Animals in child sleeping spaces and unimproved sanitation associated with diarrhea among young children in the Democratic Republic of the Congo: WASHmobile PICHA7 prospective cohort study

Background: Exposure to animal and human feces in the household environment is associated with diarrheal diseases in young children. The objective of this study was to identify exposure pathways to fecal pathogens for young children that are significant contributors to diarrheal disease to allow for targeted water, sanitation, and hygiene (WASH) interventions on these pathways. Methods: The WASHmobile Preventative Intervention for Cholera for 7 Days prospective cohort study was conducted in urban Bukavu, South Kivu province, Democratic Republic of the Congo. The cohort study of 794 children under 5 years of age included monthly diarrhea surveillance and unannounced spot checks to assess WASH behaviors and conditions over a 12-month period. Caregiver report of child mouthing of fomites was also obtained during monthly visits. Results: The presence of animals in the child's sleeping space (odds ratio (OR): 1.87; 95% confidence interval (CI): 1.14, 3.08), unimproved sanitation (OR: 2.27; 95% CI 1.19, 4.33), and consumption of food outside the household (OR: 1.88; 95% CI 1.16, 3.06) were significantly associated with diarrhea during the subsequent month.Chickens [OR: 3.38; 95% CI: 2.05, 5.59) and cats [OR 3.9; 95% CI: 1.46, 10.46] in the child’s sleeping space was also associated with significantly higher odds of diarrhea in the subsequent month. Conclusions: These results demonstrate the need for WASH interventions targeted at reducing child contact with animal feces in the indoor household environment and improved sanitation, to reduce exposure to fecal pathogens for susceptible pediatric populations.