Black MM, Walker SP, Fernald LC, Andersen CT, DiGirolamo AM, Lu C, McCoy DC, Fink G, Shawar YR, Shiffman J, 2017. Advancing early childhood development: from science to scale 1: early childhood development coming of age: science through the life course. Lancet 389: 77.
GBD Diarrhoeal Diseases Collaborators , 2017. Estimates of global, regional, and national morbidity, mortality, and aetiologies of diarrhoeal diseases: a systematic analysis for the Global Burden of Disease Study 2015. Lancet Infect Dis 17: 909–948.
Checkley W, Gilman RH, Epstein LD, Suarez M, Diaz JF, Cabrera L, Black RE, Sterling CR, 1997. Asymptomatic and symptomatic cryptosporidiosis: their acute effect on weight gain in Peruvian children. Am J Epidemiol 145: 156–163.
Lee G, Pan W, Yori PP, Olortegui MP, Tilley D, Gregory M, Oberhelman R, Burga R, Chavez CB, Kosek M, 2013. Symptomatic and asymptomatic Campylobacter infections associated with reduced growth in Peruvian children. PLoS Negl Trop Dis 7: e2036.
Lee G, Paredes Olortegui M, Penataro Yori P, Black RE, Caulfield L, Banda Chavez C, Hall E, Pan WK, Meza R, Kosek M, 2014. Effects of Shigella-, Campylobacter- and ETEC-associated diarrhea on childhood growth. Pediatr Infect Dis J 33: 1004–1009.
George CM et al.2018. Enteric infections in young children are associated with environmental enteropathy and impaired growth. Trop Med Int Health 23: 26–33.
Guerrant RL, Oriá RB, Moore SR, Oriá MO, Lima AA, 2008. Malnutrition as an enteric infectious disease with long-term effects on child development. Nutr Rev 66: 487–505.
MacIntyre J, McTaggart J, Guerrant RL, Goldfarb DM, 2014. Early childhood diarrhoeal diseases and cognition: are we missing the rest of the iceberg? Paediatr Int Child Health 34: 295–307.
Kosek M, Haque R, Lima A, Babji S, Shrestha S, Qureshi S, Amidou S, Mduma E, Lee G, Yori PP, 2013. Fecal markers of intestinal inflammation and permeability associated with the subsequent acquisition of linear growth deficits in infants. Am J Trop Med Hyg 88: 390–396.
Liu JR, Sheng XY, Hu YQ, Yu XG, Westcott JE, Miller LV, Krebs NF, Hambidge KM, 2012. Fecal calprotectin levels are higher in rural than in urban Chinese infants and negatively associated with growth. BMC Pediatr 12: 129.
Campbell DI, Elia M, Lunn PG, 2003. Growth faltering in rural Gambian infants is associated with impaired small intestinal barrier function, leading to endotoxemia and systemic inflammation. J Nutr 133: 1332–1338.
Campbell DI, McPhail G, Lunn PG, Elia M, Jeffries DJ, 2004. Intestinal inflammation measured by fecal neopterin in Gambian children with enteropathy: association with growth failure, Giardia lamblia, and intestinal permeability. J Pediatr Gastroenterol Nutr 39: 153–157.
Lunn PG, Northrop-Clewes CA, Downes RM, 1991. Intestinal permeability, mucosal injury, and growth faltering in Gambian infants. Lancet 338: 907–910.
Weisz AJ, Manary MJ, Stephenson K, Agapova S, Manary FG, Thakwalakwa C, Shulman RJ, Manary MJ, 2012. Abnormal gut integrity is associated with reduced linear growth in rural Malawian children. J Pediatr Gastroenterol Nutr 55: 747–750.
Goto R, Mascie-Taylor CG, Lunn PG, 2009. Impact of intestinal permeability, inflammation status and parasitic infections on infant growth faltering in rural Bangladesh. Br J Nutr 101: 1509–1516.
