Domestic animals and hygiene on infants' risk of contact and exposure to animal faeces in urban neighbourhoods in Kenya: A mixed methods cohort study

Contact with animals or their faeces could expose infants to zoonotic pathogens associated with diarrheal infections in infants. This study investigated the risk of infants' exposure to domestic animals and their faeces in low- and middle-income urban neighbourhoods in Kenya. A total of 275 caregivers with infants aged 0-12 months from low- income and middle-income neighbourhoods in Nairobi and Kisumu were enrolled in a cohort prospective study and completed the survey. Of these, 136 belonged to low-income and 139 to middle-income neighbourhoods. To ensure balanced recruitment of infants in each neighbourhood, community health promoters who provided a listing of caregivers and their infants aged 0-12 months to form the sampling frame. Recruitment was based on the target for each infant age cluster. Negative Binomial, Zero-Inflated Poisson (ZIP), and Zero-Inflated Negative Binomial (ZINB) regression models were used to test for the rate of infant contact (per hour) with animals and animal faeces and logistic regression for infant exposure to surfaces contaminated with animal faeces. Bayes factors were used for model selection. Overall, 27.9 % of the studied low-income neighbourhood households and 30.9 % of those in middle-income neighbourhoods owned domestic animals. Infants in households who owned cats had a 109 % increase (95 %CI = 59 %, 173 %) in contact compared to non-cat owning households. There was a 22 % decrease (95 %CI = 7 %, 42 %) in infant contact with non-feline animals compared to households that did not own them. The rate of contact with animals, animal faeces, or surfaces polluted by animal faeces increased with age. Full penning of household owned animals reduced the rate of infant contact with animal faeces by 93 % (95 %CI = 16 %, 99.7 %), compared to no penning, and reduced the odds of infant contact with a contaminated surface by 97 % (95 %CI = 42 %-99.9 %), compared to no penning. Self-reported animal faeces disposal practices were not significantly associated with a reduced rate of infant contact with animal faeces or touching surfaces contaminated by animal faeces. The study findings infants in households that owned cats have an increased contact with them while full penning of domestic animals is associated with reduced risk of exposure to animal faeces or contaminated surfaces.