Characterizing Behaviors Associated with Enteric Pathogen Exposure among Infants in Rural

Overview

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Key numbers

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• diaper changes (14/18, 77.8%); however only a third (4/11, 36.4%) were observed washing their hands; 2) the observers
• June to August of 2018 in Esmeraldas (population among others (see Supplemental Table 1 for a detailed
• plemental Table 2 for a detailed description of activities). In vation of the same infant concurrently and then compared
• recognize compared with individual contacts. they woke up from a nap (mean time 10:30 AM). We chose
• low. For the repeated spot checks, we calculated the mean and 36.3 hours during Phase 3.
• and 95% confidence intervals for the intraclass correlation Phase 1. Because observations were scheduled to begin
• vary from 0 to 1.38 We selected the spot check results at all showed that infants sometimes slept (12.5%) or could not
• available time points during Phase 1 and Phase 2 to calcu- be observed (6.2%) at least once in the final 2 hours of the
• late the ICC. In Phase 3, all spot checks items were passed observation; children slept during 18.8% of hours during the
• an ICC value lower than 0.59 were checked over three sepa- diaper change in 75.0% (12/16) of the observations (Table 2).
• (range: 1 week–23.5 months), whereas all infants in Phase 3
• Male, n (%) 28 (37.8) 9 (47.4) sion of the observation form, it was reported frequently in
• A total of 60 diaper change events were observed, 17 during Phase 1, 30 during Phase 2, and 13 during Phase 3. Of 70 observations, 45 (64.3%) included at least one diaper change event.
• that only 50.0% (15/30) of observed events were followed by during four of 32 total observations (8/92 hours) during
• often cleaned their infants with baby wipes (60.0%), followed observed. Cohen’s kappa was 0.20 (agreement due to
• as a single “episode,” we recorded 70 of 92 (76.1%) observa- checks in Phase 1 and 2 was 17.2% among mothers/
• tion hours with at least one instance of another person kiss- caregivers and 33.3% among infants. However, both meas-
• hour (interquartile range (IQR)): 1–3). Infants frequently and 0.55, respectively. Other spot check ICCs such as
• median of 1 episode per hour was observed (IQR: 1–4) hour variation throughout the observation, with ICCs higher
• (Table 3). Infants were also observed touching other people, than 0.9 (Table 4).
• Action Phase contact episode (25th, 75th percentile) Mean oral contact events/hour (SD)
• Unwashed utensils or cookware 1 and 2 26/149 (17.5%) 67/123 (54.5%) 0.74 (0.46, 0.90)
• Dusty kitchen and dining area 1 and 2 12/149 (8.1%) 55/137 (40.1%) 0.88 (0.52, 0.98)
• We observed 13 diaper changes during Phase 3 in 57.9%
• episode lasted 1.6 min (IQR: 0.9–3.8 min), while the median DISCUSSION
• In Phase 3, 75.0% of mothers reported washing hands after Infancy is a period of rapid motor development, accompa-
• diaper changes (14/18, 77.8%), whereas 4 of 11 (36.4%) nied by intense engagement and exploration of the environ-
• remember behaviors could also introduce recall bias.43,44 mouthing median frequency of 1.9 episodes per hour, Davis
• mon than prior studies in rural communities in other parts of reported an object-mouthing median frequency of 1.8 epi-

Methods (brief)

• ford University, CA; open-source link: https://github.com/ COVID-19 pandemic. No sample size calculation was per-
• 200.000), a coastal city in northwestern Ecuador. For the description). Observers collected the data on paper forms.
• recruited participants by convenience sample among write notes at least every hour throughout the observation
• click on a blank button if no other activity followed or click Additional variables. We also collected basic sociodemo-
• iors. Consistent with Phase 2, we recorded mouthing and household was located. These variables were collected
• ment between reported and observed household animal observation. Additional details were collected in the observ-
• (Phase 2 and 3) was less tiring for both observers and partic- exposure behaviors rates are based on a limited sample size
• mostly sleeping. Second, scheduling the visit in advance structured observations should use larger sample sizes.

Implications

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Wiki pages this source may touch

• Fish — marine, non-predatory (sardines, anchovies, salmon, cod)
• Baby Wipes
• Tin

Verification notes

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Update history

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