Mondal D, Minak J, Alam M, Liu Y, Dai J, Korpe P, Liu L, Haque R, Petri WA Jr., 2012. Contribution of enteric infection, altered intestinal barrier function, and maternal malnutrition to infant malnutrition in Bangladesh. Nephrol Dial Transplant 54: 185–192.
Panter-Brick C, Lunn PG, Langford RM, Maharjan M, Manandhar DS, 2009. Pathways leading to early growth faltering: an investigation into the importance of mucosal damage and immunostimulation in different socio-economic groups in Nepal. Br J Nutr 101: 558–567.
Lin A, Arnold BF, Afreen S, Goto R, Huda T, Haque R, Raqib R, Unicomb L, Ahmed T, Colford J Jr., 2013. Household environmental conditions are associated with enteropathy and impaired growth in rural Bangladesh. Am J Trop Med Hyg 89: 130–137.
George CM et al.2016. Unsafe child feces disposal is associated with environmental enteropathy and impaired growth. J Pediatr 176: 43–49.
George CM et al.2015. Fecal markers of environmental enteropathy are associated with animal exposure and caregiver hygiene in Bangladesh. Am J Trop Med Hyg 93: 269–275.
Prado EL, Dewey KG, 2014. Nutrition and brain development in early life. Nutr Rev 72: 267–284.
Berkman DS, Lescano AG, Gilman RH, Lopez SL, Black MM, 2002. Effects of stunting, diarrhoeal disease, and parasitic infection during infancy on cognition in late childhood: a follow-up study. Lancet 359: 564–571.
Walker SP, Chang SM, Powell CA, Simonoff E, Grantham-McGregor SM, 2007. Early childhood stunting is associated with poor psychological functioning in late adolescence and effects are reduced by psychosocial stimulation. J Nutr 137: 2464–2469.
Ajjampur SS, Koshy B, Venkataramani M, Sarkar R, Joseph AA, Jacob KS, Ward H, Kang G, 2011. Effect of cryptosporidial and giardial diarrhoea on social maturity, intelligence and physical growth in children in a semi-urban slum in south India. Ann Trop Paediatr 31: 205–212.
Guerrant DI, Moore SR, Lima AA, Patrick PD, Schorling JB, Guerrant RL, 1999. Association of early childhood diarrhea and cryptosporidiosis with impaired physical fitness and cognitive function four-seven years later in a poor urban community in northeast Brazil. Am J Trop Med Hyg 61: 707–713.
Pinkerton R, Oriá RB, Lima AA, Rogawski ET, Oriá MO, Patrick PD, Moore SR, Wiseman BL, Niehaus MD, Guerrant RL, 2016. Early childhood diarrhea predicts cognitive delays in later childhood independently of malnutrition. Am J Trop Med Hyg 95: 1004–1010.
Tarleton JL, Haque R, Mondal D, Shu J, Farr BM, Petri WA Jr., 2006. Cognitive effects of diarrhea, malnutrition, and Entamoeba histolytica infection on school age children in Dhaka, Bangladesh. Am J Trop Med Hyg 74: 475–481.
George CM et al., 2020. Effects of a water, sanitation and hygiene mobile health program on diarrhea and child growth in Bangladesh: A cluster-randomized controlled trial of the CHoBI7 mobile health program. Clinical Infectious Diseases. 2020 Aug 6.
George CM et al., 2019. Formative research for the design of a scalable water, sanitation, and hygiene mobile health program: CHoBI7 mobile health program. BMC Public Health 19: 1--8.
Fernald LC, Kariger P, Hidrobo M, Gertler PJ, 2012. Socioeconomic gradients in child development in very young children: evidence from India, Indonesia, Peru, and Senegal. Proc Natl Acad Sci USA 109 (Suppl 2):17273–17280.
Tofail F et al.2018. Effect of water quality, sanitation, hand washing, and nutritional interventions on child development in rural Bangladesh (WASH Benefits Bangladesh): a cluster-randomised controlled trial. Lancet Child Adolesc Health 2: 255–268.
