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Unsafe Child Feces Disposal is Associated with Environmental Enteropathy and Impaired Growth
Christine Marie George1, Lauren Oldja1, Shwapon Biswas2
1Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.
Insights
Unsafe child feces disposal in rural Bangladesh is linked to environmental enteropathy and impaired growth in young children. Interventions are crucial to protect children
Area of Science:
- Global child health
- Environmental sanitation
- Pediatric gastroenterology
Background:
- Child feces disposal practices significantly impact child health outcomes.
- Environmental enteropathy is a subclinical intestinal inflammation linked to poor sanitation.
- Impaired growth, including wasting, is a critical indicator of child malnutrition.
Purpose of the Study:
- To investigate the relationship between unsafe child feces disposal and environmental enteropathy.
- To examine the association between unsafe child feces disposal and impaired child growth.
- To assess the prevalence of unsafe child feces disposal in rural Bangladesh.
Main Methods:
- Prospective cohort study of 216 young children in rural Bangladesh.
- Assessment of unsafe child feces disposal via structured observation and caregiver reports.
- Measurement of anthropometrics and analysis of fecal markers for environmental enteropathy.
Main Results:
- 84% of households exhibited unsafe child feces disposal events.
- Unsafe disposal was associated with higher environmental enteropathy scores and increased odds of wasting.
- Observed unsafe disposal correlated with reduced changes in weight-for-age and weight-for-height z-scores.
Conclusions:
- Unsafe child feces disposal is significantly associated with environmental enteropathy and impaired growth.
- High-risk behaviors require targeted interventions to safeguard pediatric populations.
- Improving sanitation practices is critical for preventing childhood growth faltering.
Objective:
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.