Food-related risk factors for enteric pathogen detection in children aged 6-24 months living in a low-income informal area of Nairobi, Kenya: A cross-sectional study

Background: Enteric pathogen exposure is common among young children living in low-income settings and can have short- and long-term health consequences. Children between the ages of 6–24 months are particularly vulnerable as they experience increased exposure, including through the introduction of food and water, while their immune systems are still developing. The aim of this study was to estimate the prevalence of enteric pathogen detection and associated food-related risk factors among children 6–24 months old living in a densely populated, low-income neighbourhood of Nairobi, Kenya.Methods: We conducted a cross-sectional study among 537 households in the Dagoretti Division of Nairobi, Kenya. We collected stool from one child aged 6–24 months in each household and tested it for 30 enteric pathogens using a TaqMan Array Card. The relationships between food-related risk factors and the detection of ≥1 enteric pathogens, ≥1 bacterial pathogens, ≥1 protozoan pathogens, ≥1 viral pathogens, and co-detection of ≥2 enteric pathogens were explored using multivariable logistic regression.Results: We detected one or more enteric pathogens in 88.5% of children, and over half of all children had two or more pathogens detected (mean 2.0, standard deviation 1.4). The most frequently detected pathogens were Enteroaggregative E. coli (55.7%), Enteropathogenic E. coli (46.4%), and Enterotoxigenic E. coli (16.2%). No food-related risk factors were associated with detection of one or more enteric pathogens. The caregiver using their hands to feed the child was associated with increased odds of detection of one or more protozoan pathogens (aOR 2.16, 95% CI 1.27 – 3.79, p=0.005) and co-detection of ≥2 pathogens (aOR 1.58, 95% CI 1.10 – 2.25, p=0.013). Consumption of several types of foods were associated with increased odds of pathogen detection, including bread, ugali, and vegetables. Conclusion: Children in this setting experience high levels of exposure to enteric pathogens during a critical period of their development, threatening their health and well-being. Our results suggest that foodborne exposure to enteric pathogens may be important for this vulnerable age group in this setting, highlighting the need for targeted, context-relevant food hygiene interventions.