Effects of Water, Sanitation, Handwashing, and Nutritional Interventions on Environmental Enteric Dysfunction in Young Children: A Cluster-randomized, Controlled Trial in Rural Bangladesh
| Autor: | Audrie, Lin, Shahjahan, Ali, Benjamin F, Arnold, Md Ziaur, Rahman, Mohammad, Alauddin, Jessica, Grembi, Andrew N, Mertens, Syeda L, Famida, Salma, Akther, Md Saheen, Hossen, Palash, Mutsuddi, Abul K, Shoab, Zahir, Hussain, Mahbubur, Rahman, Leanne, Unicomb, Sania, Ashraf, Abu Mohd, Naser, Sarker M, Parvez, Ayse, Ercumen, Jade, Benjamin-Chung, Rashidul, Haque, Tahmeed, Ahmed, Md Iqbal, Hossain, Nuzhat, Choudhury, Kaniz, Jannat, Sarah T, Alauddin, Sandra G, Minchala, Rabije, Cekovic, Alan E, Hubbard, Christine P, Stewart, Kathryn G, Dewey, John M, Colford, Stephen P, Luby |
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| Rok vydání: | 2020 |
| Předmět: |
Rural Population
Clinical Trials and Supportive Activities early childhood intervention Medical and Health Sciences Microbiology Oral and gastrointestinal Pregnancy Clinical Research Humans Sanitation Child Preschool Nutrition Pediatric Bangladesh Prevention Water Infant Biological Sciences environmental enteropathy water sanitation hygiene trial Clean Water and Sanitation Child Preschool environmental enteric dysfunction Female Digestive Diseases Hand Disinfection |
| Zdroj: | Clinical infectious diseases : an official publication of the Infectious Diseases Society of America, vol 70, iss 5 |
| Popis: | BackgroundWe hypothesized that drinking water, sanitation, handwashing (WSH), and nutritional interventions would improve environmental enteric dysfunction (EED), a potential contributor to stunting.MethodsWithin a subsample of a cluster-randomized, controlled trial in rural Bangladesh, we enrolled pregnant women in 4 arms: control, WSH, child nutrition counseling plus lipid-based nutrient supplements (N), and nutrition plus WSH (N+WSH). Among the birth cohort, we measured biomarkers of gut inflammation (myeloperoxidase, neopterin), permeability (alpha-1-antitrypsin, lactulose, mannitol), and repair (regenerating gene 1β) at median ages 3, 14, and 28 months. Analysis was intention-to-treat.ResultsWe assessed 1512 children. At age 3 months, compared to controls, neopterin was reduced by nutrition (-0.21 log nmol/L; 95% confidence interval [CI], -.37, -.05) and N+WSH (-0.20 log nmol/L; 95% CI, -.34, -.06) interventions; similar reductions were observed at 14 months. At 3 months, all interventions reduced lactulose and mannitol (-0.60 to -0.69 log mmol/L). At 28 months, myeloperoxidase was elevated in the WSH and nutrition arms (0.23-0.27 log ng/mL) and lactulose was higher in the WSH arm (0.30 log mmol/L; 95% CI, .07, .53).ConclusionsReductions in permeability and inflammation at ages 3 and 14 months suggest that the interventions promoted healthy intestinal maturation; however, by 28 months, the WSH and nutrition arms showed elevated EED biomarkers. These results underscore the importance of developing a better understanding of EED pathophysiology and targeting interventions early in childhood, when they are likely to have the largest benefit to intestinal health.Clinical trials registrationNCT01590095. |
| Databáze: | OpenAIRE |
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