Mouthing of Soil Contaminated Objects is Associated with Environmental Enteropathy in Young Children.
To characterise childhood mouthing behaviours and to investigate the association between object-to-mouth and food-to-mouth contacts, diarrhoea prevalence and environmental enteropathy.



A prospective cohort study was conducted of 216 children ≤30 months of age in rural Bangladesh. Mouthing contacts with soil and food and objects with visible soil were assessed by 5-h structured observation. Stool was analysed for four faecal markers of intestinal inflammation: alpha-1-antitrypsin, myeloperoxidase, neopterin and calprotectin.



Overall 82% of children were observed mouthing soil, objects with visible soil, or food with visible soil during the structured observation period. Sixty two percent of children were observed mouthing objects with visible soil, 63% were observed mouthing food with visible soil, and 18% were observed mouthing soil only. Children observed mouthing objects with visible soil had significantly elevated faecal calprotectin concentrations (206.81 μg/g, 95% confidence interval [CI]: 6.27, 407.36). There was also a marginally significant association between Escherichia coli counts in soil from a child's play space and the prevalence rate of diarrhoea (diarrhoea prevalence ratio: 2.03, 95% CI 0.97, 4.25).



These findings provide further evidence to support the hypothesis that childhood mouthing behaviour in environments with faecal contamination can lead to environmental enteropathy in susceptible paediatric populations. Furthermore, these findings suggest that young children mouthing objects with soil, which occurred more frequently than soil directly (60% vs. 18%), was an important exposure route to faecal pathogens and a risk factor for environmental enteropathy.
Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
Tomohiko
T
Morita
Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
Jamie
J
Perin
Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
Lauren
L
Oldja
International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh.|Department of Internal Medicine, Rangpur Medical College Hospital, Rangpur, Bangladesh.
Shwapon
S
Biswas
Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
R Bradley
RB
Sack
International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh.
Shahnawaz
S
Ahmed
International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh.
Rashidul
R
Haque
International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh.
Nurul Amin
NA
Bhuiyan
International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh.
Tahmina
T
Parvin
International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh.
Sazzadul Islam
SI
Bhuyian
International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh.
Mahmuda
M
Akter
International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh.
Kaisar A
KA
Talukder
International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh.
Mohammad
M
Shahnaij
International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh.
Abu G
AG
Faruque
Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
Christine Marie
CM
George
D001459:Bangladesh / Q000453:epidemiology; D002652:Child Behavior; D002675:Child, Preschool; D003967:Diarrhea / Q000453:epidemiology / Q000209:etiology* / Q000382:microbiology; D004781:Environmental Exposure / Q000009:adverse effects*; D004926:Escherichia coli; D005243:Feces / Q000737:chemistry; D005260:Female; D006801:Humans; D007223:Infant; D007249:Inflammation / Q000209:etiology* / Q000378:metabolism; D007410:Intestinal Diseases / Q000209:etiology* / Q000473:pathology; D007413:Intestinal Mucosa / Q000378:metabolism; D007422:Intestines / Q000382:microbiology / Q000473:pathology; D039841:Leukocyte L1 Antigen Complex / Q000378:metabolism; D008297:Male; D009055:Mouth; D010988:Play and Playthings; D011446:Prospective Studies; D012424:Rural Population; D012987:Soil; D012988:Soil Microbiology
D039841:Leukocyte L1 Antigen Complex; D012987:Soil
child behaviour; comportamiento infantil; comportement de l'enfant; diarrea; diarrhoea; diarrhée; enteropatía ambiental; entéropathie environnementale; environmental enteropathy; environmental exposure; exposición ambiental; exposition environnementale; ingestion non alimentaire; ingestión no dietaria; llevarse objetos a la boca; mouthing; mâchonnement; non-dietary ingestion