Kurt Z. Long (1), Salvador Zamora (2), Inong Gunanti (1), Georgina Mora (3), Matthew M. Hutmacher (4), Policy Delivery and Implementation Surge Team - representing the Healthy Birth, Growth and Development knowledge integration (HBGDki) community.
(1) Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland, (2) Mathematics Department, National University of Mexico, DF, Mexico, (3) Program in Nutrition of Childhood and Adolescence, Secretariat of Health, Xalapa, Veracruz, Mexico, (4) Ann Arbor Pharmacometrics Group, Ann Arbor, Michigan, USA
Objectives: The burden of childhood diarrhea and malnutrition remains high in South Asia due to inadequate household sanitation, lack of access to improved water and poor hygiene practices [1]. We addressed the relationship between household factors, enteric pathogen infections (EPI) and impaired growth among children residing in rural communities of Bangladesh.
Methods: The relationship between household factors, EPI and impaired growth was evaluated using data from the Global Enteric Multicenter Study site of Mirzapur, Bangladesh [2]. Stool specimens collected at enrollment from children with moderate-to-severe diarrhea and matched controls were screened for bacterial, viral and protozoa EPI. Height measurements of children were also taken and information on sanitation facilities, water sources, household animals, cooking fuel type, caretaker education and hand washing practices were collected. Structural equation models tested pathways directly linking household factors with stunting (< – 2 height-age-Z score) or indirectly through their effects on EPI transmission. Effects of handwashing behaviors, water sources and caretaker education were also tested directly and indirectly.
Results: Giardia lamblia and Cryptosporidium infections were associated with increased stunting among older children. Dog or goats in compound were directly associated with increased stunting while having a refrigerator or non-dirt floor was associated with reduced stunting. Cow dung fuel use when caretakers reported no handwashing before eating had an indirect effect due to increased prevalence of Cryptosporidium. A traditional latrine with caretakers reporting no handwashing before cooking was also associated with increased prevalence of G. lamblia and Cryptosporidium infections. Increased Cryptosporidium was associated with child feces disposal when caretaker had no formal education. Greater caretaker education was directly associated with reduced stunting and indirectly through an effect on on Cryptosporidium. Overall, caretaker education had the greatest beneficial effect on stunting through direct and indirect pathways.
Conclusions: Causal pathways of childhood stunting were identified that involved animal and environmental factors as well as distinct hygiene-related behaviors. These results can inform the design. implementation and evaluation of different interventions to more effectively reduce diarrhea burden and stunting.
References:
[1] Black RE, Allen LH, Bhutta ZA, Caulfield LE, de Onis M, Ezzati M, et al. Maternal and child undernutrition: global and regional exposures and health consequences. Lancet. 2008;371:243-60.
[2]. Kotloff KL, Nataro JP, Blackwelder WC, Nasrin D, Farag TH, Panchalingam S, et al. Burden and aetiology of diarrhoeal disease in infants and young children in developing countries (the Global Enteric Multicenter Study, GEMS): a prospective, case-control study. Lancet. 2013;382:209-22.
Reference: PAGE 25 (2016) Abstr 5744 [www.page-meeting.org/?abstract=5744]
Poster: Methodology - New Modelling Approaches