Manikam, L; Rutherford, S; Emes, D; Cupp, M; Sharma, R; Sarkar, K; Aisyah, D; ... Lakhanpaul, M; + view all Manikam, L; Rutherford, S; Emes, D; Cupp, M; Sharma, R; Sarkar, K; Aisyah, D; Field, S; Hayward, A; Altamirano, H; Batura, N; Dasgupta, R; Haklay, M; Nix, E; Christen, P; Lakhanpaul, M; - view fewer (2020) Assessing the infection burden and associated risk factors in children under 5 across Jaipurs urban slums: A feasibility study using a One Health approach. (UCL Open: Environment Preprint ). UCL Press: London, UK.

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Abstract

Purpose: Infectious diseases are one of the leading causes of death among children under five (U5s) across both India & globally. This is worse in slum environments with poor access to water, sanitation & hygiene (WASH), good nutrition & a safe built environment. / Globally, a One Health (e.g. human, animal & environment) approach is increasingly advocated by WHO, FAO & OIE to reduce infections & antimicrobial resistance. As U5s living in peri-urban slums are exposed to household and community owned companion & livestock animals and pests, the CHIP Consortium hypothesized that utilizing a One Health approach to co-produce behavior change & slum upgrading interventions may reduce this burden where other WASH & nutrition interventions have failed. / This study aimed to assess the feasibility of utilising a One Health approach to assess U5 infection & risk factor prevalence in Jaipurs urban slums prior to undertaking prospective cohort studies involving culture and culture independent sampling of U5s and animals across our study sites in Jaipur, Jakarta & Antofagasta. / Methods: We administered a Rapid Household Survey to 25 purposely selected households across six slums. The questionnaire evaluated infection prevalence, health seeking behaviors, the built environment, presence of animals & pests, and individual to household-level demographics. Associations were calculated using correlations among continuous variables to show strength of significance between continuous variables. / Results: We found a high incidence of infections in children under five at 40%. This was most significantly correlated with accessibility of sanitary toilets (r = .62) and household expenditure. Vaccination coverage and child characteristics (such as size) were minimally correlated, while the presence of animals (pets or pests) was not correlated; the latter was likely due to the design of the survey. / Conclusion: This study found a higher infection prevalence than previous studies. We also found higher correlations with infection incidence among household-level characteristics, indicating that effective interventions need to address both the built and socio-economic environments. A pilot prospective cohort study, which includes researcher observations for the presence of animals to account for inconsistencies in the survey, is now underway.

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