TY - JOUR
T1 - Unsafe Child Feces Disposal is Associated with Environmental Enteropathy and Impaired Growth
AU - George, Christine Marie
AU - Oldja, Lauren
AU - Perin, Jamie
AU - Sack, R. Bradley
AU - Biswas, Shwapon
AU - Ahmed, Shahnawaz
AU - Shahnaij, Mohammad
AU - Haque, Rashidul
AU - Parvin, Tahmina
AU - Azmi, Ishrat J.
AU - Bhuyian, Sazzadul Islam
AU - Talukder, Kaisar A.
AU - Faruque, Abu G.
N1 - Publisher Copyright:
© 2016 Elsevier Inc.
PY - 2016/9/1
Y1 - 2016/9/1
N2 - 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.
AB - 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.
KW - Bangladesh
KW - child growth
KW - environmental contamination
KW - intestinal inflammation
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U2 - 10.1016/j.jpeds.2016.05.035
DO - 10.1016/j.jpeds.2016.05.035
M3 - Article
C2 - 27318380
AN - SCOPUS:84993124673
SN - 0022-3476
VL - 176
SP - 43
EP - 49
JO - Journal of Pediatrics
JF - Journal of Pediatrics
ER -