Childhood stunting is commonly observed in regions with poor sanitation and hygiene, due to the observed effect of infection on intestinal nutrient absorption. However, interventions aiming to improve sanitation have shown little effect on infant growth. Recent research suggests that residual contamination of hands and floors from domestic animals and their faeces, and subsequent ingestion via normal infant hand-to-mouth behaviours, may explain a lack of impact on stunting. Through microbial testing and survey and observational data, this formative study sought to characterise principle transmission pathways to infants in the domestic environment, considering sanitation, infant behaviours, key hygiene practices and animal exposure. These pilot results provides strong empirical evidence that animals and animal faeces are an important  major source of environmental contamination from TTC (thermotolerant coliform) bacteria across the domestic environment. Contamination of caregiver and infant hands and domestic floor surfaces within reach of the infant suggest infants are frequently exposed to faecal pathogens through linked transmission pathways. There was no evidence that coverage of water, sanitation and hygiene facilities mitigated TTC contamination across pathways. Both water, sanitation and hygiene and nutrition Iinterventions aiming to address pathogen transmission in to infants must consider contextual animal husbandry practices and the need to separate infants from animals in the domestic environment. Interventions can must assess whether reducing exposure to animal faecal contamination reduces child enteric illness and improves linear growth.

THE ROLE OF DOMESTIC ANIMALS IN THE BACTERIAL CONTAMINATION OF INFANT TRANSMISSION PATHWAYS: FORMATIVE EVIDENCE FROM RURAL ETHIOPIA