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Mouthing of Soil Contaminated Objects is Associated with Environmental Enteropathy in Young Children
Tomohiko Morita1, Jamie Perin1, Lauren Oldja1
1Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
Insights
Childhood mouthing behaviors, especially with soil-contaminated objects, are linked to environmental enteropathy. This study highlights object mouthing as a key exposure route for pathogens in young children.
Area of Science:
- Environmental health
- Pediatric health
- Microbiology
Background:
- Childhood mouthing behaviors are common and can lead to pathogen exposure.
- Environmental enteropathy is a significant health concern in low-resource settings.
- Understanding the link between mouthing behaviors and enteropathy is crucial for prevention.
Purpose of the Study:
- To characterize childhood mouthing behaviors in rural Bangladesh.
- To investigate the association between object-to-mouth and food-to-mouth contacts with diarrhoea and environmental enteropathy.
- To identify specific mouthing behaviors that pose a risk for enteropathy.
Main Methods:
- Prospective cohort study of 216 children (≤30 months) in rural Bangladesh.
- 5-hour structured observation of mouthing behaviors (soil, food, objects).
- Stool analysis for intestinal inflammation markers (alpha-1-antitrypsin, myeloperoxidase, neopterin, calprotectin) and E. coli.
Main Results:
- 82% of children exhibited mouthing behaviors involving soil, soil-contaminated objects, or food.
- Mouthing objects with visible soil was frequent (62%) and associated with elevated fecal calprotectin.
- A marginal association was found between soil E. coli counts and diarrhoea prevalence.
Conclusions:
- Childhood mouthing behaviors in contaminated environments contribute to environmental enteropathy.
- Mouthing soil-contaminated objects is a significant exposure route for pathogens.
- Interventions targeting object mouthing may reduce the risk of environmental enteropathy in children.
Objective:
To characterise childhood mouthing behaviours and to investigate the association between object-to-mouth and food-to-mouth contacts, diarrhoea prevalence and environmental enteropathy.
Methods:
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.
Results:
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).
Conclusion:
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.
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