TY - JOUR
T1 - Mouthing of Soil Contaminated Objects is Associated with Environmental Enteropathy in Young Children
AU - Morita, Tomohiko
AU - Perin, Jamie
AU - Oldja, Lauren
AU - Biswas, Shwapon
AU - Sack, R. Bradley
AU - Ahmed, Shahnawaz
AU - Haque, Rashidul
AU - Bhuiyan, Nurul Amin
AU - Parvin, Tahmina
AU - Bhuyian, Sazzadul Islam
AU - Akter, Mahmuda
AU - Talukder, Kaisar A.
AU - Shahnaij, Mohammad
AU - Faruque, Abu G.
AU - George, Christine Marie
N1 - Publisher Copyright:
© 2017 John Wiley & Sons Ltd
PY - 2017/6
Y1 - 2017/6
N2 - Objective: To characterise childhood mouthing behaviours and to investigate the association between object-to-mouth and food-to-mouth contacts, diarrhoea prevalence and environmental enteropathy. Methods: A prospective cohort study was conducted of 216 children ≤30 months of age in rural Bangladesh. Mouthing contacts with soil and food and objects with visible soil were assessed by 5-h structured observation. Stool was analysed for four faecal markers of intestinal inflammation: alpha-1-antitrypsin, myeloperoxidase, neopterin and calprotectin. Results: Overall 82% of children were observed mouthing soil, objects with visible soil, or food with visible soil during the structured observation period. Sixty two percent of children were observed mouthing objects with visible soil, 63% were observed mouthing food with visible soil, and 18% were observed mouthing soil only. Children observed mouthing objects with visible soil had significantly elevated faecal calprotectin concentrations (206.81 μg/g, 95% confidence interval [CI]: 6.27, 407.36). There was also a marginally significant association between Escherichia coli counts in soil from a child's play space and the prevalence rate of diarrhoea (diarrhoea prevalence ratio: 2.03, 95% CI 0.97, 4.25). Conclusion: These findings provide further evidence to support the hypothesis that childhood mouthing behaviour in environments with faecal contamination can lead to environmental enteropathy in susceptible paediatric populations. Furthermore, these findings suggest that young children mouthing objects with soil, which occurred more frequently than soil directly (60% vs. 18%), was an important exposure route to faecal pathogens and a risk factor for environmental enteropathy.
AB - Objective: To characterise childhood mouthing behaviours and to investigate the association between object-to-mouth and food-to-mouth contacts, diarrhoea prevalence and environmental enteropathy. Methods: A prospective cohort study was conducted of 216 children ≤30 months of age in rural Bangladesh. Mouthing contacts with soil and food and objects with visible soil were assessed by 5-h structured observation. Stool was analysed for four faecal markers of intestinal inflammation: alpha-1-antitrypsin, myeloperoxidase, neopterin and calprotectin. Results: Overall 82% of children were observed mouthing soil, objects with visible soil, or food with visible soil during the structured observation period. Sixty two percent of children were observed mouthing objects with visible soil, 63% were observed mouthing food with visible soil, and 18% were observed mouthing soil only. Children observed mouthing objects with visible soil had significantly elevated faecal calprotectin concentrations (206.81 μg/g, 95% confidence interval [CI]: 6.27, 407.36). There was also a marginally significant association between Escherichia coli counts in soil from a child's play space and the prevalence rate of diarrhoea (diarrhoea prevalence ratio: 2.03, 95% CI 0.97, 4.25). Conclusion: These findings provide further evidence to support the hypothesis that childhood mouthing behaviour in environments with faecal contamination can lead to environmental enteropathy in susceptible paediatric populations. Furthermore, these findings suggest that young children mouthing objects with soil, which occurred more frequently than soil directly (60% vs. 18%), was an important exposure route to faecal pathogens and a risk factor for environmental enteropathy.
KW - child behaviour
KW - diarrhoea
KW - environmental enteropathy
KW - environmental exposure
KW - mouthing
KW - non-dietary ingestion
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U2 - 10.1111/tmi.12869
DO - 10.1111/tmi.12869
M3 - Article
C2 - 28319300
AN - SCOPUS:85018622992
SN - 1360-2276
VL - 22
SP - 670
EP - 678
JO - Tropical Medicine and International Health
JF - Tropical Medicine and International Health
IS - 6
ER -