Child Mouthing of Feces and Fomites and Animal Contact are Associated with Diarrhea and Impaired Growth among Young Children in the Democratic Republic of the Congo: A prospective cohort study.

Abstract Objective To identify exposure pathways to fecal pathogens that are significant contributors to diarrheal diseases and impaired growth in young children, and to evaluate scalable interventions to reduce fecal contamination from these pathways. Study design This prospective cohort study of 370 children under 5 years of age was conducted in Walungu Territory, South Kivu, Democratic Republic of the Congo. Child mouthing behaviors were assessed through caregiver reports and five-hour structured observations. Caregiver reports of child contact with animals and child diarrhea were also obtained. Anthropometric measurements were collected at baseline and at a 6-month follow-up. Results Children observed putting soil in their mouth during structured observation at baseline had a significantly higher odds of diarrhea at the 6-month follow-up (OR: 1.79 (95% CI: 1.04,3.07)). Children observed mouthing feces during structured observation had a significant reduction in height-for-age z-scores(HAZ) from baseline to the 6-month follow-up(ΔHAZ -0.69 (95% Confidence Interval (CI): -1.34,-0.04). A significant reduction in HAZ was also observed for children with caregiver reports of touching guinea pigs(-0.33 (95% CI: -0.58,-0.08)) and rabbits(-0.34 (95% CI: -0.64, -0.04)), and children with feces in their sleeping space during unannounced spot checks(-0.41(95% CI: -0.74,-0.09)). Conclusion These findings emphasize the urgent need for infant water, sanitation, and hygiene interventions targeting child mouthing behaviors, fecal contamination in child living spaces, and child contact with domestic animals to reduce exposure to fecal pathogens among susceptible populations.