feces in households that own domesticated animals in Northwestern Ecuador.

Go-along in-depth interviews (IDIs) and a survey were utilized to explore exposure to animals, animal feces, and fecal contaminated environments among children under 2 years of age, as well as interpersonal dynamics and influences of exposure in households that own animals. From February to April 2021, 32 IDIs and surveys were conducted in Spanish with mothers ages 19-47 years old along an urban-rural gradient. IDIs were completed with mothers of children ages 10-18 months old to gain insight on the following topics of interest: exposure inside the household, exposure outside but near the household, and exposure at non-household locations.

Participants discussed exposure to animals and animal feces occurring inside the house, outside as well as near the household and even at non-household locations. These non-household locations included relatives, businesses, and neighbor’s houses. The exposure to owned and stray domestic animals varied depending on locations, with most exposure occurring with domestic animals and feces being from cats, dogs, and creole chickens. Many participants revealed that interpersonal dynamics with family members, household characteristics, and their own behaviors influenced child exposure to animals, animal feces, and fecal contaminated environments. The participants also reported child exposure occurring across the urban-rural gradient in Northwestern Ecuador, which seemed to vary.

The findings of this study help explain child exposure to animals and animal feces occurring inside households, outside but near households, and at non-household locations. The findings of this study can be used to inform a quantitative survey to better characterize child exposure risk to animals and their feces in Northwestern Ecuador as well as inform future interventions how to effectively decrease exposure to pathogens from animals in Ecuador. 

Table of Contents

Chapter 1: Introduction 1

Problem Statement 3

Purpose Statement 4

Research Objective 4

Significance Statement 6

Chapter 2: Literature Review 7

Introduction 7

One Health Model and Zoonotic Disease Transmission 7

Limitations of Current WASH Interventions 10

Exposure to Animals and Animal Feces in LMICs 13

Caregiver and Child Behavior/Play Practices with Animals in Household in LMICs 15

Impacts of Child Exposure to Animals and Animals Feces in LMICs 17

Child Exposure to Animals and Animal Feces in Ecuador 20

Conclusion 21

Chapter 3: Manuscript 22

Abstract 22

Introduction 24

Methods 27

Study Design 27

Study Setting 27

In-Depth Interviews 28

Sampling 29

Data collection 30

Data analysis 31

Ethics 32

Results 33

Exposure Inside the House 33

Exposure Outside the House in Household Compound 40

Exposure in Other Households and/or Space Away from Household 47

Discussion 52

Limitations and Strengths 54

Chapter 4: Conclusions and Implications 56

References 57

Appendix 68

Table 1: Domestic Animals Owned in each Household of Child 68

Table 2: Demographic and Household Characteristics 69 

About this Master's Thesis

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School	Rollins School of Public Health
Department	Hubert Department of Global Health
Degree	M.P.H.
Submission	Master's Thesis
Language	English
Research Field	Environmental Health Health Sciences, Public Health
Keyword	animal feces animal fecal-contaminated environments fomites urban-rural gradient child floor play Northwestern Ecuador mothers WASH animals children under two years of age
Committee Chair / Thesis Advisor	Bethany Caruso, Emory University
Committee Members	April Ballard, Emory University

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