Unsafe Child Feces Disposal is Associated with Environmental Enteropathy and Impaired Growth

Christine Marie George, Lauren Oldja, Jamie Perin, R. Bradley Sack, Shwapon Biswas, Shahnawaz Ahmed, Mohammad Shahnaij, Rashidul Haque, Tahmina Parvin, Ishrat J. Azmi, Sazzadul Islam Bhuyian, Kaisar A. Talukder, Abu G. Faruque

Research output: Contribution to journalArticlepeer-review

24 Scopus citations


Objective To investigate the relationship between unsafe child feces disposal, environmental enteropathy, and impaired growth, we conducted a prospective cohort study of 216 young children in rural Bangladesh. Study design Using a prospective cohort study design in rural Bangladesh, unsafe child feces disposal, using the Joint Monitoring Program definition, was assessed using 5-hour structured observation by trained study personnel as well as caregiver reports. Anthropometric measurements were collected at baseline and at a 9-month follow-up. Stool was analyzed for fecal markers of environmental enteropathy: alpha-1-antitrypsin, myeloperoxidase, neopterin (combined to form an environmental enteropathy disease activity score), and calprotectin. Findings Among 216 households with young children, 84% had an unsafe child feces disposal event during structured observation and 75% had caregiver reported events. There was no significant difference in observed unsafe child feces disposal events for households with or without an improved sanitation option (82% vs 85%, P =.72) or by child's age (P =.96). Children in households where caregivers reported unsafe child feces disposal had significantly higher environmental enteropathy scores (0.82-point difference, 95% CI 0.11-1.53), and significantly greater odds of being wasted (weight-for-height z score <−2 SDs) (9% vs 0%, P =.024). In addition, children in households with observed unsafe feces disposal had significantly reduced change in weight-for-age z-score (−0.34 [95% CI −0.68, −0.01] and weight-for-height z score (−0.52 [95% CI −0.98, −0.06]). Conclusion Unsafe child feces disposal was significantly associated with environmental enteropathy and impaired growth in a pediatric population in rural Bangladesh. Interventions are needed to reduce this high-risk behavior to protect the health of susceptible pediatric populations.

Original languageEnglish (US)
Pages (from-to)43-49
Number of pages7
JournalJournal of Pediatrics
StatePublished - Sep 1 2016


  • Bangladesh
  • child growth
  • environmental contamination
  • intestinal inflammation

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health


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