Abstract:
In certain lower-income regions, poor infant health outcomes remain a key concern.
These include diarrhoea and infection which can impede development. Water, sanitation
and hygiene (WASH) interventions should block faecal-oral transmission and prevent
infection from pathogenic organisms. However, interventions have focused on
containing human faeces whilst overlooking the burden from domestic animals.
Interventions also often neglect the age- and behaviour-related pathways to infection
and are so not adequately tailored to mitigate it. This thesis sought to better understand
the risk factors and transmission pathways to infant infection in Ethiopia and how a
household playspace (HPS) might reduce this. Multiple methods were employed.
Initially, a literature review examined the contribution of domestic animals to infant
infection, malnutrition and household contamination. Following, two phases of
formative fieldwork used environmental and clinical sampling, anthropometry, survey,
and observational data to identify specific risk factors and transmission pathways
contributing to infection in rural Ethiopian households. Important was the effect of
keeping animals inside on maternal and infant hand and floor contamination (all
p<0.005), and with infant stools positive for Campylobacter (p=0.027, OR 3.5). WASH
facilities did not reduce contamination (p=0.76) nor the odds of infection (p>0.5).
Concurrent fieldwork involved the design and build of an HPS to block key
transmission pathways. Through a multi-stage, participatory design process, an HPS
prototype was developed and trialled in a feasibility trial. This aimed to determine the
feasibility of a definitive trial. The trial demonstrated good acceptance and adherence
among intervention households and multiple secondary benefits, including on maternal
time burden and infant injury prevention. Through multiple stages, this thesis describes
the impact of animal faecal contamination on domestic hygiene and infant infection risk
and how a WASH intervention component might mitigate this. Future interventions
must consider age-specific needs and the importance of overall domestic hygiene to
improve infant health.
