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Effects of Water, Sanitation, Handwashing, and Nutritional Interventions on Environmental Enteric Dysfunction in Young Children: A Cluster-randomized, Controlled Trial in Rural Bangladesh.
- Author(s): Lin, Audrie
- Ali, Shahjahan
- Arnold, Benjamin F
- Rahman, Md Ziaur
- Alauddin, Mohammad
- Grembi, Jessica
- Mertens, Andrew N
- Famida, Syeda L
- Akther, Salma
- Hossen, Md Saheen
- Mutsuddi, Palash
- Shoab, Abul K
- Hussain, Zahir
- Rahman, Mahbubur
- Unicomb, Leanne
- Ashraf, Sania
- Naser, Abu Mohd
- Parvez, Sarker M
- Ercumen, Ayse
- Benjamin-Chung, Jade
- Haque, Rashidul
- Ahmed, Tahmeed
- Hossain, Md Iqbal
- Choudhury, Nuzhat
- Jannat, Kaniz
- Alauddin, Sarah T
- Minchala, Sandra G
- Cekovic, Rabije
- Hubbard, Alan E
- Stewart, Christine P
- Dewey, Kathryn G
- Colford, John M
- Luby, Stephen P
- et al.
Published Web Location
https://academic.oup.com/cid/advance-article/doi/10.1093/cid/ciz291/5432324No data is associated with this publication.
Abstract
Background
We hypothesized that drinking water, sanitation, handwashing (WSH), and nutritional interventions would improve environmental enteric dysfunction (EED), a potential contributor to stunting.Methods
Within 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.Results
We 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).Conclusions
Reductions 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 registration
NCT01590095.Many UC-authored scholarly publications are freely available on this site because of the UC's open access policies. Let us know how this access is important for you.