Environmental and behavioral exposure pathways associated with diarrhea and enteric pathogen detection in twenty-six week old urban Kenyan infants: a cross-sectional study

The prevalence of enteric pathogen detection in children in low-income countries climbs rapidly between birth and 6 months of age. Few studies have tested whether improved household environmental and behavioral hygiene conditions protects infants from exposure to enteric pathogens spread via unhygienic human and animal sanitation conditions, especially during this early window of infancy. This cross-sectional study utilized enrollment survey data among households with 6 month old infants in Kisumu, Kenya participating in the Safe Start cluster-randomized controlled trial to estimate associations between household water access and treatment, animal vectors, sanitation access, hand washing practices, supplemental feeding, and flooring, with the outcomes of caregiver-reported 7-day diarrhea prevalence and sum count of different enteric viruses, bacteria, and parasites pathogens in infant stool. Then, we tested whether household environmental hygiene and behavioral practices moderated associations between infant exposure outcomes and latrine access and domestic animal co-habitation. We found that reported handwashing after handling animals and before eating were strongly associated with lower risk of caregiver-reported diarrhea, while owning and co-habitating with animals (versus no animals), living in a household with vinyl covered dirt floors (versus finished floors), and feeding infants cow milk (versus no milk) were strongly associated with pathogen detection in infants. Caregiver handwashing after child or self-defecation moderated the relationship between shared sanitation (vs private) sanitation access and infant exposure to pathogens such that handwashing had the greatest benefit for preventing pathogen exposure of infants in households with private latrines. In the absence of handwashing, access to private sanitation posed no benefits over shared latrines for protecting infants from exposure. Our evidence highlights eliminating animal co-habitation, improving flooring, improving post-defecation and food-related handwashing, and improving safety of cow milk sources and/or safe household storage of milk as interventions to prevent enteric pathogen exposure of infants less than 6 months age.

Association between humidifier disinfectant exposure during infancy and subsequent neuropsychiatric outcomes during childhood: a nation-wide cross-sectional study

Background The purpose was to determine the association between infant exposure to humidifier disinfectant (HD) with neuropsychiatric problems in pre-school children. Methods A total of 2,150 children (age 4–11 months) were enrolled in the Panel Study of Korean Children (PSKC) study. The Korean version of the Child Behavior Checklist (CBCL) was used for assessments of neuropsychiatric problems. 1,113 children who participated in all the first to third PSKC studies and answered a question about HD exposure were finally enrolled. Results There were 717 (64.5%) children in non-HD group who were not exposed to HD and 396 (35.5%) in HD group with former exposure to HD. Exposure to HD was associated with total neuropsychiatric problems (adjusted odds ratio, aOR = 1.54, 95% CI = 1.15–2.06), being emotionally reactive (aOR = 1.55, 95% CI = 1.00–2.39), having attention problems (aOR = 1.96, 95% CI = 1.10–3.47), having oppositional defiant problems (aOR = 1.70, 95% CI = 1.07–2.71), and having attention deficit/hyperactivity problems (aOR = 11.57, 95% CI = 1.03–2.38). The risks for neuropsychiatric problems were clearly increased in boy, firstborn, and secondary smoker. Conclusions Exposure to HD during early childhood had a potential association with subsequent behavioral abnormalities.

Human immunodeficiency virus transmission from a 24-year-old woman to her 78-year-old grandmother: a case report

Introduction Since its debut recognition in 1981, human immunodeficiency virus/acquired immunodeficiency syndrome has affected over 77 million people and has resulted in premature cessation of 35.4 million lives worldwide. Commonly, human immunodeficiency virus is transmitted by sexual contact across mucosal surfaces, by sharing of injecting equipment, through contaminated blood transfusions, and by maternal–infant exposure. Nevertheless, accidental transmission incidences involving family members are rare but possible. Case presentation A 78-year-old woman of African descent from Mtwara Region south of Tanzania was referred to us for further evaluation and treatment. She is 30 years postmenopausal and has a 35-year history of hypertension. Her last attendance to our institute was 11 months prior the index visit and she tested negative for human immunodeficiency virus. She came with complaints of weight loss, recurrent fevers, and cough. Her hematological tests revealed leukopenia with lymphocytosis, together with a normocytic normochromic anemia. Enzyme-linked immunosorbent assay for human immunodeficiency virus was positive, and she had a CD4 count of 177 cells/µL. We went back to history taking to identify the potential source of infection. We were informed that for the past 6 months, the 78-year-old lady has been living with her unwell 24-year-old granddaughter who has been divorced. The granddaughter had a history of recurrent fevers, significant weight loss, and a suppurative skin condition. As a way to show love and care, the old lady was puncturing the suppurative lesions with bare hands; then she would suck them to clear away the discharge. We requested to see the young lady, and she tested positive for human immunodeficiency virus. Both were started on tenofovir/lamivudine/dolutegravir combination plus cotrimoxazole 960 mg. The family was in total disarray following these findings. The patient was discharged through infectious diseases department and died of Pneumocystis jirovecii pneumonia 12 weeks later. Conclusions Certain sociocultural norms that are believed to express love, care, and togetherness in developing rural communities, particularly Sub-Saharan Africa, have a potential of spreading human immunodeficiency virus, thus warranting prompt transformation.

Effect of maternal aflatoxin exposure through diet on growth of infants 0 - 3 months in Kisumu county, Kenya

Aflatoxins are naturally occurring carcinogenic toxins associated with poor growth outcomes in young children. Although evidence supports mother-to-infant exposure during pregnancy and breastfeeding, evidence of its effect on growth is limited to the period after introduction of complementary foods. It is, therefore, unclear whether early maternal exposure to aflatoxins affects infant growth right from birth. Prevalence of aflatoxin levels of 40% has been observed in Nyanza region, Kenya, and 22.7% of children under 5 years are stunted. The purpose of this study was to determine the effect of maternal aflatoxin exposure on growth of infants 0-3 months old in Kisumu County, Kenya. Specific objectives were to: establish association between maternal baseline characteristics and aflatoxin exposure; establish association between infant baseline characteristics at birth and maternal aflatoxin exposure; determine effect of maternal aflatoxin exposure on infant growth indicators at 3 months of age. Out of 553 pregnant women who were screened for aflatoxin exposure, 137 exposed and 137 non-exposed women, matched for age and household income, participated in an 8-month cohort study. The women were followed up to delivery and their infants up to 3 months after delivery. Infant length and weight data was collected monthly. Length-for-age (LAZ), weight-for-length (WLZ)) and weight-for-age (WAZ) z-scores were generated. Aflatoxin levels were analyzed using Enzyme Linked Immunosorbent Assay (ELISA) in parts per billion (ppb). Effects of aflatoxin on infant growth outcomes were assessed using multi-variate linear and logistic regression. Effect of maternal aflatoxin exposure on infant length, weight, LAZ, WLZ, WAZ was determined using Cox regression with constant time at risk. Infants of exposed women had lower weight (95% CI:-0.85,-0.53), length (95% CI: -4.08, -3.36), LAZ (95% CI: -1.93, -1.16) and WAZ (95% CI:-1.03, -0.54) at 3 months of age, but there was no difference in WLZ (95% CI:-0.03, 0.74). Risk for stunting was higher in infants of exposed women (RR=4.08; 95% CI: 1.35, 12.29). There was no difference in the risk for underweight (RR=6.61; 95% CI: 0.80-54.33) and wasting (RR=0.37; 95% CI: 0.40, 3.39, P=0.38).These results underpin the need to reduce aflatoxin exposure in infants and young children who are very vulnerable.