Assessing the Infection Burden and Associated Risk Factors in Children under 5 Across Jaipur's Urban Slums: A Feasibility Study Using a One Health Approach
Authors: Manikam Logan , Rutherford Spencer , Emes David , Cupp Meghan , Sharma Radhika , Sarkar Dr Kaushik , Aisyah Dr Dewi , Field Dr Samantha , Hayward Prof Andrew , Altamirano Dr Hector , Batura Dr Neha , Dasgupta Prof Rajib , Haklay Prof Muki , Nix Dr Emily , Christen Paula , Lakhanpaul Prof Monica 
Published: January 2021

Purpose:
Infectious diseases are one of the leading causes of death among children under five (U5s) both in India and globally. This is worse in slum environments with poor access to water, sanitation and hygiene (WASH), good nutrition and a safe built environment. Globally, a One Health (i.e. human, animal and environment) approach is increasingly advocated for by the WHO-FAO-OIE tripartite to reduce infections and antimicrobial resistance. As under-5s living in peri-urban slums are exposed to household- and community-owned companion and livestock animals and pests, the CHIP consortium hypothesised that employing a One Health approach to co-produce behavioural change and slum upgrading interventions may reduce this burden where other WASH and nutrition interventions have failed. This study aimed to assess the feasibility of employing a One Health approach to assess under-5 infection and risk factor prevalence in Jaipurs peri-urban slums, prior to undertaking prospective cohort studies involving culture and culture-independent sampling of under-5s and animals across our study sites in Jaipur (Rajasthan, India), Jakarta (Indonesia) and Antofagasta (Chile).

Methods:
We administered a rapid household survey to 25 purposively selected households across six slums in Jaipur. The questionnaire used evaluated infection prevalence, healthseeking behaviours, the built environment, the presence of companion and livestock animals and pests, and individual- and household-level demographics. We displayed the correlations between infection incidence and a range of factors in our sample, and displayed the portion of children under 5 who experienced one or multiple episodes of ill health, categorised by a range of One Health factors.

Results:
Parents reported at least one recent episode of ill health for a large portion (40%) of under-5s within the last 30 days. 80% of under-5s had no access to safe drinking water; every household reported the presence of at least one kind of pest within the respondents own home; and 20% of under-5s feeding equipment was cleaned with water only. Only one household reported owning a companion or livestock animal, potentially reflecting confusion about the definition of these animals. The incidence of infection appeared to be related to WASH and socio-economic factors as expected.

Conclusion:
Safe drinking water, pest control and behavioural change surrounding the cleaning of under-5 feeding equipment should be given consideration in future research in this locale. Future studies should not rely solely on parent reporting of childrens symptoms cross referencing symptom reporting from multiple household members should be combined with culture and culture-independent sampling. Where possible, researchers should measure the presence of companion and livestock animals directly to avoid misinterpretation and to observe practices rather than relying on reporting alone.