title: Effects of Shigella-, Campylobacter- and ETEC-associated diarrhea on childhood growth.
abstract: BACKGROUND
  Studies examining the etiology-specific effects of diarrheal disease on growth are limited and variable in their analytic methods, making comparisons difficult and priority setting based on these findings challenging. A study by Black et al (Black RE, Brown KH, Becker S. Effects of diarrhea associated with specific enteropathogens on the growth of children in rural Bangladesh. Pediatrics. 1984;33:1004-1009.) examined the association between Shigella and enterotoxigenic Escherichia coli-related disease and weight gain and linear growth in Bangladeshi children aged 0-5 years. We estimated similar associations in a 2002 cohort of 0- to 6-year-old children in the Peruvian Amazon.
  
  
  METHODS
  Diarrheal surveillence was conducted using household visits 3 times per week. Anthropometry was collected monthly. Mixed-effect models were used to estimate the association between Shigella, ETEC and Campylobacter diarrhea and weight gain in a 2-month period and linear growth over a 9-month period. Diarrheal disease burdens and growth intervals were quantified so as to be as comparable as possible to the original report.
  
  
  RESULTS
  Shigella- and ETEC-associated diarrhea were not associated with diminished weight gain, although the association between ETEC diarrhea and weight gain (-4.5 g/percent of days spent with ETEC, P = 0.098) was twice that of other etiologic agents, as well as similar in magnitude to the original report. Shigella-associated diarrhea was associated with decreased linear growth (0.055 cm less growth/percent days, P = 0.008), also similar to the original study.
  
  
  CONCLUSIONS
  Our findings suggest that associations between enteropathogen-specific diarrheal episodes and growth, particularly Shigella, are comparable across geographic and epidemiological contexts.
authors.affiliation: From the *Department of International Health, the Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; †Asociaciόn Benéfica Proyectos de Informática, Salud, Medicina, y Agricultura (A.B. PRISMA), Iquitos, Peru; ‡Naval Medical Research Center, Bethesda, MD; §Duke Global Health Institute and Nicholas School of Environment, Duke University, Durham, NC; and ¶Department of Bacteriology, US Naval Medical Research Unit Six, Lima, Peru.
authors.forename: Gwenyth
authors.initials: G
authors.lastname: Lee
authors.forename: Maribel
authors.initials: M
authors.lastname: Paredes Olortegui
authors.forename: Pablo
authors.initials: P
authors.lastname: Peñataro Yori
authors.forename: Robert E
authors.initials: RE
authors.lastname: Black
authors.forename: Laura
authors.initials: L
authors.lastname: Caulfield
authors.forename: Cesar
authors.initials: C
authors.lastname: Banda Chavez
authors.forename: Eric
authors.initials: E
authors.lastname: Hall
authors.forename: William K
authors.initials: WK
authors.lastname: Pan
authors.forename: Rina
authors.initials: R
authors.lastname: Meza
authors.forename: Margaret
authors.initials: M
authors.lastname: Kosek
mesh_terms: D002167:Campylobacter / Q000302:isolation & purification; D002169:Campylobacter Infections / Q000453:epidemiology / Q000473:pathology*; D002648:Child; D002657:Child Development; D002675:Child, Preschool; D003967:Diarrhea / Q000453:epidemiology / Q000473:pathology*; D004405:Dysentery, Bacillary / Q000453:epidemiology / Q000473:pathology*; D054307:Enterotoxigenic Escherichia coli / Q000302:isolation & purification; D016021:Epidemiologic Studies; D004927:Escherichia coli Infections / Q000453:epidemiology / Q000473:pathology*; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D010568:Peru / Q000453:epidemiology; D011446:Prospective Studies; D012760:Shigella / Q000302:isolation & purification