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      Assessing the infection burden and associated risk factors in children under 5 across Jaipurs urban slums: A feasibility study using a One Health approach


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          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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          Author and article information

          UCL Open: Environment Preprint
          UCL Press
          3 May 2020
          [1 ] Department of Epidemiology and Public Health, UCL
          [2 ] Population, Policy and Practice Department, UCL
          [3 ] Jeevan Ashram Sanstha
          [4 ] Indonesia One Health University Network
          [5 ] Health and Wellbeing Department, Southwark Council
          [6 ] Bartlett School of Environmental Design and Engineering, UCL
          [7 ] Institute for Global Health, UCL
          [8 ] Jawaharlal Nehru University
          [9 ] Department of Geography, UCL

          This is an open access article distributed under the terms of the Creative Commons Attribution License (CC BY) 4.0, which permits unrestricted use, distribution and reproduction in any medium, provided the original author and source are credited.

          The datasets generated during and/or analysed during the current study are available from the corresponding author on reasonable request.

          Life sciences, Public health, Infectious disease & Microbiology

          One Health, Infectious Diseases, Children Under Five, Slum, India, Pollution and health


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