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Millions of young children annually are not meeting their developmental potential in low- and middle-income countries. Previous studies have shown that diarrheal diseases during early life are associated with subsequent malnutrition. This prospective cohort study of 576 children under 5 years was conducted in urban Dhaka, Bangladesh, to investigate the association between diarrhea prevalence, child growth, and child cognitive developmental outcomes. Height and weight were measured at baseline and a 12-month follow-up. Diarrhea prevalence was assessed through monthly surveillance visits. Developmental outcomes were assessed by communication, fine motor, gross motor, personal social, problem-solving, and combined developmental scores measured by the Extended Ages and Stages Questionnaire (EASQ) at the 12-month follow-up visit. To assess the association between diarrhea prevalence, child growth, and child cognitive developmental outcomes, linear regression models were fit using generalized estimating equations to account for clustering at the household level and to approximate 95% CIs. Diarrhea prevalence was negatively associated with change in height-for-age (HAZ) Z-scores from baseline to the 12-month follow-up (coefficient −0.85 [95% CI: −1.42, −0.28]). Diarrhea prevalence was a significant predictor of combined EASQ Z-scores with and without baseline stunting included in the model (−0.89 [95% CI: −1.67, −0.09] [baseline stunting included]) and (−0.88 [95% CI: −1.69, −0.07]). Change in HAZ from baseline to the 12-month follow-up was positively associated with follow-up combined EASQ Z-scores (0.28 [95% CI: 0.15, 0.42]). High diarrhea prevalence and linear growth faltering were associated with negative cognitive developmental outcomes among children residing in urban Dhaka, Bangladesh. Furthermore, high diarrhea prevalence was associated with negative child cognitive developmental outcomes with stunting included in the model, suggesting an effect of diarrhea on cognition independent of stunting.
Financial support: This research was supported by a United States Agency for International Development (USAID) grant awarded to Johns Hopkins School of Public Health.
Authors’ addresses: Christine Marie George, Jamie Perin, and Elizabeth D. Thomas, Department of International Health Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, E-mails: firstname.lastname@example.org, email@example.com, and firstname.lastname@example.org. Tahmina Parvin, Md Sazzadul Islam Bhuyian, Shirajum Monira, Fatema Zohura, M. Tasdik Hasan, Munirul Alam, and Fahmida Tofail, International Centre for Diarrheal Disease Research, Bangladesh (icddr,b), Centre for Nutrition and Food Security (CNFS), Dhaka, Bangladesh, E-mails: email@example.com, firstname.lastname@example.org, email@example.com, firstname.lastname@example.org, email@example.com, firstname.lastname@example.org, and email@example.com.