Carriage of antimicrobial-resistant bacteria in a high-density informal settlement in Kenya is associated with environmental risk-factors

Omulo, Sylvia; Lofgren, Eric T.; Lockwood, Svetlana; Thumbi, Samuel M.; Bigogo, Godfrey; Ouma, Alice; Verani, Jennifer R.; Juma, Bonventure; Njenga, M. Kariuki; Kariuki, Samuel; McElwain, Terry F.; Palmer, Guy H.; Call, Douglas R.

doi:10.1186/s13756-021-00886-y

Antimicrobial Resistance & Infection Control

Table 2 Proportion of household responses (mean and 95% confidence interval) for questions regarding water, sanitation, and hygiene-related practices at enrollment (V1) and over nine sampling visits

From: Carriage of antimicrobial-resistant bacteria in a high-density informal settlement in Kenya is associated with environmental risk-factors

Water			Sanitation			Hygiene
	V1	Mean [95% CI]		V1	Mean [95% CI]		V1	Mean [95% CI]
Type of water source^a			Type of toilet used during daytime			Washed hands after urination only [last 3 toilet visits]
Private-protected	0.40	0.36 [0.29, 0.43]	Flush toilet	0.45	0.48 [0.46, 0.50]	1 out of 3 events	0.16	0.09 [0.06, 0.12]
Public-protected	0.52	0.61 [0.53, 0.69]	Ventilated-improved pit	0.03	0.04 [0.03, 0.05]	2 out of 3 events	0.20	0.14 [0.10, 0.18]
Private-unprotected	0.01	0.01 [0.00, 0.02]	Pit with slab	0.41	0.34 [0.32, 0.36]	All 3 events	0.64	0.77 [0.70, 0.84]
Public-unprotected	0.09	0.03 [− 0.01, 0.07]	Traditional pit latrine^d	0.12	0.13 [0.12, 0.14]	^cWashed with soap^c [yes]	0.80	0.83 [0.79, 0.87]
Time taken to go, collect water, and return			Households sharing same daytime toilet facility			Washed hands after defecation [last 3 toilet visits]
5 min or less	0.28	0.19 [0.16, 0.22]	1–10	0.21	0.20 [0.19, 0.21]	1 out of 3 events	0.08	0.02 [0.00, 0.04]
5–9 min	0.34	0.44 [0.39, 0.49]	11–50	0.30	0.26 [0.24, 0.28]	2 out of 3 events	0.18	0.10 [0.06, 0.14]
10–14 min	0.18	0.18 [0.15, 0.21]	51–100	0.44	0.33 [0.23, 0.43]	All 3 events	0.74	0.88 [0.83, 0.93]
≥ 15 min	0.20	0.19 [0.16, 0.22]	> 100	0.06	0.21 [0.11, 0.31]	Washed with soap^c [yes]	0.74	0.90 [0.85, 0.95]
Water unavailable at source in the last 14 days			Frequency of toilet cleaning during the last 14 days			Washed hands before feeding baby [last 3 feeding events]
1–6 days	0.44	0.13 [0.04, 0.22]	Daily	0.47	0.56 [0.53, 0.59]	1 out of 3 events	0.09	0.05 [0.04, 0.06]
7–14 days	0.08	0.02 [0.01, 0.03]	Alternate days	0.21	0.16 [0.13, 0.19]	2 out of 3 events	0.23	0.12 [0.07, 0.17]
Methods used to make water safer to drink^b			Occasionally	0.26	0.23 [0.22, 0.24]	All 3 events	0.67	0.83 [0.77, 0.89]
Boiling	0.65	0.52 [0.47, 0.57]	Location of daytime toilet facility			Washed with soap^c [yes]	0.69	0.86 [0.81, 0.91]
Chemical cleansers	0.54	0.62 [0.57, 0.67]	Within HH compound	0.30	0.32 [0.31, 0.33]	Location of hand-washing station
Frequency of water treatment in last 14 days^b			Outside HH compound	0.70	0.68 [0.67, 0.69]	Within household compound	0.25	0.25 [0.19, 0.31]
Every collection	0.71	0.75 [0.70, 0.80]	Type of toilet used during the night			Around kitchen area	0.32	0.45 [0.41, 0.49]
Occasionally	0.29	0.25 [0.20, 0.30]	Flush toilet	0.16	0.07 [0.04, 0.1]	Elsewhere [excl. kitchen/toilet]	0.46	0.37 [0.30, 0.44]
Last household water treatment^b			Ventilated-improved pit	0.03	0.04 [0.03, 0.05]	Nonspecific	0.61	0.59 [0.56, 0.62]
Today/yesterday	0.21	0.26 [0.23, 0.29]	Pit with concrete slab	0.39	0.37 [0.36, 0.38]	Time spent by the enrolled child outside household
2–6 days ago	0.67	0.63 [0.58, 0.68]	Traditional pit latrine	0.12	0.13 [0.12, 0.14]	1–2 h	0.15	0.14 [0.13, 0.15]
≥ 7 days ago	0.11	0.11 [0.08, 0.14]	Bucket/plastic bags	0.29	0.35 [0.32, 0.38]	3–4 h	0.21	0.19 [0.16, 0.22]
			Open areas around HH	0.02	0.03 [0.02, 0.04]	5 + h	0.30	0.21 [0.16, 0.26]
						Places where the enrolled child spends time
						Plays in school compound	0.00	0.01 [− 0.03, 0.05]
						Within household environment	0.93	0.87 [0.83, 0.91]
						Relative in another household	0.07	0.12 [0.09, 0.15]
						Enrolled child eats soil [yes]	0.55	0.49 [0.37, 0.61]

Two hundred households were enrolled
HH household
^aA protected source prevents water contamination by the environment e.g., a source covered with a concrete slab or a completely covered tank
^bApplies only to households that reported treating water (mean = 44%)
^cApplies to those who reported washing hands mean = 80% (urination), 98% (defecation) or 87% (feeding baby)
^dSingle pit covered by a wooden, earthen, or concrete slab with a drop hole

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