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FN1Financial support: Valerie Bauza was supported by the National Science Foundation Graduate Research Fellowship Program under grant no. DGE-1144245 while conducting this work, and travel and supplies were supported by the Safe Global Water Institute (SGWI) and the Department of Civil and Environmental Engineering at the University of Illinois at Urbana-Champaign.
FN2Authors' addresses: Valerie Bauza, Thanh H. Nguyen, and Jeremy S. Guest, Department of Civil and Environmental Engineering, University of Illinois at Urbana-Champaign, Urbana, IL, E-mails: firstname.lastname@example.org, email@example.com, and firstname.lastname@example.org. R. M. Ocharo, Department of Sociology and Social Work, University of Nairobi, Nairobi, Kenya, E-mail: email@example.com.
Diarrhea is a leading cause of mortality in children under 5 years of age. We conducted a cross-sectional study of 54 children aged 3 months to 5 years old in Kibera, an urban slum in Nairobi, Kenya, to assess the relationship between caregiver-reported soil ingestion and child diarrhea. Diarrhea was significantly associated with soil ingestion (adjusted odds ratio = 9.9, 95% confidence interval = 2.1–47.5). Soil samples from locations near each household were also collected and analyzed for Escherichia coli and a human-associated Bacteroides fecal marker (HF183). Escherichia coli was detected in 100% of soil samples (mean 5.5 log colony forming units E. coli per gram of dry soil) and the Bacteroides fecal marker HF183 was detected in 93% of soil samples. These findings suggest that soil ingestion may be an important transmission pathway for diarrheal disease in urban slum settings.