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Multicenter Study
. 2017 Aug 4;11(8):e0005795.
doi: 10.1371/journal.pntd.0005795. eCollection 2017 Aug.

Animal-related factors associated with moderate-to-severe diarrhea in children younger than five years in western Kenya: A matched case-control study

Anne Conan  1 , Ciara E O'Reilly  2 , Eric Ogola  3 , J Benjamin Ochieng  4 , Anna J Blackstock  2 , Richard Omore  4 , Linus Ochieng  4 , Fenny Moke  4 , Michele B Parsons  5 , Lihua Xiao  2 , Dawn Roellig  2 , Tamer H Farag  6 , James P Nataro  6 , Karen L Kotloff  6 , Myron M Levine  6 , Eric D Mintz  2 , Robert F Breiman  7 , Sarah Cleaveland  8 , Darryn L Knobel  1
Affiliations
Multicenter Study

Animal-related factors associated with moderate-to-severe diarrhea in children younger than five years in western Kenya: A matched case-control study

Anne Conan et al. PLoS Negl Trop Dis. .

Abstract

Background: Diarrheal disease remains among the leading causes of global mortality in children younger than 5 years. Exposure to domestic animals may be a risk factor for diarrheal disease. The objectives of this study were to identify animal-related exposures associated with cases of moderate-to-severe diarrhea (MSD) in children in rural western Kenya, and to identify the major zoonotic enteric pathogens present in domestic animals residing in the homesteads of case and control children.

Methodology/principal findings: We characterized animal-related exposures in a subset of case and control children (n = 73 pairs matched on age, sex and location) with reported animal presence at home enrolled in the Global Enteric Multicenter Study in western Kenya, and analysed these for an association with MSD. We identified potentially zoonotic enteric pathogens in pooled fecal specimens collected from domestic animals resident at children's homesteads. Variables that were associated with decreased risk of MSD were washing hands after animal contact (matched odds ratio [MOR] = 0.2; 95% CI 0.08-0.7), and presence of adult sheep that were not confined in a pen overnight (MOR = 0.1; 0.02-0.5). Variables that were associated with increased risk of MSD were increasing number of sheep owned (MOR = 1.2; 1.0-1.5), frequent observation of fresh rodent excreta (feces/urine) outside the house (MOR = 7.5; 1.5-37.2), and participation of the child in providing water to chickens (MOR = 3.8; 1.2-12.2). Of 691 pooled specimens collected from 2,174 domestic animals, 159 pools (23%) tested positive for one or more potentially zoonotic enteric pathogens (Campylobacter jejuni, C. coli, non-typhoidal Salmonella, diarrheagenic E. coli, Giardia, Cryptosporidium, or rotavirus). We did not find any association between the presence of particular pathogens in household animals, and MSD in children.

Conclusions and significance: Public health agencies should continue to promote frequent hand washing, including after animal contact, to reduce the risk of MSD. Future studies should address specific causal relations of MSD with sheep and chicken husbandry practices, and with the presence of rodents.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Flow diagram showing selection and enrollment of case and control children into the GEMS-ZED study of moderate-to-severe diarrhea in children in western Kenya.
See this image and copyright information in PMC

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