Prospective cohort study of child mouthing of faeces and fomites in Dhaka, Bangladesh (CHoBI7 Program)

Abstract

Objective To characterize childhood mouthing and handling behaviors and to assess the association between hand‐to‐object and object‐to‐mouth contacts and diarrhea prevalence in young children in urban Dhaka, Bangladesh. Methods A prospective cohort study was conducted among 494 children under 5 years of age in Dhaka, Bangladesh. This study was nested within the randomized controlled trial of the Cholera‐Hospital‐Based‐Intervention‐for‐7‐Days (CHoBI7) mobile health (mHealth) program. The CHoBI7 mobile health program focuses on promoting handwashing with soap and water treatment to diarrhea patients and their household members through mobile messages and face‐to‐face visits. Mouthing and handling of feces and fomites among young children was measured by five‐hour structured observation and caregiver reports. Diarrhea surveillance data was collected monthly for 12 months. Results 55% of caregivers reported that their child put a visibly dirty fomite (object or soil) in their mouth in the past week. Caregivers reported that 50% of children had mouthed visibly dirty objects, 26% had mouthed dirt, and 2% had mouthed feces. 45% of children were observed mouthing a visibly dirty fomite during structured observation. 40% of children were observed mouthing an object, 10% were observed mouthing soil, and one child (0.2%) was observed mouthing feces. Mouthing of visibly dirty fomites was most frequent among children 12‐18 months of age; 69% of these children were reported to do so by caregivers, and 54% were observed doing so. Children with caregiver reports of mouthing feces had significantly higher odds of diarrhea over the subsequent month (Odds Ratio: 4.54; 95% Confidence Interval: 1.06, 19.48). Conclusion These findings demonstrate that mouthing of contaminated fomites among young children is frequent in urban environments in Bangladesh, and that mouthing feces is associated with significantly higher odds of diarrhea. Interventions are urgently needed to protect young children from fecal pathogens in their play spaces.