Household Environmental Conditions Are Associated with Enteropathy and Impaired Growth in Rural Bangladesh

Abstract

We assessed the relationship of fecal environmental contamination and environmental enteropathy. We compared markers of environmental enteropathy, parasite burden, and growth in 119 Bangladeshi children (≤ 48 months of age) across rural Bangladesh living in different levels of household environmental cleanliness defined by objective indicators of water quality and sanitary and hand-washing infrastructure. Adjusted for potential confounding characteristics, children from clean households had 0.54 SDs (95% confidence interval [CI] = 0.06, 1.01) higher height-for-age z scores (HAZs), 0.32 SDs (95% CI = −0.72, 0.08) lower lactulose:mannitol (L:M) ratios in urine, and 0.24 SDs (95% CI = −0.63, 0.16) lower immunoglobulin G endotoxin core antibody (IgG EndoCAb) titers than children from contaminated households. After adjusting for age and sex, a 1-unit increase in the ln L:M was associated with a 0.33 SDs decrease in HAZ (95% CI = −0.62, −0.05). These results are consistent with the hypothesis that environmental contamination causes growth faltering mediated through environmental enteropathy.

Geophagy is Associated with Environmental Enteropathy and Stunting in Children in Rural Bangladesh

“…[2][3][4][5][6][7][8][9][10] Although its etiology is not fully defined, EE is thought to be caused by unsanitary environmental conditions leading to repeated exposures to enteric pathogens. 11 The gold standard to measure EE is endoscopy and biopsy, which is impractical in most low-income settings. 12 Therefore, generally markers of intestinal barrier function and absorptive capacity of the small intestine are used as surrogate measures.…”

Place and Child Health: The Interaction of Population Density and Sanitation in Developing Countries

“…Humphrey (2009) posited that chronic but subclinical "environmental enteropathy," caused by ingestion of fecal pathogens, may also lead to slowed growth. Lin et al (2013) found associations among fecal environmental contamination, enteropathy, and child height in Bangladesh. Poor sanitation can also spread parasitic infections, which are rarely fatal by themselves but contribute to poor health and poor physical growth (Haque 2007).…”

Effects of Early-Life Exposure to Sanitation on Childhood Cognitive Skills: Evidence from India's Total Sanitation Campaign

“…Evidence is converging that this chronic 4 disorder of the small intestine, due to "faecal bacteria ingested in large quantities by young children living in conditions of poor sanitation and hygiene" (Humphrey, 2009(Humphrey, , 1032, could cause widespread malabsorption of nutrients among children living in places where open defecation is common (Petri et al, 2008;Mondal et al, 2011;Korpe and Petri, 2012). In a recent study in rural Bangladesh, Lin et al (2013) show that children exposed to less sanitary conditions show more biologically measured markers of enteropathy and do not grow as tall (also see Kosek et al, 2013). These epidemiological and medical studies, combined with a growing literature within economics that documents effects of poor sanitation on earlylife health, 2 suggest that diminished human capital and cognitive skills may be a further consequence of open defecation.…”