Fernald LC, Kariger P, Engle P, Raikes A, 2009. Examining Early Child Development in Low-Income Countries: A Toolkit for the Assessment of Children in the First Five Years of Life. Washington, DC: World Bank.
de Onis M, Onyango AW, 2008. WHO child growth standards. Lancet 371: 204.
Supply WUJW, Programme SM, World Health Organization , 2015. Progress on Sanitation and Drinking Water: 2015 Update and MDG Assessment. Geneva, Switzerland: WHO.
George CM et al., 2017. Psychosocial factors mediating the effect of the CHoBI7 intervention on handwashing with soap: a randomized controlled trial. Health Education & Behavior 44: 613--625.
George CM et al., 2021. Psychosocial factors mediating the effect of the CHoBI7 mobile health program on handwashing with soap and household stored water quality: a randomized controlled trial. Health Education & Behavior 2021 May 5: 1090198120987134.
Fischer Walker CL, Lamberti L, Adair L, Guerrant RL, Lescano AG, Martorell R, Pinkerton RC, Black RE, 2012. Does childhood diarrhea influence cognition beyond the diarrhea-stunting pathway? PLoS One 7: e47908.
Bhutta ZA, Das JK, Rizvi A, Gaffey MF, Walker N, Horton S, Webb P, Lartey A, Black RE, 2013. Evidence-based interventions for improvement of maternal and child nutrition: what can be done and at what cost? Lancet 382: 452–477.
Brown JL, Pollitt E, 1996. Malnutrition, poverty and intellectual development. Sci Am 274: 38–43.
Past two years | Past Year | Past 30 Days | |
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Abstract Views | 1201 | 435 | 36 |
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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: cgeorg19@jhu.edu, jperin@jhu.edu, and liz.thomas@jhu.edu. 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: tparvin@icddrb.org, sazzadul.islam@icddrb.org, smonira@icddrb.org, fzohura@icddrb.org, tasdikhdip@yahoo.com, munirul@icddrb.org, and ftofail@icddrb.org.
Black MM, Walker SP, Fernald LC, Andersen CT, DiGirolamo AM, Lu C, McCoy DC, Fink G, Shawar YR, Shiffman J, 2017. Advancing early childhood development: from science to scale 1: early childhood development coming of age: science through the life course. Lancet 389: 77.
GBD Diarrhoeal Diseases Collaborators , 2017. Estimates of global, regional, and national morbidity, mortality, and aetiologies of diarrhoeal diseases: a systematic analysis for the Global Burden of Disease Study 2015. Lancet Infect Dis 17: 909–948.
Checkley W, Gilman RH, Epstein LD, Suarez M, Diaz JF, Cabrera L, Black RE, Sterling CR, 1997. Asymptomatic and symptomatic cryptosporidiosis: their acute effect on weight gain in Peruvian children. Am J Epidemiol 145: 156–163.
Lee G, Pan W, Yori PP, Olortegui MP, Tilley D, Gregory M, Oberhelman R, Burga R, Chavez CB, Kosek M, 2013. Symptomatic and asymptomatic Campylobacter infections associated with reduced growth in Peruvian children. PLoS Negl Trop Dis 7: e2036.
Lee G, Paredes Olortegui M, Penataro Yori P, Black RE, Caulfield L, Banda Chavez C, Hall E, Pan WK, Meza R, Kosek M, 2014. Effects of Shigella-, Campylobacter- and ETEC-associated diarrhea on childhood growth. Pediatr Infect Dis J 33: 1004–1009.
George CM et al.2018. Enteric infections in young children are associated with environmental enteropathy and impaired growth. Trop Med Int Health 23: 26–33.
Guerrant RL, Oriá RB, Moore SR, Oriá MO, Lima AA, 2008. Malnutrition as an enteric infectious disease with long-term effects on child development. Nutr Rev 66: 487–505.
