Is there a greater concentration of pathogens in child or adult feces? - And child faeces disposal practices
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TOPIC: Is there a greater concentration of pathogens in child or adult feces? - And child faeces disposal practices

Is there a greater concentration of pathogens in child or adult feces? - And child faeces disposal practices 08 Oct 2013 14:43 #5926

  • emilype
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I've heard it said that there is a greater concentration of pathogens in child feces than in adult feces. Does anyone have a reference for that or evidence that the opposite might be true?
Last Edit: 08 Oct 2013 15:23 by emilype.

Re: Is there a greater concentration of pathogens in child or adult feces? 08 Oct 2013 16:46 #5927

  • JKMakowka
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Hmm, can't point you to a reference off my head, but I *think* that is not really correct.

As far as I am aware, toddler feces, especially those still primarily breast fed are usually *perceived* as not dangerous, which is however not necessarily the case, especially when the child has diarrhea. In general as the immune system of a child is still weaker, you can maybe expect there to be more surviving pathogens in the stool in case of a disease incident.

So I guess the relatively low awareness combined with the potentially higher pathogen load, is where the idea comes from that child-feces are more dangerous. But I don't think that can be stated in general.

Can anyone else link to a good publication on that general topic?
Krischan Makowka
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Re: Is there a greater concentration of pathogens in child or adult feces? 08 Oct 2013 20:48 #5930

  • joeturner
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I am pretty sure I've read academic work that suggests there are more pathogens in children, but I don't recall where I saw it or the reasoning.

I have found this paper which (appears to) suggests this (see esp fig 1), I will do some more work and see if there what other sources there are.
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Previously trained and worked as a Soil Scientist and worked on projects composting sewage sludge.
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Re: Is there a greater concentration of pathogens in child or adult feces? 08 Oct 2013 22:39 #5931

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That graphic is slightly misleading, it only states the relative presence of different pathogens in the stool of diarrhea effected persons according to age-groups (in this case specifically for E. coli strains, the missing percentages to 100 are other causes like adenovirus etc. where no pathogenic E.coli were found in the stool samples).

This has basically no meaning in regards to pathogen concentration, e.g. the total level of risk.

At most one could maybe conclude that the feces from one age-group are more likely to be dangerous to the individuals from the same age-group (or that different ages groups have different vulnerabilities to certain pathogens as the authors seem to argue), but as I suspect the samples were taken in relative proximity, this rather just proves that different age-groups are likely to have different sources of infection due to different lifestyles.
Krischan Makowka
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Last Edit: 08 Oct 2013 22:42 by JKMakowka.

Re: Is there a greater concentration of pathogens in child or adult feces? 09 Oct 2013 08:26 #5934

  • joeturner
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JKMakowka wrote:
That graphic is slightly misleading, it only states the relative presence of different pathogens in the stool of diarrhea effected persons according to age-groups (in this case specifically for E. coli strains, the missing percentages to 100 are other causes like adenovirus etc. where no pathogenic E.coli were found in the stool samples).

This has basically no meaning in regards to pathogen concentration, e.g. the total level of risk.

At most one could maybe conclude that the feces from one age-group are more likely to be dangerous to the individuals from the same age-group (or that different ages groups have different vulnerabilities to certain pathogens as the authors seem to argue), but as I suspect the samples were taken in relative proximity, this rather just proves that different age-groups are likely to have different sources of infection due to different lifestyles.


Hmm. Well it is true that the samples were taken from individuals who had diarrhea, so the cases where none of the identified strains were identified either had no pathogens or had pathogens that were not measured. That said, more of the children had more of the measured pathogens.
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Last Edit: 09 Oct 2013 08:26 by joeturner.

Re: Is there a greater concentration of pathogens in child or adult feces? 09 Oct 2013 09:46 #5937

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I can't find anything much that has specifically compared pathogens in child faecal stools to adult stools.

Wouldn't we expect more children to pick up more infections (so that the children are 'reservoirs' of disease compared to adults), and hence have a higher risk of pathogens in faeces? Or do we say that infection rates are consistent across age groups in a given area?
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Previously trained and worked as a Soil Scientist and worked on projects composting sewage sludge.

Re: Is there a greater concentration of pathogens in child or adult feces? 09 Oct 2013 11:47 #5941

  • Florian
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joeturner wrote:
Wouldn't we expect more children to pick up more infections (so that the children are 'reservoirs' of disease compared to adults), and hence have a higher risk of pathogens in faeces?


Without being aware of related studies, this is what I'd expect as well.

