ArticlePLOS global public health2024
The development and validation of a survey to measure fecal-oral child exposure to zoonotic enteropathogens: The FECEZ Enteropathogens Index.
Article in PLOS global public health, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 9 papers.
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Who cites it
9 citing papers in PubMed.
- Household determinants of animal and human fecal contamination on floors and hands in northwestern coastal Ecuador.medRxiv : the preprint server for health sciences · 2026Article
- Antimicrobial-resistantmedRxiv : the preprint server for health sciences · 2026Article
- Formative research for a One Health, animal-inclusive approach to Community-Led Total Sanitation in rural Mali.One health (Amsterdam, Netherlands) · 2026Article
- Child exposure to animal feces and zoonotic pathogens in northwest Ecuador: A mixed-methods study.PLoS neglected tropical diseases · 2026Article
- Environmental exposures associated with the gut microbiome and resistome of pregnant women and children in Northwest Ecuador.Nature communications · 2025Article
- Prenatal and postnatal environmental influences on child growth trajectories across a rural-urban gradient: an analysis of the ECoMiD longitudinal birth cohort.medRxiv : the preprint server for health sciences · 2025Article
- Environmental Exposures and the Human Gut Resistome in Northwest Ecuador.medRxiv : the preprint server for health sciences · 2025Article
- Environmental Exposures Associated with Enteropathogen Infection in Six-Month-Old Children Enrolled in the ECoMiD Cohort along a Rural-Urban Gradient in Northern Ecuador†.Environmental science & technology · 2025Article
- The development and validation of a survey to measure fecal-oral child exposure to zoonotic enteropathogens: The FECEZ Enteropathogens Index.PLOS global public health · 2024Article
Corrections and comments
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Authors and funding
8 authors.
Funding
Abstract
Child exposure to animal feces and associated enteropathogens contribute to a significant burden of disease in low- and middle-income countries. However, there are no standardized, validated survey-based approaches to enable accurate assessment of child exposure to zoonotic enteropathogens. We developed and validated a survey-based measure of exposure, the fecal-oral child exposure to zoonotic enteropathogens Index (the FECEZ Enteropathogens Index). First, we identified critical attributes of child exposure through in-depth interviews (IDIs) in Ecuador among individuals who care for animals (n = 29) and mothers of children under two years old (n = 58), and through a systematic review of existing exposure measures. Second, based on these findings, we developed a 105-question survey and administered it to 297 mothers with children under age five. Third, we refined the survey, using principal component analysis to determine the optimal number of components. The final index consisted of 34 items across two sub-domains: the child Environment and child Behavior. Lastly, we compared index scores to two commonly used, unvalidated measures of child exposure-maternal reported household animal ownership and presence of animal feces. Using the FECEZ Enteropathogens Index revealed varying degrees of exposure in our study population, with only two children having no exposure. In contrast, if we had used animal ownership or the presence of animal feces as a measure of exposure, 44% and 33% of children would have been classified as having no exposure, respectively. These common binary exposure measures may be inadequate because they do not provide sufficient information to identify the relative risk of zoonotic pathogen exposure. The FECEZ Enteropathogens Index overcomes this limitation, advancing our ability to assess exposure by quantifying the multiple components of child exposure to zoonotic enteropathogens with higher resolution. Additional testing and evaluation of the index is needed to ensure its reliability, validity, and cross-cultural equivalence in other contexts.
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Registered trials
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