Ballard April M, Haardörfer Regine, Angulo Betty Corozo, Freeman Matthew C, Eisenberg Joseph N S, Lee Gwenyth O, Levy Karen, Caruso Bethany A
Department of Population Health Sciences, Georgia State University School of Public Health, Atlanta, Georgia, United States of America.
Gangarosa Department of Environmental Health, Emory University Rollins School of Public Health, Atlanta, Georgia, United States of America.
PLOS Glob Public Health. 2024 Sep 10;4(9):e0002690. doi: 10.1371/journal.pgph.0002690. eCollection 2024.
Child exposure to animal feces and associated enteropathogens contribute to a significant burden of disease in low- and middle-income countries. However, there are no standardized, validated survey-based approaches to enable accurate assessment of child exposure to zoonotic enteropathogens. We developed and validated a survey-based measure of exposure, the fecal-oral child exposure to zoonotic enteropathogens Index (the FECEZ Enteropathogens Index). First, we identified critical attributes of child exposure through in-depth interviews (IDIs) in Ecuador among individuals who care for animals (n = 29) and mothers of children under two years old (n = 58), and through a systematic review of existing exposure measures. Second, based on these findings, we developed a 105-question survey and administered it to 297 mothers with children under age five. Third, we refined the survey, using principal component analysis to determine the optimal number of components. The final index consisted of 34 items across two sub-domains: the child Environment and child Behavior. Lastly, we compared index scores to two commonly used, unvalidated measures of child exposure-maternal reported household animal ownership and presence of animal feces. Using the FECEZ Enteropathogens Index revealed varying degrees of exposure in our study population, with only two children having no exposure. In contrast, if we had used animal ownership or the presence of animal feces as a measure of exposure, 44% and 33% of children would have been classified as having no exposure, respectively. These common binary exposure measures may be inadequate because they do not provide sufficient information to identify the relative risk of zoonotic pathogen exposure. The FECEZ Enteropathogens Index overcomes this limitation, advancing our ability to assess exposure by quantifying the multiple components of child exposure to zoonotic enteropathogens with higher resolution. Additional testing and evaluation of the index is needed to ensure its reliability, validity, and cross-cultural equivalence in other contexts.
在低收入和中等收入国家，儿童接触动物粪便及相关肠道病原体是疾病负担的一个重要因素。然而，目前尚无标准化、经过验证的基于调查的方法来准确评估儿童接触人畜共患肠道病原体的情况。我们开发并验证了一种基于调查的接触测量方法——儿童粪便 - 口腔接触人畜共患肠道病原体指数（FECEZ肠道病原体指数）。首先，我们通过在厄瓜多尔对照顾动物的个体（n = 29）和两岁以下儿童的母亲（n = 58）进行深入访谈（IDI），以及对现有接触测量方法进行系统回顾，确定了儿童接触的关键属性。其次，基于这些发现，我们开发了一份包含105个问题的调查问卷，并将其发放给297名有五岁以下儿童的母亲。第三，我们使用主成分分析来确定最佳成分数量，对调查问卷进行了优化。最终指数由两个子领域的34个项目组成：儿童环境和儿童行为。最后，我们将指数得分与两种常用的、未经验证的儿童接触测量方法——母亲报告的家庭动物所有权和动物粪便的存在情况进行了比较。使用FECEZ肠道病原体指数显示，我们研究人群中的接触程度各不相同，只有两名儿童没有接触。相比之下，如果我们使用动物所有权或动物粪便的存在作为接触的衡量标准，分别会有44%和33%的儿童被归类为没有接触。这些常见的二元接触测量方法可能不够充分，因为它们没有提供足够的信息来确定人畜共患病原体接触的相对风险。FECEZ肠道病原体指数克服了这一局限性，通过以更高的分辨率量化儿童接触人畜共患肠道病原体的多个成分，提高了我们评估接触情况的能力。需要对该指数进行进一步的测试和评估，以确保其在其他环境中的可靠性、有效性和跨文化等效性。
