Microbiological contamination of young children's hands in rural Bangladesh: Associations with child age and observed hand cleanliness as proxy.
Journal
PloS one
ISSN: 1932-6203
Titre abrégé: PLoS One
Pays: United States
ID NLM: 101285081
Informations de publication
Date de publication:
2019
2019
Historique:
received:
10
03
2019
accepted:
27
08
2019
entrez:
11
9
2019
pubmed:
11
9
2019
medline:
11
3
2020
Statut:
epublish
Résumé
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. 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. 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. 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.
Sections du résumé
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.
Identifiants
pubmed: 31504064
doi: 10.1371/journal.pone.0222355
pii: PONE-D-19-06952
pmc: PMC6736272
doi:
Banques de données
figshare
['10.6084/m9.figshare.7823948']
Types de publication
Journal Article
Randomized Controlled Trial
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
e0222355Subventions
Organisme : NICHD NIH HHS
ID : R01 HD078912
Pays : United States
Déclaration de conflit d'intérêts
The authors have declared that no competing interests exist.
Références
Am J Clin Nutr. 1978 Nov;31(11):2114-23
pubmed: 102181
Lancet Infect Dis. 2002 Feb;2(2):103-10
pubmed: 11901641
J Appl Microbiol. 2002;93(4):585-92
pubmed: 12234341
Acta Paediatr Suppl. 2006 Apr;450:86-95
pubmed: 16817682
Am J Public Health. 2007 May;97(5):846-52
pubmed: 17267712
Am J Public Health. 2008 Aug;98(8):1372-81
pubmed: 18556606
Am J Trop Med Hyg. 2010 Feb;82(2):270-8
pubmed: 20134005
Am J Infect Control. 2010 May;38(4):332-4
pubmed: 20189686
Environ Sci Technol. 2010 May 1;44(9):3267-72
pubmed: 20222746
J Epidemiol Community Health. 2010 Jul;64(7):645-7
pubmed: 20547700
Water Res. 2010 Sep;44(16):4674-91
pubmed: 20656314
BMC Public Health. 2010 Sep 09;10:545
pubmed: 20828412
Trop Med Int Health. 2011 Feb;16(2):233-9
pubmed: 21091858
J Appl Microbiol. 1998 Dec;85 Suppl 1:83S-89S
pubmed: 21182696
Am J Trop Med Hyg. 2011 Apr;84(4):510-6
pubmed: 21460002
J Water Health. 2011 Jun;9(2):265-78
pubmed: 21942192
Trop Med Int Health. 2013 Jul;18(7):854-60
pubmed: 23557125
BMJ Open. 2013 Aug 30;3(8):e003476
pubmed: 23996605
Trop Med Int Health. 2014 Aug;19(8):906-16
pubmed: 24889816
PLoS One. 2014 Sep 24;9(9):e107429
pubmed: 25250662
Am J Trop Med Hyg. 2015 Jan;92(1):159-62
pubmed: 25385856
Appl Environ Microbiol. 2015 Mar;81(5):1735-43
pubmed: 25548044
Am J Trop Med Hyg. 2015 Jun;92(6):1117-24
pubmed: 25918214
Am J Trop Med Hyg. 2015 Sep;93(3):509-516
pubmed: 26149868
Epidemiol Infect. 2016 Apr;144(5):1000-9
pubmed: 26424385
Environ Sci Technol. 2016 May 3;50(9):4642-9
pubmed: 27045990
Int J Environ Res Public Health. 2016 Jun 04;13(6):
pubmed: 27271651
Am J Trop Med Hyg. 2016 Aug 3;95(2):288-97
pubmed: 27296388
Environ Sci Process Impacts. 2016 Aug 10;18(8):944-55
pubmed: 27384220
Trop Med Int Health. 2017 May;22(5):547-557
pubmed: 28164415
J Clin Microbiol. 1988 Aug;26(8):1513-8
pubmed: 2844846
Environ Sci Technol. 2017 Aug 1;51(15):8725-8734
pubmed: 28686435
Am J Trop Med Hyg. 2018 Aug;99(2):513-525
pubmed: 29869596
Environ Sci Technol. 2018 Jul 17;52(14):7928-7936
pubmed: 29902374
Environ Sci Technol. 2018 Nov 6;52(21):12089-12097
pubmed: 30256095
Lancet Glob Health. 2019 Jan;7(1):e132-e147
pubmed: 30554749
J Expo Sci Environ Epidemiol. 2019 Aug 5;:null
pubmed: 30728484