Risk factors for childhood enteric infection in urban Maputo, Mozambique: A cross-sectional study

PLoS Negl Trop Dis. 2018 Nov 12;12(11):e0006956. doi: 10.1371/journal.pntd.0006956. eCollection 2018 Nov.

Abstract

Background: Enteric infections are common where public health infrastructure is lacking. This study assesses risk factors for a range of enteric infections among children living in low-income, unplanned communities of urban Maputo, Mozambique.

Methods & findings: We conducted a cross-sectional survey in 17 neighborhoods of Maputo to assess the prevalence of reported diarrheal illness and laboratory-confirmed enteric infections in children. We collected stool from children aged 1-48 months, independent of reported symptoms, for molecular detection of 15 common enteric pathogens by multiplex RT-PCR. We also collected survey and observational data related to water, sanitation, and hygiene (WASH) characteristics; other environmental factors; and social, economic, and demographic covariates. We analyzed stool from 759 children living in 425 household clusters (compounds) representing a range of environmental conditions. We detected ≥1 enteric pathogens in stool from most children (86%, 95% confidence interval (CI): 84-89%) though diarrheal symptoms were only reported for 16% (95% CI: 13-19%) of children with enteric infections and 13% (95% CI: 11-15%) of all children. Prevalence of any enteric infection was positively associated with age and ranged from 71% (95% CI: 64-77%) in children 1-11 months to 96% (95% CI: 93-98%) in children 24-48 months. We found poor sanitary conditions, such as presence of feces or soiled diapers around the compound, to be associated with higher risk of protozoan infections. Certain latrine features, including drop-hole covers and latrine walls, and presence of a water tap on the compound grounds were associated with a lower risk of bacterial and protozoan infections. Any breastfeeding was also associated with reduced risk of infection.

Conclusions: We found a high prevalence of enteric infections, primarily among children without diarrhea, and weak associations between bacterial and protozoan infections and environmental risk factors including WASH. Findings suggest that environmental health interventions to limit infections would need to be transformative given the high prevalence of enteric pathogen shedding and poor sanitary conditions observed.

Trial registration: ClinicalTrials.gov NCT02362932.

Publication types

  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

  • Bacterial Infections / diagnosis
  • Bacterial Infections / epidemiology*
  • Child, Preschool
  • Cohort Studies
  • Coinfection / epidemiology
  • Coinfection / microbiology
  • Coinfection / parasitology
  • Coinfection / virology
  • Cross-Sectional Studies
  • Diarrhea / epidemiology*
  • Diarrhea / microbiology
  • Diarrhea / parasitology
  • Diarrhea / virology
  • Feces / parasitology*
  • Female
  • Humans
  • Hygiene
  • Infant
  • Male
  • Models, Theoretical
  • Mozambique / epidemiology
  • Poverty
  • Prevalence
  • Protozoan Infections / diagnosis
  • Protozoan Infections / epidemiology*
  • Protozoan Infections / parasitology
  • Public Health / statistics & numerical data*
  • Risk Factors
  • Sanitation / statistics & numerical data
  • Socioeconomic Factors
  • Soil / parasitology
  • Toilet Facilities / statistics & numerical data
  • Urban Renewal / statistics & numerical data
  • Virus Diseases / diagnosis
  • Virus Diseases / epidemiology*

Substances

  • Soil

Associated data

  • ClinicalTrials.gov/NCT02362932

Grants and funding

This study was funded by the United States Agency for International Development (www.usaid.gov) under Translating Research into Action (Cooperative Agreement No. GHS-A-00-09-00015-00) and the Bill and Melinda Gates Foundation (www.gatesfoundation.org) grant OPP1137224. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.