Associations between Fecal Contamination of the Household Environment and Enteric Pathogen Detection in Children Living in Maputo, Mozambique

David A Holcomb ORCID logo ; Jackie Knee ORCID logo ; Zaida Adriano ; Drew Capone ORCID logo ; Oliver Cumming ORCID logo ; Erin Kowalsky ; Rassul Nalá ; Edna Viegas ; Jill R Stewart ORCID logo ; Joe Brown ORCID logo ; (2025) Associations between Fecal Contamination of the Household Environment and Enteric Pathogen Detection in Children Living in Maputo, Mozambique. Environment & health (Washington, D.C.), 3 (7). pp. 757-767. ISSN 2833-8278 DOI: 10.1021/envhealth.4c00283
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Environmental exposure to enteric pathogens is generally assessed using fecal indicators but relationships between markers of fecal contamination and actual exposure to enteric pathogens remain poorly characterized. We investigated whether <i>Escherichia coli</i> and two human fecal markers (HF183 and Mnif) in urban Mozambican household soil and drinking water were associated with detection of eight bacteria, three viruses, and three protozoa measured by multiplex reverse-transcription PCR and soil transmitted helminths assessed by microscopy in stool samples from children. We used mixed-effects logistic regression with marginal standardization to obtain a pooled estimate of the overall indicator-pathogen relationship while simultaneously estimating pathogen-specific associations that accounted for assessing multiple pathogens per sample. At least one pathogen was detected in 88% (169/192) of stool samples from children. Increasing drinking water <i>E. coli</i> gene concentration was associated with higher <i>Ascaris</i> prevalence, while human HF183 in drinking water was weakly associated with lower prevalence of the most common pathogens but was infrequently detected. No fecal marker in the soil was clearly associated with any pathogen. We did not find evidence to support human markers as reliable indicators of enteric pathogen carriage in a high-prevalence domestic setting and recommend targeting enteric pathogens directly.


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