Prevalence of enteric pathogens in mothers and children from communities in the La Paz River Basin Bolivia; associations with water, sanitation, and hygiene conditions

Abstract

Enteric infections remain a major public health challenge in low- and middle-income countries, disproportionately affecting young children. We conducted a cross-sectional study to characterize the prevalence of enteropathogens among mothers and children from peri-urban and rural communities in the La Paz River Basin Bolivia, and to examine associations with water, sanitation, and hygiene (WASH) conditions. Fecal samples were analyzed by real-time PCR to detect 21 viral, bacterial, and parasitic pathogens, alongside household surveys and water quality assessments. Sixteen pathogens were detected, 85% of participants carried at least one pathogen, with frequent coinfections. The most prevalent pathogens were <i>Helicobacter pylori</i>, adenovirus, EPEC, <i>Giardia lamblia</i>, and <i>Shigella</i>. Pathogen carriage was higher in rural than in peri-urban settings, with bacterial infections predominating in the lower basin and viral infections in the upper basin. Children carried more viral and parasitic pathogens, while mothers had more bacterial pathogens. Significant mother-child concordance was observed for several pathogens, supporting shared household exposures. Enteric pathogen carriage was strongly associated with drinking water source, sanitation practices, housing quality, and hygiene behaviors, particularly reliance on cistern/spring water, open defecation, and inadequate hand hygiene. These findings highlight a substantial and heterogeneous burden of enteric infections, underscoring the need for integrated WASH interventions.