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Microbiological contamination of young children’s hands in rural Bangladesh: Associations with child age and observed hand cleanliness as proxy


Autoři: Sarker Masud Parvez aff001;  Rashidul Azad aff001;  Amy J. Pickering aff002;  Laura H. Kwong aff003;  Benjamin F. Arnold aff004;  Musarrat Jabeen Rahman aff001;  Md. Zahidur Rahman aff001;  Mahfuja Alam aff001;  Debashis Sen aff001;  Sharmin Islam aff001;  Mahbubur Rahman aff001;  John M. Colford, Jr. aff004;  Stephen P. Luby aff003;  Leanne Unicomb aff001;  Ayse Ercumen aff004
Působiště autorů: International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh aff001;  School of Engineering, Tufts University, Medford, MA, United States of America aff002;  Stanford University, Stanford, CA, United States of America aff003;  Division of Epidemiology and Biostatistics, School of Public Health, University of California, Berkeley, CA, United States of America aff004;  North Carolina State University, Raleigh, NC, United States of America aff005
Vyšlo v časopise: PLoS ONE 14(9)
Kategorie: Research Article
doi: https://doi.org/10.1371/journal.pone.0222355

Souhrn

Background

Hands are a route of transmission for fecal-oral pathogens. This analysis aimed to assess associations between hand E. coli contamination and child age and determine if observed hand cleanliness can serve as a proxy for E. coli contamination on young children’s hands.

Methods

Trained field workers collected hand rinse samples from children aged 1–14 months in 584 households in rural Bangladesh and assessed the visual cleanliness of child hands (fingernails, finger pads and palms). Samples were analyzed using the IDEXX most probable number (MPN) methodto enumerate E. coli. We assessed if child age (immobile children aged 1–4 months vs. mobile children aged 5–14 months) is associated with log10 E. coli counts on hands using generalized estimating equations (GEE). We estimated the log10 difference in hand E. coli counts associated with the cleanliness of different hand parts using a multivariable GEE model.We calculated the sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) for dirty fingernails, fingerpads, palms and overall hands (the three observed parts combined) against binary E. coli presence on hands.

Results

E. coli was detected on 43% of child hands. Children in the mobile age range had 0.17 log10 MPN higher E. coli on hands than those in the immobile age range (Δlog10 = 0.17, 95% CI = 0.02, 0.32, p = 0.03). Children with visible dirt particles on finger pads had 0.46 log10 MPN higher E. coli on hands than those with clean finger pads (Δlog10 = 0.46, 95% CI = 0.05, 0.87, p = 0.03). Dirty fingernails indicated binary E. coli presence with 81% sensitivity and 26% specificity while dirty fingerpads and palms indicated E. coli presence with 29% sensitivity and 75–77% specificity. The PPV was 45–48% and NPV 59–65% for all three types of observations.

Conclusion

Hand contamination with E. coli was prevalent among young children in rural Bangladesh, with higher levels of contamination among mobile children. Studies should assess if strategies to remove animal feces from the courtyard, provide designated hygienic play spaces for children and deliver targeted messaging to mothers to wipe or wash children’s hands after contact with animals and animal feces reduce child hand contamination. Visible hand cleanliness was a poor predictor of E. coli presence on young children’s hands so other low-cost field measurements are needed to accurately detect fecal contamination on hands.

Klíčová slova:

Biology and life sciences – Anatomy – Musculoskeletal system – Body limbs – Fingers – Microbiology – Medical microbiology – Microbial pathogens – Bacterial pathogens – Organisms – Eukaryota – Animals – Animal types – Domestic animals – Zoology – Medicine and health sciences – Arms – Health care – Environmental health – Sanitation – Public and occupational health – Hygiene – Pathology and laboratory medicine – Pathogens – People and places – Population groupings – Age groups – Children – Families – Geographical locations – Asia – Bangladesh


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