Fecal Contamination of Shanty Town Toddlers in Households with Feccs-To-Mouth Episodes Were Performed with the Following 37°C Under Microaerophilic Conditions
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CONTAMINATION OF TODDLERS WITH P0l!|lSW3y-'r?E,eES Fecal Contamination of Shanty Town Toddlers in Households with feccs-to-mouth episodes were performed with the following 37°C under microaerophilic conditions. Camp.yJb.&S§jjgj&spe- variables: number of fowl, hours in the house/12 hours, and cics were identified based on colony morphojjjgy. oxidase Non-corralled Poultry, Lima, Peru number poultry stools/12 hours. production, and spiral appearance in the GranTsfain. 10 Poultry Raising Practices and Beliefs GRACE S. MARQUIS, MS, GLADYS VENTURA, BS, ROBERT H. GILMAN, MD, ESPERANZA PORRAS, BS, Results o ELBA MIRANDA, MS, Luz CARBAJAL, MS, AND MARTA PENTAFIEL, BS We surveyed a group of !08 families living in Las Pampas de San Juan to document their practices and beliefs regarding Direct Observation in the Homes w the raising of chickens and other fowl. The survey identified The interaction between toddlers and poult© was ob- Abstract: We used direct observer techniques to measure the association between feces-to-mouth contamination and the number the reasons families gave for raising or not raising poultry, served for a total of 119 hours in 10 Huascar hoiisthoja's. The frequency with which toddlcr-agcd children were contaminated by of stools deposited in the house (r - 0.66). For each additional their beliefs about corralling the poultry, and the effect that majority of the poultry were chickens (fowWVbusfc = 5:4. poultry (trees in homes in a peri-urban shanty town in Lima, Peru. chicken stool deposited during the day, there was an average confinement has on the growth and the health of the animal, chickens/house = 4.4). Three out of 10 families also had The mean number of fowl was 5.4 (SD 3.11. with 10.0 <SD 10.7) increase of 0.27 in feces-to-mouth episodes. the perceived advantages of raising chickens in the home ducks and turkeys. Chickens and ducks only were allowed to poultry defecations per 12 hours. Toddlers' hand contact with We collected feecs from 68 infected chickens and found viable compared to buying them commercially, and the mothers' roam freely through the house for about one-third of the poultry feces occurred a mean of 2.9 (SD 3.0) times/12 hours. A mean Cwnpytobacler jejuni for up to 48 hours after deposition. Yet, a perception concerning whether poultry roaming within the 12-hour observation period (Table 1). The number of poultry of 3.9 (SD 4.6) feces-to-mouth episodes per houschold/12 hours survey of 108 families demonstrated that free-roaming poultry were house presented a health risk to young children. and the time they were in the house were correlated (r = 0.64), as were the number of observed stools and the time the occurred both by direct hand-to-mouth contamination and indirectly often not thought of as a health risk for children. An intervention Socioeconomic Data by handling soiled objects which were then placed in the mouth. program to reduce oral-fecal contamination should emphasize that all animals spent within the house (r = 0.86). There was a strong correlation between feces-to-hand contamination poultry be corralled and not allowed access into the house. [Am 3 As part of a longitudinal study of Enterobitts vermicu- The children had approximately three feces-to-hand and feces-to-mouth contamination (r - 0.94). There was also an Public Health I99O;80:146-149.) laris. 121 randomly selected families from Huascar were episodes per 12 hours (Table I). The risk of feces-to-hand included in a socioeconomic survey. The same data were contamination was from both fresh stool and from that collected for the Pampas families that participated in the deposited several days previously but not removed from the poultry raising practices survey. The socioeconomic survey household surfaces. In three households where no observed Introduction shanty towns): Huascar, Canto Grande'' and Las Pampas dc detailed age, sex. level of education, and occupation of all defecations occurred, hand and oral contamination still San Juan, San Juan de Miraflores, in Lima Peru. The majority members of the family. Questions on housing quality in- Diarrhea! disease is an important factor in Ihe infection- happened with stools that had been deposited prior to the day of the study population are rural immigrants who are daily cluded the materials used to build the house, number of of observation. The two most important variables were malnutrition cycle of infants and young children in develop- laborers or street vendors with low, unstable incomes. rooms, ownership of functioning radios, televisions, and ing countries. In Peru, children under three years of age have number of droppings and number of minutes chickens were Housing materials in Huascar and San Juan range from refrigerators, and presence or