MacIntyre J, McTaggart J, Guerrant RL, Goldfarb DM, 2014. Early childhood diarrhoeal diseases and cognition: are we missing the rest of the iceberg? Paediatr Int Child Health 34: 295–307.
Kosek M, Haque R, Lima A, Babji S, Shrestha S, Qureshi S, Amidou S, Mduma E, Lee G, Yori PP, 2013. Fecal markers of intestinal inflammation and permeability associated with the subsequent acquisition of linear growth deficits in infants. Am J Trop Med Hyg 88: 390–396.
Liu JR, Sheng XY, Hu YQ, Yu XG, Westcott JE, Miller LV, Krebs NF, Hambidge KM, 2012. Fecal calprotectin levels are higher in rural than in urban Chinese infants and negatively associated with growth. BMC Pediatr 12: 129.
Campbell DI, Elia M, Lunn PG, 2003. Growth faltering in rural Gambian infants is associated with impaired small intestinal barrier function, leading to endotoxemia and systemic inflammation. J Nutr 133: 1332–1338.
Campbell DI, McPhail G, Lunn PG, Elia M, Jeffries DJ, 2004. Intestinal inflammation measured by fecal neopterin in Gambian children with enteropathy: association with growth failure, Giardia lamblia, and intestinal permeability. J Pediatr Gastroenterol Nutr 39: 153–157.
Lunn PG, Northrop-Clewes CA, Downes RM, 1991. Intestinal permeability, mucosal injury, and growth faltering in Gambian infants. Lancet 338: 907–910.
Weisz AJ, Manary MJ, Stephenson K, Agapova S, Manary FG, Thakwalakwa C, Shulman RJ, Manary MJ, 2012. Abnormal gut integrity is associated with reduced linear growth in rural Malawian children. J Pediatr Gastroenterol Nutr 55: 747–750.
Goto R, Mascie-Taylor CG, Lunn PG, 2009. Impact of intestinal permeability, inflammation status and parasitic infections on infant growth faltering in rural Bangladesh. Br J Nutr 101: 1509–1516.
Mondal D, Minak J, Alam M, Liu Y, Dai J, Korpe P, Liu L, Haque R, Petri WA Jr., 2012. Contribution of enteric infection, altered intestinal barrier function, and maternal malnutrition to infant malnutrition in Bangladesh. Nephrol Dial Transplant 54: 185–192.
Panter-Brick C, Lunn PG, Langford RM, Maharjan M, Manandhar DS, 2009. Pathways leading to early growth faltering: an investigation into the importance of mucosal damage and immunostimulation in different socio-economic groups in Nepal. Br J Nutr 101: 558–567.
Lin A, Arnold BF, Afreen S, Goto R, Huda T, Haque R, Raqib R, Unicomb L, Ahmed T, Colford J Jr., 2013. Household environmental conditions are associated with enteropathy and impaired growth in rural Bangladesh. Am J Trop Med Hyg 89: 130–137.
George CM et al.2016. Unsafe child feces disposal is associated with environmental enteropathy and impaired growth. J Pediatr 176: 43–49.
George CM et al.2015. Fecal markers of environmental enteropathy are associated with animal exposure and caregiver hygiene in Bangladesh. Am J Trop Med Hyg 93: 269–275.
Prado EL, Dewey KG, 2014. Nutrition and brain development in early life. Nutr Rev 72: 267–284.
Berkman DS, Lescano AG, Gilman RH, Lopez SL, Black MM, 2002. Effects of stunting, diarrhoeal disease, and parasitic infection during infancy on cognition in late childhood: a follow-up study. Lancet 359: 564–571.
Walker SP, Chang SM, Powell CA, Simonoff E, Grantham-McGregor SM, 2007. Early childhood stunting is associated with poor psychological functioning in late adolescence and effects are reduced by psychosocial stimulation. J Nutr 137: 2464–2469.
