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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.