Enteric Infections in Young Children are Associated with Environmental Enteropathy and Impaired Growth

Objective To investigate the relationship between faecal contamination in child play spaces, enteric infections, environmental enteropathy (EE) and impaired growth among young children. Methods A prospective cohort study was conducted of 203 children 6–30 months of age in rural Bangladesh. Stool samples were analysed by quantitative PCR for Shigella, Enterotoxigenic Escherichia coli (ETEC), Campylobacter jejuni, Giardia intestinalis and Cryptosporidium spp. Four faecal markers of intestinal inflammation were also measured: alpha‐1‐antitrypsin, myeloperoxidase, neopterin and calprotectin. Child growth was measured at baseline and 9 months after enrolment. E. coli was measured in soil in child play spaces. Results Forty‐seven percent of study children had three or more enteric pathogens in their stool. Thirty five percent (71/203) of children had Shigella, 30% (61/203) had ETEC, 73% (148/203) had C. jejuni, 79% (160/203) had Giardia intestinalis and none had Cryptosporidium. Children with ETEC had significantly higher calprotectin concentrations (Coefficient: 1.35, 95% Confidence Interval [CI]: 1.005, 1.82). Children with Shigella had a significantly higher odds of being stunted at our 9‐month follow‐up (OR: 2.01, 95% CI: 1.02, 3.93). Children with Giardia intestinalis had significantly higher E.coli counts in the soil collected from their play spaces (OR: 1.23, 95% CI: 1.02, 1.48). Conclusion Enteric infections were significantly associated with EE and impaired growth in rural Bangladesh. These findings provide further evidence to support the hypothesis that contaminated soil in child play spaces can lead to enteric infections, many of which are likely subclinical, resulting in EE and impaired growth in young children. Objectif Etudier la relation entre la contamination fécale dans les aires de jeux pour enfants, les infections entériques, l'entéropathie environnementale (EE) et l'altération de la croissance chez les jeunes enfants. Méthodes Etude de cohorte prospective de 203 enfants âgés de 6 à 30 mois dans les zones rurales du Bangladesh. Les échantillons de selles ont été analysés par la PCR quantitative pour la détection de Shigella, Escherichia coli entérotoxigène (ECET), Campylobacter jejuni, Giardia spp et Cryptosporidium spp. Quatre marqueurs fécaux de l'inflammation intestinale ont également été mesurés: alpha‐1‐antitrypsine, myéloperoxydase, néoptérine et calprotectine. La croissance de l'enfant a été mesurée au départ et 9 mois après l'inscripti