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Enteric pathogens from water, hands, surface, soil, drainage ditch, and stream exposure points in a low-income neighborhood of Nairobi, Kenya
Valerie Bauza | Vincent Madadi | Robinson Ocharo | Thanh H. Nguyen | Jeremy S. Guest
Date of Publication:
March 20, 2020
Science of The Total Environment
Child exposure to fecal-oral pathogens occurs through several transmission pathways. However, the relative importance of different exposure points for pathogen transmission both inside and outside households is not well understood. We conducted a cross-sectional study in the urban slum of Kibera in Nairobi, Kenya, collecting 237 environmental samples from 40 households from source water, stored drinking water, caregiver hands, child hands, household surfaces, soil, standing water, open drainage ditches, and streams. We quantified the fecal indicator Escherichia coli and the enteric pathogens of adenovirus, Campylobacter jejuni, Shigella spp./enteroinvasive E. coli (EIEC), and Vibrio cholerae. At least one enteric pathogens was detected in 13% of household stored water, 47% of hand, 46% of table surface, 26% of plate surface, 75% of floor surface, 96% of soil, 56% of standing water, 77% of drainage ditch, and 100% of stream samples despite all households having access to a toilet or latrine. Our results provide evidence that children may be exposed to enteric pathogens from several exposure points, that domestic hygiene practices related to water treatment and child handwashing were associated with reduced pathogen detection in this setting, but household table and floor cleaning practices were not, that ownership or presence of chickens in the compound was associated with increased detection of C. jejuni inside households and on soil, that there were interactions among different transmission pathways for enteric pathogens, and that there were differential correlations between E. coli and enteric pathogens for different pathogens and environmental sample types. Additionally, V. cholerae was detected at several exposure points during a cholera outbreak. Overall, these results suggest that interventions that can disrupt many transmission pathways may be needed to reduce enteric pathogen exposure in this urban slum setting.
Knowledge, attitude and practices on cholera in an arid county, Kenya, 2018: A mixed-methods approach
Erick Otieno Orimbo | Elvis Oyugi | Diba Dulacha | Mark Obonyo | Abubakar Hussein | Jane Githuku | Maurice Owiny | Zeinab Gura
Date of Publication:
Evaluation of a Rapid Cholera Response Activity - Nyanza Province, Kenya, 2008
K. Date | B. Person | B. Nygren | V. Were | S. Kola | T. Ayers | R. Quick
Date of Publication:
Journal of Infectious Diseases
In response to recurrent cholera outbreaks in Nyanza Province, Kenya, a local nongovernmental organization assisted the Ministry of Health by providing cholera education activities to some cholera-affected communities. We evaluated the impact on cholera prevention knowledge and practices.
In November–December 2008, we conducted a cross-sectional household survey and tested stored water for chlorine in 6 cholera-affected enumeration areas (intervention-EAs) where response activities had occurred between March–September 2008, and 6 comparison-EAs with no known reports of cholera outbreaks or response activities.
We enrolled 358 individuals from intervention-EAs and 365 from comparison-EAs. Overall, >80% knew cholera symptoms and over 60% knew that water treatment prevented diarrhea; <20% had chlorine residual in stored water. More intervention-EA respondents than comparison-EA respondents recalled a cholera outbreak in their community (52% vs 19%, P < .0001), and of those, 51% versus 39%, respectively, had attended a cholera response event. Detectable chlorine residuals in stored water were found in a higher percentage of intervention-EA and comparison-EA event attendees (21% and 25%, respectively) than non attendees (17% and 8%, respectively).
There was a gap between knowledge and practice of water treatment as a cholera preventive measure. Cholera event attendance may have modestly motivated increased household water treatment.