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

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• 作者：Christine Marie George ; PhD¹ ; ^{cgeorg19@jhu.edu" class="auth_mail" title="E-mail the corresponding author} ; Lauren Oldja ; MSPH¹ ; Shwapon Biswas ; MBBS² ; Jamie Perin ; PhD¹ ; R. Bradley Sack ; ScD ; MD¹ ; Shahnawaz Ahmed ; MBBS² ; Mohammad Shahnaij ; MS² ; Rashidul Haque ; PhD² ; Tahmina Parvin ; MS² ; Ishrat J. Azmi ; PhD² ; Sazzadul Islam Bhuyian ; BS² ; Kaisar A. Talukder ; PhD² ; Abu G. Faruque ; MBBS ; MPH²
• 关键词：Bangladesh ; child growth ; environmental contamination ; intestinal inflammation
• 刊名：The Journal of Pediatrics
• 出版年：2016
• 出版时间：September 2016
• 年：2016
• 卷：176
• 期：Complete
• 页码：43-49
• 全文大小：241 K

文摘

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.