Environmental Exposures\nAssociated with Enteropathogen\nInfection in Six-Month-Old Children Enrolled in the ECoMiD Cohort\nalong a Rural–Urban Gradient in Northern Ecuador

Enteropathogens are major contributors to mortality and\nmorbidity,\nparticularly in settings with limited access to water, sanitation,\nand hygiene infrastructure. To assess transmission pathways associated\nwith enteropathogen infection, we measured household environmental\nconditions and assayed 22 enteropathogens using TaqMan Array Cards\nin stool samples from 276 six-month-old children living in communities\nalong a rural–urban gradient in Northern Ecuador. We utilized\nmultivariable models, risk factor importance, and distance-based statistical\nmethods to test factors associated with infection. Most children (89%)\ncarried at least one pathogen, and 72% carried two or more. Bacterial\ninfections (82% of participants) were more common than viruses (58%)\nor parasites (9.1%). Infants living in the urban site had decreased\ninfection risks compared to those in rural locations. Improved water\nand sanitation were most predictive of reduced infection risk. Improved\nwater was associated with decreased enterotoxigenic E. coli prevalence, and improved sanitation was associated\nwith lower prevalence of any infection and specifically norovirus.\nAnimal exposure was associated with increased <i>Salmonella</i> prevalence. Children measured during the rainy season had fewer\nviral and more bacterial infections. Identifying environmental exposures\nassociated with specific pathogen outcomes provides insights into\ntransmission pathways, which contribute critical information for developing\neffective strategies to improve child health.