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Undernutrition is estimated to be an underlying cause of over half of all deaths in young children globally. There is a growing body of literature suggesting that increased exposure to enteric pathogens is responsible for environmental enteropathy (EE), a disorder associated with impaired growth in children. To determine if household unsanitary environmental conditions were significantly associated with EE and stunting in children, we conducted a cohort of 216 children (≤ 30 months) in rural Bangladesh. Stool was analyzed for four fecal markers of EE: alpha-1-antitrypsin, myeloperoxidase, and neopterin combined to form an EE disease activity score, and calprotectin. We observed a significant association between having an animal corral in a child's sleeping room and elevated EE scores (1.0 point difference, 95% confidence interval [CI]: 0.13, 1.88) and a two times higher odds of stunting (height-for-age z-score < −2) (odds ratio [OR]: 2.53, 95% CI: 1.08, 5.43) after adjusting for potential confounders. In addition, children of caregivers with visibly soiled hands had significantly elevated fecal calprotectin (μg/g) (384.1, 95% CI: 152.37, 615.83). These findings suggest that close contact with animals and caregiver hygiene may be important risk factors for EE in young children. These findings are consistent with the hypothesis that unsanitary environmental conditions can lead to EE in susceptible pediatric populations.
Financial support: This study was funded by a grant from the Johns Hopkins Sherrilyn and Ken Fisher Center for Environmental Infectious Diseases.
Authors' addresses: Christine M. George, Lauren Oldja, Jamie Perin, Gwenyth O. Lee, and R. Bradley Sack, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, E-mails: firstname.lastname@example.org, email@example.com, firstname.lastname@example.org, email@example.com, and firstname.lastname@example.org. Shwapon K. Biswas and Sazzadul Islam Bhuyian, Center for Communicable Diseases, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh, E-mails: email@example.com and firstname.lastname@example.org. Shahnawaz Ahmed and Tahmina Parvin, Centre for Nutrition and Food Security (CNFS), icddr,b, Dhaka, Bangladesh, E-mails: email@example.com and firstname.lastname@example.org. Rashidul Haque, icddr,b, Dhaka, Bangladesh, E-mail: email@example.com. Ishrat J. Azmi and Kaisar A. Talukder, Enteric Microbiology Unit, Centre for Health and Population Research, icddr,b, Dhaka, Bangladesh, E-mails: firstname.lastname@example.org and email@example.com. Abu G. Faruque, Clinical Sciences Division, icddr,b, Dhaka, Bangladesh, E-mail: firstname.lastname@example.org.