absence of a latrine. Finally the in the house. a diarrhea! incidence of 10 episodes per child-year, which can woven cane matting to permanent structures of brick and number and types of animals belonging to the home owners significantly affect their growth rales.' One important cause were also registered. There were about four feces-to-mouth episodes per child of diarrhea in Lima children less than one year of age is cement. Although the majority of pueblos jovenes do not (Table 1). Children only rarely washed their hands after Campylobacier jejuni. This organism was found in 15 percent have electrical installations, most of our study households The practices and beliefs of mothers who did and did not touching feces, and often put their fingers in their mouths, so of diarrhea stool samples2 and accounted for the majority of had them. Water is scarce in both pueblos. It is provided raise poultry were compared using Chi square analysis. Each feces-to-hand and feces-to-mouth episodes were highly cor- dysenteric diarrheas. through tanker trucks, and in half of San Juan through piped socioeconomic data set from the two pueblos jovenes was related (r = 0.94); feces-to-hand episodes and the number of communal water spigot, ln-housc sewage systems arc not In Peru, C. jejuni has heen isolated from 88 percent of analyzed individually, and compared for socioeconomic poultry accounted for 93 percent of the variation in the commercial chickens and 50 percent of free-ranging domestic available. indicators, using Student t test and Chi-Square analysis. dependent variable—the number of feces-to-mouth episodes. Direct Observation Data chickens in a pueblo joven (a peri-urban shanty town Survlvabillly of C. jtjuni In Deposited Chicken Kee« Neither feces-to-hand nor feces-to-mouth episodes were community).' In an aged-matched case-control study of Lima Ten families from Huascar participated in an in-depth related to the number of young children in study families. For Stool samples were taken from C. x/7m/-positive chick- each additional chicken stool deposited during the day, there peri-urban households, children in families with chickens had behavioral observation study, with a total of 21 children ens, raised in a household in Huascar, Canto Grande. A a Ihree-fold relative risk of having C. jejuni diarrhea which under five years of age. All the families had at least one child was an average increase of 0.27 in feces-to-mouth episodes. cloaca! swab was taken immediately after Ihc chicken defe- Poultry Raising Practices increased to 12.5 in families with C. jejuni infected chickens.- under two years of age, and domestic chickens which were cated and another swab was taken from the stool on the These risk factors suggest thai direct contact with free- not corralled at least part of the day. They gave informed ground. These served as baseline samples. The stool sample, roaming C. ./yam-infected chickens (hat defecate on house- One hundred and eight mothers from the Pampas de San verbal consent prior to their participation. The study received on the ground of a sun-cxposcd patio, was fenced in with a Juan participated in the poultry raising practices survey. hold surfaces is an important transmission vehicle for young ethical approval by all involved Peruvian institutions (Uni- metallic wire and marked with its respective identification children. Eighty-one (75 percent) of the mothers were migrants, versidad Peruana Cayetano Hcredia, Instituto de Investiga- number and code. After 24 and 48 hours, additional samples usually from the sierra zones. Whereas 88 percent (14/16) of Direct observation of the personal hygiene of small cion Nutricional, and PRISMA - Proyectos en Informatica, were taken. All the samples were immediately placed in Cary 7 the Lima-born mothers raised multiple types of poultry, only children and mother-child behavioral patterns is the most Salud, Meuicina y Agricultural. Blair media containing Skirrow's antibiotic supplement, and half of the migrant mothers raised other types of poultry in reliable method for obtaining data.' W,e used directed ob- To gather the direct observation data, a field worker processed by direct plating on blood agar with Butzler's addition to chickens (27/54). server techniques to measure the rate at which toddlers in a remained in the toddler's home for one 12-hour observation supplement. Another sample was inoculated into thioglyco- The major reasons given for a raising poultry (Table 2) shanty town contaminate themselves with domestic poultry period (7am to 7pm). At the beginning of the visit, a late broth supplemented with iron and the following antibi- included their use for home consumption and enjoyment of feces. descriptive inventory of the domestic animals was com- otics: vancomycin 10 u.g/ml, polymyxin B 2.5 I.U./ml and raising animals. The majority of mothers realized that com- pleted. During the 12-hour period the observer noted all trimclhoprim lactatc 5 u.g/ml.