Browsing by Author "Tulu, Tizita"
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Item Open Access Do domestic animals contribute to bacterial contamination of infant transmission pathways? Formative evidence from Ethiopia(IWA Publishing, 2019-08-26) Budge, Sophie; Hutchings, Paul; Parker, Alison; Tyrrel, Sean; Tulu, Tizita; Gizaw, Mesfin; Garbutt, CamilaChild stunting is associated with poor water, sanitation and hygiene (WASH), partly due to the effect of infection on intestinal nutrient absorption. WASH interventions, however, show little effect on growth. A hypothesis is that bacterial contamination of hands and floors from domestic animals and their faeces, and subsequent ingestion via infant hand-to-mouth behaviours, may explain this. This formative study used microbial testing and survey and observational data from 20 households in Ethiopia to characterise principle bacterial transmission pathways to infants, considering WASH facilities and practices, infant behaviours and animal exposure. Microbial swabbing showed the contamination of hands and floor surfaces from thermotolerant coliform bacteria. Animal husbandry practices, such as keeping animals inside, contributed significantly (all p < 0.005). There was no evidence that latrine facilities mitigated contamination across infant (p = 0.76) or maternal (p = 0.86) hands or floor surfaces (p = 0.36). This small study contributes to the evidence that animal faeces are an important source of domestic bacterial contamination. The results imply that interventions aiming to reduce pathogen transmission to infants should think beyond improving WASH and also consider the need to separate infants and animals in the home. Intervention studies will be required to determine whether this reduces infant infection and improves linear growth.Item Open Access Do domestic animals contribute to bacterial contamination of infant transmission pathways? Formative evidence from Ethiopia(IWA Publishing, 2019-08-26) Budge, Sophie; Hutchings, Paul; Parker, Alison; Tyrrel, Sean; Tulu, Tizita; Gizaw, Mesfin; Garbutt, CamilaChild stunting is associated with poor water, sanitation and hygiene (WASH), partly due to the effect of infection on intestinal nutrient absorption. WASH interventions however show little effect on growth. A hypothesis is that bacterial contamination of hands and floors from domestic animals and their faeces, and subsequent ingestion via infant hand-to-mouth behaviours, may explain this. This formative study used microbial testing and survey and observational data from twenty households in Ethiopia to characterise principle bacterial transmission pathways to infants, considering WASH facilities and practices, infant behaviours and animal exposure. Microbial swabbing showed contamination of hands and floor surfaces from thermotolerant coliform (TTC) bacteria. Animal husbandry practices, such as keeping animals inside, contributed significantly (all p<0.005). There was no evidence that latrine facilities mitigated contamination across infant (p=0.76) or maternal (p=0.86) hands or floor surfaces (p=0.36). This small study contributes to the evidence that animal faeces are an important source of domestic bacterial contamination. The results imply that interventions aiming to reduce pathogen transmission to infants should think beyond improving WASH and also consider the need to separate infants and animals in the home. Intervention studies will be required to determine whether this reduces infant infection and improves linear growth.Item Open Access Multi-sectoral participatory design of a babyWASH playspace for rural Ethiopian households(American Society of Tropical Medicine and Hygiene, 2021-03-03) Budge, Sophie; Parker, Alison; Hutchings, Paul; Garbutt, Camila; Rosenbaum, Julia; Tulu, Tizita; Woldemedhin, Fitsume; Jemal, Mohammedyasin; Engineer, Bhavin; Williams, LeonGrowing evidence suggests current water, sanitation, and hygiene interventions do not improve domestic hygiene sufficiently to improve infant health, nor consider the age-specific behaviors which increase infection risk. A household playspace (HPS) is described as one critical intervention to reduce direct fecal–oral transmission within formative growth periods. This article details both the design and development (materials and methods), and testing (results) of a HPS for rural Ethiopian households. Design and testing followed a multi-sectoral, multistep participatory process. This included a focus group discussion (FGD), two user-centered and participatory design workshops in the United Kingdom and Ethiopia, discussions with local manufacturers, and a Trials by Improved Practices (TIPs) leading to a final prototype design. Testing included the FGD and TIPs study and a subsequent randomized controlled feasibility trial in Ethiopian households. This multi-sectoral, multistage development process demonstrated a HPS is an acceptable and feasible intervention in these low-income, rural subsistence Ethiopian households. A HPS may help reduce fecal–oral transmission and infection—particularly in settings where free-range domestic livestock present an increased risk. With the need to better tailor interventions to improve infant health, this article also provides a framework for future groups developing similar material inputs and highlights the value of participatory design in this field