The development and validation of a survey to measure fecal-oral child exposure to zoonotic enteropathogens: The FECEZ Enteropathogens Index.

Autor:	Ballard AM; Department of Population Health Sciences, Georgia State University School of Public Health, Atlanta, Georgia, United States of America.; Gangarosa Department of Environmental Health, Emory University Rollins School of Public Health, Atlanta, Georgia, United States of America., Haardörfer R; Department of Behavioral, Social and Health Education Sciences, Emory University Rollins School of Public Health, Atlanta, Georgia, United States of America., Angulo BC; Universidad Técnica Luis Vargas Torres de Esmeraldas, Esmeraldas, Ecuador., Freeman MC; Gangarosa Department of Environmental Health, Emory University Rollins School of Public Health, Atlanta, Georgia, United States of America.; Hubert Department of Global Health, Emory University Rollins School of Public Health, Atlanta, Georgia, United States of America., Eisenberg JNS; Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, Michigan, United States of America., Lee GO; Rutgers Global Health Institute and Department of Biostatistics and Epidemiology, Rutgers School of Public Health, Piscataway, New Jersey, United States of America., Levy K; Department of Environmental and Occupational Health Sciences, University of Washington School of Public Health, Seattle, Washington, United States of America., Caruso BA; Gangarosa Department of Environmental Health, Emory University Rollins School of Public Health, Atlanta, Georgia, United States of America.; Department of Behavioral, Social and Health Education Sciences, Emory University Rollins School of Public Health, Atlanta, Georgia, United States of America.; Hubert Department of Global Health, Emory University Rollins School of Public Health, Atlanta, Georgia, United States of America.
Jazyk:	angličtina
Zdroj:	PLOS global public health [PLOS Glob Public Health] 2024 Sep 10; Vol. 4 (9), pp. e0002690. Date of Electronic Publication: 2024 Sep 10 (Print Publication: 2024).
DOI:	10.1371/journal.pgph.0002690
Abstrakt:	Child exposure to animal feces and associated enteropathogens contribute to a significant burden of disease in low- and middle-income countries. However, there are no standardized, validated survey-based approaches to enable accurate assessment of child exposure to zoonotic enteropathogens. We developed and validated a survey-based measure of exposure, the fecal-oral child exposure to zoonotic enteropathogens Index (the FECEZ Enteropathogens Index). First, we identified critical attributes of child exposure through in-depth interviews (IDIs) in Ecuador among individuals who care for animals (n = 29) and mothers of children under two years old (n = 58), and through a systematic review of existing exposure measures. Second, based on these findings, we developed a 105-question survey and administered it to 297 mothers with children under age five. Third, we refined the survey, using principal component analysis to determine the optimal number of components. The final index consisted of 34 items across two sub-domains: the child Environment and child Behavior. Lastly, we compared index scores to two commonly used, unvalidated measures of child exposure-maternal reported household animal ownership and presence of animal feces. Using the FECEZ Enteropathogens Index revealed varying degrees of exposure in our study population, with only two children having no exposure. In contrast, if we had used animal ownership or the presence of animal feces as a measure of exposure, 44% and 33% of children would have been classified as having no exposure, respectively. These common binary exposure measures may be inadequate because they do not provide sufficient information to identify the relative risk of zoonotic pathogen exposure. The FECEZ Enteropathogens Index overcomes this limitation, advancing our ability to assess exposure by quantifying the multiple components of child exposure to zoonotic enteropathogens with higher resolution. Additional testing and evaluation of the index is needed to ensure its reliability, validity, and cross-cultural equivalence in other contexts. Competing Interests: The authors have declared that no competing interests exist. (Copyright: © 2024 Ballard et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)
Databáze:	MEDLINE
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