Handwashing (HW) with soap is considered the most cost-effective intervention for reducing the risk of child diarrhea, but reliable measurement of HW behaviors is difficult. This study examined the association between proxy HW measures and child diarrhea by analyzing nationally representative household survey data from 25 countries in sub-Saharan Africa (n = 212,492). The main explanatory variable was the HW ladder, representing a varying level of availability of HW materials in the household, and the outcome variable was a 2-week prevalence of child diarrhea. We estimated the prevalence ratio of child diarrhea between children with a basic HW station and without a HW place. Our analysis revealed that availability of water and soap at a HW place was associated with both increased and decreased prevalence ratios: 0.89 (95% CI 0.79–0.99) in Chad, 0.82 (0.69–0.97) in Mauritania, 1.30 (1.02–1.66) in Burkina Faso, and 1.67 (1.20–2.33) in Ghana. After controlling for country-fixed effects, the prevalence ratio was 0.95 (0.92–0.99), suggesting a protective effect of having a HW station with water and soap. Availability of HW resources is an important indicator to prevent child diarrhea, and HW promotion programs should be tailored to the unique context of each country.

Small-scale livestock production plays an essential role as a source of income and nutrition for households in low- and middle-income countries, yet these practices can also increase risk of zoonotic infectious diseases, especially among young children. To mitigate this risk, there is a need to better understand how livestock producers perceive and manage risks of disease transmission. Twenty semistructured, in-depth interviews were conducted with small-scale livestock producers in a semirural parish of Quito, Ecuador. Interviews explored livestock-raising practices, including animal health-care practices and use of antimicrobials, family members interactions with livestock and other animals, and perceptions of health risk associated with these practices and activities. Interviews were analyzed for common themes. Awareness of zoonotic disease transmission was widespread, yet few study participants considered raising livestock a significant health risk for themselves or their families. Several study households reported handling and consuming meat or poultry from sick or dead animals and using animal waste as a fertilizer on their crops. Households typically diagnosed and treated their sick animals, occasionally seeking treatment advice from employees of local animal feed stores where medications, including antimicrobials, are available over the counter. Despite a basic understanding of zoonotic disease risk, this study identified several factors, such as the handling and consumption of sick and dead animals and purchasing medications for sick animals over the counter, that potentially increase the risk of zoonotic disease transmission as well as the development and spread of antimicrobial resistance.

Background

High-risk water, sanitation, and hygiene (WASH) practices are still prevalent in most low-income countries. Because of limited access to WASH, children may be put at an increased risk of diarrheal diseases.

Objectives

This study aims to 1) develop a new measure of WASH-induced burden, the WASH Resource Index (WRI), and estimate its correlation with child diarrhea and an additive index of high-risk WASH practices; 2) explore the geographic distribution of high-risk WASH practices, child diarrhea, and summary indices at the cluster level; and 3) examine the association between the WRI and child diarrhea at the individual level.

Design

A sample of 7,019 children from the Uganda Demographic and Health Survey 2011 were included in this study. Principal component analysis was used to develop a WRI, and households were classified as WASH poorest, poorer, middle, richer, and richest. A hot spot analysis was conducted to assess whether and how high-risk WASH practices and child diarrhea were geographically clustered. A potential association between the WRI and child diarrhea was examined through a nested regression analysis.

Results

High-risk WASH practices were clustered at geographically distant regions from Kampala. The 2-week prevalence of child diarrhea, however, was concentrated in Eastern and East Central regions where high-risk WASH practices were not prevalent. At the individual level, none of the high-risk WASH practices were significantly associated with child diarrhea. Being in the highest WASH quintile was, however, significantly associated with 24.9% lower prevalence of child diarrhea compared to being in the lowest quintile (p<0.05).

Conclusions

Only a weak association was found between the WRI and child diarrhea in this study. Future research should explore the potential utility of the WRI to examine WASH-induced burden.

Background

Antimicrobial use in food-animal production is an issue of growing concern. The application of antimicrobials for therapy, prophylaxis, and growth promotion in broiler chicken production has been associated with the emergence and dissemination of antimicrobial-resistant enteric bacteria. Although human exposure to antimicrobial-resistant bacteria through food has been examined extensively, little attention has been paid to occupational and environmental pathways of exposure.

Objective

Our objective was to measure the relative risk for colonization with antimicrobial-resistant Escherichia coli among poultry workers compared with community referents.

Methods

We collected stool samples and health surveys from 16 poultry workers and 33 community referents in the Delmarva region of Maryland and Virginia. E. coli was cultured from stool samples, and susceptibility to ampicillin, ciprofloxacin, ceftriaxone, gentamicin, nitrofurantoin, and tetracycline was determined for each E. coli isolate. We estimated the relative risk for carrying antimicrobial-resistant E. coli among poultry workers compared with community referents.

Results

Poultry workers had 32 times the odds of carrying gentamicin-resistant E. coli compared with community referents. The poultry workers were also at significantly increased risk of carrying multidrug-resistant E. coli.

Conclusions

Occupational exposure to antimicrobial-resistant E. coli from live-animal contact in the broiler chicken industry may be an important route of entry for antimicrobial-resistant E. coli into the community.

Small-scale livestock production plays an essential role as a source of income and nutrition for households in low- and middle-income countries, yet these practices can also increase risk of zoonotic infectious diseases, especially among young children. To mitigate this risk, there is a need to better understand how livestock producers perceive and manage risks of disease transmission. Twenty semistructured, in-depth interviews were conducted with small-scale livestock producers in a semirural parish of Quito, Ecuador. Interviews explored livestock-raising practices, including animal health-care practices and use of antimicrobials, family members' interactions with livestock and other animals, and perceptions of health risk associated with these practices and activities. Interviews were analyzed for common themes. Awareness of zoonotic disease transmission was widespread, yet few study participants considered raising livestock a significant health risk for themselves or their families. Several study households reported handling and consuming meat or poultry from sick or dead animals and using animal waste as a fertilizer on their crops. Households typically diagnosed and treated their sick animals, occasionally seeking treatment advice from employees of local animal feed stores where medications, including antimicrobials, are available over the counter. Despite a basic understanding of zoonotic disease risk, this study identified several factors, such as the handling and consumption of sick and dead animals and purchasing medications for sick animals over the counter, that potentially increase the risk of zoonotic disease transmission as well as the development and spread of antimicrobial resistance.