Behaviors, Conditions, and Child Hand Contamination Among Children and Caregivers in Peri-Urban Households in Accra, Ghana Open Access

Abstract

Exposure to fecal pathogens can result in enteric diseases such as diarrhea and soil-transmitted helminth (STH) infection, creating a heavy disease burden particularly among children under five years of age. These diseases can be mitigated by improvements in infrastructure and behaviors that address major enteric pathogen transmission pathways. In poor urban areas, a confluence of transmission pathways appear in the form of overcrowding, poverty, water contamination, and lack of sanitation infrastructure to heighten the risk of exposure. Few studies exist on the link between behaviors and exposure to fecal pathogens, particularly in low-income urban or peri-urban environments and among children under five years of age, the population most vulnerable to enteric diseases and their health repercussions. This study quantified observed behaviors of children under five years of age and their caregivers in Accra, Ghana and assessed their relationship with household conditions and child hand contamination. We observed numerous opportunities for fecal hand contamination, which were rarely intercepted by hygiene behaviors, signaling frequent contamination risks in the household environment. We found a weak association between the frequency of child bathing events and enterococci concentration on children's hands, suggesting that increasing child bathing could be investigated as a way to decrease child hand contamination. We also found a severe lack of sanitation and hygiene infrastructure, which could be a major barrier to improving hygiene behaviors and decreasing exposures to fecal contamination in urban and peri-urban households.

Table of Contents

Introduction. 1

Methods. 5

Background. 5

Ethics. 6

Study design and enrollment. 6

Structured observation. 8

Household conditions survey. 9

Microbiological data. 9

Measurements. 10

Analysis. 12

Results. 13

Demographics. 13

Reported defecation behaviors. 15

Observed caregiver behaviors. 15

Observed child behaviors. 16

Child locations. 18

Caregiver and child behaviors by demographic characteristics. 19

E. coli and enterococci child hand contamination. 19

Child hand contamination, hygiene behaviors, and household conditions. 20

Discussion. 20

Strengths and limitations. 23

Conclusion. 24

Tables and figures. 26

References. 35

About this Master's Thesis

Rights statement

• Permission granted by the author to include this thesis or dissertation in this repository. All rights reserved by the author. Please contact the author for information regarding the reproduction and use of this thesis or dissertation.

School	Rollins School of Public Health
Department	Epidemiology
Subfield / Discipline	Global Epidemiology - MPH & MSPH
Degree	MPH
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Public Health Health Sciences, Epidemiology
Keyword	Household Environment Urban Hygiene Behavior Fecal Pathogen Contamination
Committee Chair / Thesis Advisor	Freeman, Matthew, Emory University
Partnering Agencies	Emory University schools, faculty or affiliated programs

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