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



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.



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]).



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.
Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD. Electronic address: cgeorg19@jhu.edu.
Christine Marie
CM
George
Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.
Lauren
L
Oldja
International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b) Dhaka, Bangladesh.
Shwapon
S
Biswas
Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.
Jamie
J
Perin
Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.
R Bradley
RB
Sack
International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b) Dhaka, Bangladesh.
Shahnawaz
S
Ahmed
International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b) Dhaka, Bangladesh.
Mohammad
M
Shahnaij
International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b) Dhaka, Bangladesh.
Rashidul
R
Haque
International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b) Dhaka, Bangladesh.
Tahmina
T
Parvin
International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b) Dhaka, Bangladesh.
Ishrat J
IJ
Azmi
International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b) Dhaka, Bangladesh.
Sazzadul Islam
SI
Bhuyian
International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b) Dhaka, Bangladesh.
Kaisar A
KA
Talukder
International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b) Dhaka, Bangladesh.
Abu G
AG
Faruque
D001459:Bangladesh / Q000453:epidemiology; D001835:Body Weight; D002675:Child, Preschool; D004781:Environmental Exposure / Q000009:adverse effects*; D005243:Feces; D005260:Female; D006130:Growth Disorders / Q000453:epidemiology* / Q000209:etiology*; D006801:Humans; D007223:Infant; D007410:Intestinal Diseases / Q000453:epidemiology* / Q000209:etiology*; D008297:Male; D011446:Prospective Studies; D012423:Rural Health; D012499:Sanitation / Q000592:standards*
Bangladesh; child growth; environmental contamination; intestinal inflammation