The association between sibling care and infant exposure to faecal contamination and related diarrhoea risk in rural Gambia

Graphical Abstract. Infographic showing rural Gambia study linking young children’s ground exposure and caregiving patterns to diarrhoea risk. In low-income countries, infants and young children (IYC) who play on contaminated ground face increased diarrhoea risk. Where childcare is limited and mothers face multiple burdens, supportive interventions are needed. We aimed to describe IYC play and ground exposure in rural Gambia and examine associations with caregiving practices and reported diarrhoea. This cross-sectional study in the Central River Region included 735 households with IYC aged 6–36 months. We recorded IYC play, ground and domestic animal exposure, and care behaviours. Regression analysis assessed associations with caregiver-reported diarrhoea. IYC (median age 22 months, IQR 13–30) were mostly observed on the ground (87.1%) for a median of 106 min (IQR 50–211). In 84.4% of compounds, IYC shared ground space with livestock, mainly poultry (77%). Longer ground contact (median 93 min, IQR 46–195) increased diarrhoea risk (AOR 1.12). Care by older siblings versus adults reduced odds by 48% (AOR 0.52). The presence of poultry appeared protective (AOR 0.55, p = 0.057). Increased ground time correlated with diarrhoea prevalence in IYC, while older sibling care and poultry presence showed a protective effect. Further research might explore household care patterns among other responsibilities, gender time burdens and other childcare-related factors impacting diarrhoea risk.