Household environmental conditions are associated with enteropathy and impaired growth in rural Bangladesh

Audrie Lin, Benjamin F Arnold, Sadia Afreen, Rie Goto, Tarique Mohammad Nurul Huda, Rashidul Haque, Rubhana Raqib, Leanne Unicomb, Tahmeed Ahmed, John M Colford, Stephen P Luby, Audrie Lin, Benjamin F Arnold, Sadia Afreen, Rie Goto, Tarique Mohammad Nurul Huda, Rashidul Haque, Rubhana Raqib, Leanne Unicomb, Tahmeed Ahmed, John M Colford, Stephen P Luby

Abstract

We assessed the relationship of fecal environmental contamination and environmental enteropathy. We compared markers of environmental enteropathy, parasite burden, and growth in 119 Bangladeshi children (≤ 48 months of age) across rural Bangladesh living in different levels of household environmental cleanliness defined by objective indicators of water quality and sanitary and hand-washing infrastructure. Adjusted for potential confounding characteristics, children from clean households had 0.54 SDs (95% confidence interval [CI] = 0.06, 1.01) higher height-for-age z scores (HAZs), 0.32 SDs (95% CI = -0.72, 0.08) lower lactulose:mannitol (L:M) ratios in urine, and 0.24 SDs (95% CI = -0.63, 0.16) lower immunoglobulin G endotoxin core antibody (IgG EndoCAb) titers than children from contaminated households. After adjusting for age and sex, a 1-unit increase in the ln L:M was associated with a 0.33 SDs decrease in HAZ (95% CI = -0.62, -0.05). These results are consistent with the hypothesis that environmental contamination causes growth faltering mediated through environmental enteropathy.

Figures

Figure 1.
Figure 1.
Tukey box plots of total IgG, EndoCAb titer, and L:M ratio distributions by environmental group. Heavy horizontal lines mark median values, and box edges mark the interquartile range. If the box notches do not overlap between groups, there is strong evidence that the median values differ (there is slight overlap in both cases, consistent with the marginally significant differences reported in Table 2). EndoCAb standard median units (MUs) are arbitrary and are based on medians of ranges for 1,000 healthy adults in a specific location.

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