Ajjampur SS, Koshy B, Venkataramani M, Sarkar R, Joseph AA, Jacob KS, Ward H, Kang G, 2011. Effect of cryptosporidial and giardial diarrhoea on social maturity, intelligence and physical growth in children in a semi-urban slum in south India. Ann Trop Paediatr 31: 205–212.
Guerrant DI, Moore SR, Lima AA, Patrick PD, Schorling JB, Guerrant RL, 1999. Association of early childhood diarrhea and cryptosporidiosis with impaired physical fitness and cognitive function four-seven years later in a poor urban community in northeast Brazil. Am J Trop Med Hyg 61: 707–713.
Pinkerton R, Oriá RB, Lima AA, Rogawski ET, Oriá MO, Patrick PD, Moore SR, Wiseman BL, Niehaus MD, Guerrant RL, 2016. Early childhood diarrhea predicts cognitive delays in later childhood independently of malnutrition. Am J Trop Med Hyg 95: 1004–1010.
Tarleton JL, Haque R, Mondal D, Shu J, Farr BM, Petri WA Jr., 2006. Cognitive effects of diarrhea, malnutrition, and Entamoeba histolytica infection on school age children in Dhaka, Bangladesh. Am J Trop Med Hyg 74: 475–481.
George CM et al., 2020. Effects of a water, sanitation and hygiene mobile health program on diarrhea and child growth in Bangladesh: A cluster-randomized controlled trial of the CHoBI7 mobile health program. Clinical Infectious Diseases. 2020 Aug 6.
George CM et al., 2019. Formative research for the design of a scalable water, sanitation, and hygiene mobile health program: CHoBI7 mobile health program. BMC Public Health 19: 1--8.
Fernald LC, Kariger P, Hidrobo M, Gertler PJ, 2012. Socioeconomic gradients in child development in very young children: evidence from India, Indonesia, Peru, and Senegal. Proc Natl Acad Sci USA 109 (Suppl 2):17273–17280.
Tofail F et al.2018. Effect of water quality, sanitation, hand washing, and nutritional interventions on child development in rural Bangladesh (WASH Benefits Bangladesh): a cluster-randomised controlled trial. Lancet Child Adolesc Health 2: 255–268.
Fernald LC, Kariger P, Engle P, Raikes A, 2009. Examining Early Child Development in Low-Income Countries: A Toolkit for the Assessment of Children in the First Five Years of Life. Washington, DC: World Bank.
de Onis M, Onyango AW, 2008. WHO child growth standards. Lancet 371: 204.
Supply WUJW, Programme SM, World Health Organization , 2015. Progress on Sanitation and Drinking Water: 2015 Update and MDG Assessment. Geneva, Switzerland: WHO.
George CM et al., 2017. Psychosocial factors mediating the effect of the CHoBI7 intervention on handwashing with soap: a randomized controlled trial. Health Education & Behavior 44: 613--625.
George CM et al., 2021. Psychosocial factors mediating the effect of the CHoBI7 mobile health program on handwashing with soap and household stored water quality: a randomized controlled trial. Health Education & Behavior 2021 May 5: 1090198120987134.
Fischer Walker CL, Lamberti L, Adair L, Guerrant RL, Lescano AG, Martorell R, Pinkerton RC, Black RE, 2012. Does childhood diarrhea influence cognition beyond the diarrhea-stunting pathway? PLoS One 7: e47908.
Bhutta ZA, Das JK, Rizvi A, Gaffey MF, Walker N, Horton S, Webb P, Lartey A, Black RE, 2013. Evidence-based interventions for improvement of maternal and child nutrition: what can be done and at what cost? Lancet 382: 452–477.
Brown JL, Pollitt E, 1996. Malnutrition, poverty and intellectual development. Sci Am 274: 38–43.
Past two years | Past Year | Past 30 Days | |
---|---|---|---|
Abstract Views | 1201 | 435 | 36 |
Full Text Views | 101 | 58 | 1 |
PDF Downloads | 112 | 55 | 2 |