This review synthesises the latest understanding of key pathways of fecal microbe ingestion by infants and young children (IYC) and their links to diarrhoea, environmental enteric dysfunction, and poor nutrition and development outcomes.
Specifically, the review sought to:
- consider both human and animal sources of fecal contamination and the pathways presenting major exposure risks to IYC, including sources and pathways previously underemphasized;
- to the extent possible, seek to understand the relative potential importance of the various pathways in terms of magnitude of pathogen transmission;
- examine technological and behavioral interventions to disrupt the transmission pathways (including established sanitation and hygiene measures) as well as interventions that address the underemphasized pathways, such as clean play spaces, animal husbandry, IYC feeding practices, and IYC-focused sanitation and hygiene behaviours;
- and, identify areas of priority for implementation research to address the issue of clean play spaces for infants and young children.
The findings of the literature review will inform the design of research to measure the additive effects of specific measures to reduce IYC exposure to fecal pathogens and other fecal microbes in their home environments when coupled with independent or integrated sanitation and hygiene and nutrition interventions.