Unsafe Child Feces Disposal is Associated with Environmental Enteropathy and Impaired Growth.
OBJECTIVE To investigate the relationship between unsafe child feces disposal, environmental enteropathy, and impaired growth, we conducted a prospective cohort study of 216 young children in rural Bangladesh. STUDY DESIGN Using a prospective cohort study design in rural Bangladesh, unsafe child feces disposal, using the Joint Monitoring Program definition, was assessed using 5 hour structured observation by trained study personnel as well as caregiver reports. Anthropometric measurements were collected at baseline and at a 9 month follow up. Stool was analyzed for fecal markers of environmental enteropathy: alpha 1 antitrypsin, myeloperoxidase, neopterin (combined to form an environmental enteropathy disease activity score) and calprotectin. FINDINGS Among 216 households with young children, 84% had an unsafe child feces disposal event during structured observation and 75% had caregiver reported events. There was no significant difference in observed unsafe child feces disposal events for households with or without an improved sanitation option (82% vs 85% P .72) or by child's age (P .96) Children in households where caregivers reported unsafe child feces disposal had significantly higher environmental enteropathy scores (0.82 point difference, 95% CI 0.11 1.53) and significantly greater odds of being wasted (weight for height z score 2 SDs) (9% vs 0% P .024) In addition, children in households with observed unsafe feces disposal had significantly reduced change in weight for age z score 0.34 [95% CI 0.68, 0.01] and weight for height z score 0.52 [95% CI 0.98, 0.06] CONCLUSION Unsafe child feces disposal was significantly associated with environmental enteropathy and impaired growth in a pediatric population in rural Bangladesh. Interventions are needed to reduce this high risk behavior to protect the health of susceptible pediatric populations.
The Journal of pediatrics