title: Fecal Markers of Environmental Enteropathy are Associated with Animal Exposure and Caregiver Hygiene in Bangladesh.
abstract: Undernutrition is estimated to be an underlying cause of over half of all deaths in young children globally. There is a growing body of literature suggesting that increased exposure to enteric pathogens is responsible for environmental enteropathy (EE), a disorder associated with impaired growth in children. To determine if household unsanitary environmental conditions were significantly associated with EE and stunting in children, we conducted a cohort of 216 children (≤ 30 months) in rural Bangladesh. Stool was analyzed for four fecal markers of EE: alpha-1-antitrypsin, myeloperoxidase, and neopterin combined to form an EE disease activity score, and calprotectin. We observed a significant association between having an animal corral in a child's sleeping room and elevated EE scores (1.0 point difference, 95% confidence interval [CI]: 0.13, 1.88) and a two times higher odds of stunting (height-for-age z-score < -2) (odds ratio [OR]: 2.53, 95% CI: 1.08, 5.43) after adjusting for potential confounders. In addition, children of caregivers with visibly soiled hands had significantly elevated fecal calprotectin (μg/g) (384.1, 95% CI: 152.37, 615.83). These findings suggest that close contact with animals and caregiver hygiene may be important risk factors for EE in young children. These findings are consistent with the hypothesis that unsanitary environmental conditions can lead to EE in susceptible pediatric populations.
authors.affiliation: Johns Hopkins University, Baltimore, Maryland; International Center for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh cmgeorge@jhsph.edu.
authors.forename: Christine Marie
authors.initials: CM
authors.lastname: George
authors.affiliation: Johns Hopkins University, Baltimore, Maryland; International Center for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh.
authors.forename: Lauren
authors.initials: L
authors.lastname: Oldja
authors.affiliation: Johns Hopkins University, Baltimore, Maryland; International Center for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh.
authors.forename: Shwapon K
authors.initials: SK
authors.lastname: Biswas
authors.affiliation: Johns Hopkins University, Baltimore, Maryland; International Center for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh.
authors.forename: Jamie
authors.initials: J
authors.lastname: Perin
authors.affiliation: Johns Hopkins University, Baltimore, Maryland; International Center for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh.
authors.forename: Gwenyth O
authors.initials: GO
authors.lastname: Lee
authors.affiliation: Johns Hopkins University, Baltimore, Maryland; International Center for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh.
authors.forename: Shahnawaz
authors.initials: S
authors.lastname: Ahmed
authors.affiliation: Johns Hopkins University, Baltimore, Maryland; International Center for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh.
authors.forename: Rashidul
authors.initials: R
authors.lastname: Haque
authors.affiliation: Johns Hopkins University, Baltimore, Maryland; International Center for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh.
authors.forename: R Bradley
authors.initials: RB
authors.lastname: Sack
authors.affiliation: Johns Hopkins University, Baltimore, Maryland; International Center for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh.
authors.forename: Tahmina
authors.initials: T
authors.lastname: Parvin
authors.affiliation: Johns Hopkins University, Baltimore, Maryland; International Center for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh.
authors.forename: Ishrat J
authors.initials: IJ
authors.lastname: Azmi
authors.affiliation: Johns Hopkins University, Baltimore, Maryland; International Center for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh.
authors.forename: Sazzadul Islam
authors.initials: SI
authors.lastname: Bhuyian
authors.affiliation: Johns Hopkins University, Baltimore, Maryland; International Center for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh.
authors.forename: Kaisar A
authors.initials: KA
authors.lastname: Talukder
authors.affiliation: Johns Hopkins University, Baltimore, Maryland; International Center for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh.
authors.forename: Abu G
authors.initials: AG
authors.lastname: Faruque
mesh_terms: D000818:Animals; D001459:Bangladesh / Q000453:epidemiology; D017028:Caregivers; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D004781:Environmental Exposure; D005191:Family Characteristics; D005243:Feces / Q000737:chemistry*; D005260:Female; D006235:Hand Disinfection / Q000592:standards; D006801:Humans; D006920:Hygiene; D007223:Infant; D007410:Intestinal Diseases / Q000453:epidemiology*; D039841:Leukocyte L1 Antigen Complex / Q000032:analysis; D016014:Linear Models; D016015:Logistic Models; D008297:Male; D019798:Neopterin / Q000032:analysis; D009195:Peroxidase / Q000032:analysis; D012111:Residence Characteristics; D012307:Risk Factors; D012424:Rural Population; D012987:Soil / Q000737:chemistry; D000515:alpha 1-Antitrypsin / Q000032:analysis
chemical_list: D039841:Leukocyte L1 Antigen Complex; D012987:Soil; D000515:alpha 1-Antitrypsin; D019798:Neopterin; D009195:Peroxidase