Study finds high levels of enteric pathogens in children from Alabama’s rural areas, highlights sanitation issues


In a current examine revealed in the US (U.S.) Facilities for Illness Management and Prevention’s (CDC Emerging Infectious Diseases Journal, a group of scientists carried out a cross-sectional evaluation of stool samples from kids in Alabama’s Black Belt area to find out the enteric pathogen prevalence and the danger components related to publicity to such pathogens.

Examine: Risk Factors for Enteric Pathogen Exposure among Children in Black Belt Region of Alabama, USA. Picture Credit score: Kateryna Kon / Shutterstock


Alabama’s Black Belt area has been so named as a result of wealthy, clayey black soil discovered within the area. Exterior of areas reminiscent of cities and cities which have typical sewage methods, the residents of rural areas within the area do not need sufficient sanitation amenities. Moreover, the soil’s excessive clay content material reduces floor infiltration, inflicting home wastewater to be discharged near the floor. The counties that fall inside the area are additionally a few of Alabama’s poorest areas, and the unaffordability of septic system options has resulted in ineffective or non-existent wastewater disposal methods.

Improperly managed human feces may be transported again to people via numerous fecal-oral pathways, reminiscent of contaminated consuming water, flies, palms, fomites, and soil. Downstream contamination of consuming water sources and meals may cause enteric pathogen infections, leading to diarrheal ailments and, ultimately, environmental enteric dysfunction, cognitive impairments, immune system issues, and development deficits.

In regards to the examine

Within the current examine, the scientists carried out a cross-sectional evaluation of fecal samples collected from near 500 kids within the Black Belt area and used molecular strategies to find out the enteric pathogen prevalence within the samples. In addition they aimed to determine the enteric pathogen-associated danger components to know the well being burden resulting from poor sanitization amenities in rural areas and to evaluate the infrastructural modifications wanted to handle this public well being downside.

The examine was a part of a extra intensive examine carried out in rural Alabama to survey helminths and was carried out utilizing community-based participatory analysis ideas that intention to work with stakeholders locally. Youngsters between the ages of two and 18 have been included within the examine, and all the youngsters in every family have been inspired to take part. Stool assortment kits have been supplied to all the youngsters, and samples have been collected for 3 bowel actions.

The individuals have been additionally required to finish a questionnaire to supply details about demographic traits, family sanitation infrastructure, and potential publicity to enteric pathogens. All individuals have been monetarily compensated for his or her participation within the examine.

The stool samples have been initially visually inspected to rule out contamination of non-human origin, reminiscent of filth, animal hair, or something of atypical morphology. Complete nucleic acids have been then extracted from the samples, and digital polymerase chain response (dPCR) was used to additional display screen for human mitochondrial deoxyribonucleic acid (DNA). The samples have been screened for the presence of 30 enteric pathogens, together with Acanthamoeba species, Cyclospora cayetanensi, Clostridioides difficile, Escherichia coli, Giardia species, Entamoeba species, Shigella species, Helicobacter pylori, Salmonella species, extreme acute respiratory syndrome coronavirus 2 (SARS-CoV-2), and lots of extra.

The info was analyzed utilizing Poisson regression to calculate the adjusted and unadjusted danger ratios and to find out whether or not the impartial variables such because the sanitation infrastructure in a family, existence of a water connection, stories of uncooked sewage in and across the house, and demographic components and up to date journey historical past of the kid predict the detection of nucleic acids from a number of enteric pathogens within the stool samples.


The outcomes indicated the presence of quite a few enteric pathogens within the stool samples collected from kids residing within the Black Belt area of Alabama. Moreover, the discharge of fecal waste immediately into the setting across the households via straight pipes was not linked to the next danger of enteric pathogen detection within the stool samples in comparison with the traditional sewage disposal mechanisms.

Nonetheless, the examine discovered that effectively water consumption was linked to the next chance of detecting enteric pathogens within the stool samples, indicating groundwater contamination resulting from a scarcity of correct sanitation amenities. The soil’s excessive clay content material causes repeated shrinking and swelling resulting from desiccation and moistening, which might result in fecal waste getting transported from improperly functioning septic tanks or discharges from straight pipes into the groundwater.

The collective public well being impacts of improper sanitation spotlight the necessity for brand spanking new fashions of delivering and managing sanitation infrastructure to households within the Black Belt area.


General, the findings recommended that whereas sanitation amenities involving straight pipes that discharged fecal waste into the setting weren’t immediately linked to a rise in enteric pathogen detection in stool samples, the fecal contamination of groundwater within the Black Belt area of Alabama was probably related to a rise within the danger of enteric pathogen detection. Households that used effectively water versus a water utility service have been at the next danger of contracting enteric pathogens.

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