There was no context given with the question, so I'd just like to add that even if child feces would indeed have generally higher pathogen load than adults, that wouldn't change a thing for sanitation and hygiene measures needed.
Florian Klingel
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Re: Is there a greater concentration of pathogens in child or adult feces? 09 Oct 2013 12:33 #5943

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Putting some more emphasis on how to deal with the feces from infants and toddlers, who generally are not using toilets yet, is probably needed though.
Not because they are more dangerous per se, but simply because their handling is usually given little attention (for example the diapers are simply washed by hand and the polluted wash-water thrown out just like other wash-water).
Krischan Makowka
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Last Edit: 09 Oct 2013 12:34 by JKMakowka.
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Re: Is there a greater concentration of pathogens in child or adult feces? 14 Oct 2013 13:24 #5995

  • F H Mughal
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Women (mothers) in the rural areas of Sindh, Pakistan, do not wash their hands, after anal cleaning of infants, because they believe infants' feces are harmless. This concept is in practice in Sindh since the last 100 years!

F H Mughal
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Re: Is there a greater concentration of pathogens in child or adult feces? 14 Oct 2013 13:37 #5996

  • joeturner
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Florian wrote:


There was no context given with the question, so I'd just like to add that even if child feces would indeed have generally higher pathogen load than adults, that wouldn't change a thing for sanitation and hygiene measures needed.


I have been thinking about this - if it could be shown that in an individual community, a particular group or age group was a source of continued reinfection, I think it is a reasonable suggestion to treat the faeces from that group differently to the wider community.

There are lots of 'ifs' there, but I don't think it follows that there could never be a differential need for sanitation and hygiene measures. If you have limited funds, it surely makes most sense to target those who are having most effect on the wider community (assuming, of course, that you actually know this rather than just guessing).

F H Mughal's comment is also interesting. If there is a group where there is obviously limited sanitation and hygiene, it would probably make good sense to target that group, particularly when they're especially susceptible such as mothers and small children.
I don't work for anyone, I am a philosopher interested to think about how we think about WASH and sanitation. All thoughts are mine alone, I am responsible for any errors.

Previously trained and worked as a Soil Scientist and worked on projects composting sewage sludge.
Last Edit: 14 Oct 2013 13:43 by joeturner.

Re: Is there a greater concentration of pathogens in child or adult feces? 14 Oct 2013 18:46 #5998

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Typhoid Mary obviously shouldn't be working in a kitchen, but I think what Florian meant is the the goal of proper sanitation is to contain and treat all of it regardless of the actual pathogen content (to be on the safe side).
Krischan Makowka
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Child Feces Disposal Practices 27 Feb 2014 07:37 #7526

  • F H Mughal
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A very recent paper by Fiona Majorin et al. (Majorin F, Freeman MC, Barnard S, Routray P, Boisson S, et al. (2014) Child Feces Disposal Practices in Rural Orissa: A Cross Sectional Study. PLoS ONE 9(2): e89551. doi:10.1371/journal.pone.0089551), gives an interesting overview and discussion on child feces disposal in Orissa, India.

The paper notes that in many low-income settings, nappies (i.e. diapers or cloth) and potties are rarely available or used, making the hygienic collection of young children's feces difficult; if collected, such feces are often disposed of in a manner that does not prevent further exposure to household members or contamination of water sources.

This is almost a similar situation that we have here in the rural areas of Sindh province of Pakistan. Since, it is the job of rural women to clean the child, they do so in most irresponsible manner. A woman would hold infant on her feet, such that the feet act as a channel. The feces are poorly dispersed with few mugs of water. Children, on the other hand, defecate in open channels (if they exist), or just outside the house.

This is serious, when read in conjunction with what the paper says: “the unsanitary disposal of child feces may present a greater health risk than that of adults. First, young children represent the highest incidence of enteric infections, and their feces are most likely to contain agents. Second, young children tend to defecate in areas where susceptible children could be exposed. Third, young children who are also most at risk of mortality and the serious sequelae associated with enteric infection are most likely to be exposed to these ambient agents due to the time they spend on the ground, their tendency to put fingers and fomites in their mouths, and common behaviors such as geophagia.”

The authors, and the forum colleagues, would be surprised to know that, in the rural areas here, the rural women still consider infants’ feces as harmless, and consequently, do not wash their hands with soap, after cleaning the infants.

There is one important conclusion in the paper. The paper says: “the Total Sanitation Campaign has not led to high levels of safe disposal of child feces.” Total Sanitation Campaign, now known as Nirmal Bharat Abhiyan, is India’s largest rural sanitation campaign. It is “a subsidy-based approach that seeks to create demand and provide subsidies to below the poverty line households towards construction of individual household latrines.”

This is in line with what I have stated in the forum’s another post, that a country should use a sanitation strategy that delivers in that particular settings; and, this may, or may not be, a flagship program.

The paper is attached. Enjoy!

F H Mughal
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