Changes over time in the epidemiology of diarrhea and malnutrition among children in an Urban Brazilian Shantytown, 1989 to 1996

Moore, Sean R.; Lima, Aldo A. M.; Schorling, John B.; Barboza, Manuel S.; Soares, Arlete A.; Guerrant, Richard L.

doi:10.1016/s1201-9712(00)90106-1

Cited by 28 publications

(11 citation statements)

References 16 publications

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“…When taken with impaired fitness (that correlates in adults with impaired work productivity) 10 and with impaired growth, the additional impact of early childhood diarrhea on cognitive function even further magnifies its potential lasting "disability costs." Furthermore, these findings likely represent a "best case" scenario in that our long-term follow-up (with its concomitant education about breast-feeding, oral rehydration, and treatment of recognized helminthic infections) has been associated with reduced diarrhea rates and improvement in nutritional status over the study period, 11 effects that we have not seen in nearby shantytown communities not under study (Lima and Guerrant, unpublished observations). Finally, treatment of helminth infections has been shown to improve cognitive function in Indonesian children aged 6 to 8 years 12 and Jamaican children aged 6 to 10.…”

Section: Discussionmentioning

confidence: 75%

Early childhood diarrhea is associated with diminished cognitive function 4 to 7 years later in children in a northeast Brazilian shantytown.

Niehaus

Moore²,

Patrick³

et al. 2002

The American Journal of Tropical Medicine and Hygiene

273

154

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Abstract. Diarrhea is well recognized as a leading cause of childhood mortality and morbidity in developing countries; however, possible long-term cognitive deficits from heavy diarrhea burdens in early childhood remain poorly defined. To assess the potential long-term impact of early childhood diarrhea (in the first 2 years of life) on cognitive function in later childhood, we studied the cognitive function of a cohort of children in an urban Brazilian shantytown with a high incidence of early childhood diarrhea. Forty-six children (age range, 6-10 years) with complete diarrhea surveillance during their first 2 years of life were given a battery of five cognitive tests. Test of Non-Verbal Intelligence-III (TONI) scores were inversely correlated with early childhood diarrhea (P ‫ס‬ .01), even when controlling for maternal education, duration of breast-feeding, and early childhood helminthiasis (Ascaris or Trichuris). Furthermore, Wechsler Intelligence Scale for Children (WISC-III) Coding Tasks and WISC-III Digit Span (reverse and total) scores were also significantly lower in the 17 children with a history of early childhood persistent diarrhea (PD; P < .05), even when controlling for helminths and maternal education. No correlations were seen between diarrhea rates and Wide Range Assessment of Memory and Learning subtests or WISC-III Mazes. This report (with larger numbers of participants and new tests) confirms and substantially extends previous pilot studies, showing that long-term cognitive deficits are associated with early childhood diarrhea. These findings have important implications for the importance of interventions that may reduce early childhood diarrheal illnesses or their consequences.

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Section: Discussionmentioning

confidence: 75%

Early childhood diarrhea is associated with diminished cognitive function 4 to 7 years later in children in a northeast Brazilian shantytown.

Niehaus

Moore²,

Patrick³

et al. 2002

The American Journal of Tropical Medicine and Hygiene

273

154

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“…In Brazil, diarrhea prevalence was found to be associated with lower cognitive test scores when the age variable was removed from the regression suggesting a correlation between age at testing and diarrhea prevalence (R. Pinkerton, personal communication). In Brazil this might be due in part to progressive declines in early childhood diarrhea burdens during a decade of surveillance [25]. It appears that the effect of age on cognition is context dependent because it varies among these four studies.…”

Section: Discussionmentioning

confidence: 98%

Does Childhood Diarrhea Influence Cognition Beyond the Diarrhea-Stunting Pathway?

et al. 2012

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BackgroundDiarrhea is a leading cause of morbidity among children under 5 years of age in low- and middle-income countries yet the additional effects and sequelae, such as cognitive impairment associated with diarrhea, have not been quantified.MethodsWe quantified the association between diarrhea prevalence and cognitive outcomes while controlling for linear growth in 4 study populations. Cognition was assessed using different methods across sites and was expressed in standardized units. We built linear regression models for each study with standardized cognitive score as the outcome and diarrhea prevalence as the main predictor variable. We then conducted meta-analyses of the regression coefficients to generate pooled estimates of the association between diarrhea prevalence and cognition whilst controlling for anthropometric status and other covariates.ResultsDiarrhea was not a significant predictor of cognitive score in any site in the regression models or in the meta-analyses (Coefficient = 0.07; 95% CI: −0.1, 0.2). The length for age Z- score was negatively related to cognition in all sites (0.18; 95% CI: 0.14, 0.21), with coefficients remarkably similar across sites (Coefficient Range: 0.168–0.186).ConclusionsWe did not demonstrate an association between diarrhea and cognition with stunting included in the model. The links between diarrhea, stunting, and cognition provide additional rationale for accelerating interventions to reduce diarrhea.

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“…In addition, case-control studies are being done in Brazil and Bangladesh, as closely followed cohorts can have reduced diarrhea and improved growth over time due to close observation and contact with study personnel. 3 These case-control studies are collecting information on 500 children with moderate to severe malnutrition (weight-for-age [WAZ] Z-scores <-2) and 500 matched controls (WAZ >-1). As the MAL-ED study comes to completion, we wait with eager anticipation for the important information it will provide about diarrheal patterns, growth, nutrition and cognitive outcomes of early childhood illness.…”

Section: Paper: Headings and Subheadings To Break Up The Textmentioning

confidence: 99%

Recent Advances in Understanding the Long-Term Sequelae of Childhood Infectious Diarrhea

Scharf

DeBoer

Guerrant

2014

Curr Infect Dis Rep

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Worldwide, early childhood infectious diarrhea continues to be a significant concern. Diarrheal illness affects the world’s youngest and most vulnerable citizens disproportionately. Estimates are that over 70% of the deaths from diarrhea occur in people younger than 24 months of age. Diarrhea and environmental enteropathy have been associated with growth failure and stunting. In addition, the burden of enteric disease also leads to cognitive and academic losses, thus resulting in loss of human capital and economic productivity. While considerable progress has been made on preventing and treating childhood diarrheal illness, the mortality and morbidity still remain unacceptably high. This paper seeks to review the recent (mainly from 2013) publications surrounding the global burden of childhood diarrhea and the implications for long-term sequelae.

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Changes over time in the epidemiology of diarrhea and malnutrition among children in an Urban Brazilian Shantytown, 1989 to 1996

Abstract: These results demonstrate marked changes over time in the diarrhea burden and nutritional status of children in this population and provide further evidence of a significant association between malnutrition and increased incidence of diarrhea.

Cited by 28 publications

References 16 publications

Early childhood diarrhea is associated with diminished cognitive function 4 to 7 years later in children in a northeast Brazilian shantytown.

Early childhood diarrhea is associated with diminished cognitive function 4 to 7 years later in children in a northeast Brazilian shantytown.

Does Childhood Diarrhea Influence Cognition Beyond the Diarrhea-Stunting Pathway?

Recent Advances in Understanding the Long-Term Sequelae of Childhood Infectious Diarrhea

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