Opportunities to assess factors contributing to the development of the intestinal microbiota in infants living in developing countries

Abstract

Recent evidence suggests that establishment of a healthy gut microbiota shortly after birth is important to achieve optimal growth and development of children. Being born into a resource-poor environment presents challenges to the establishment of a healthy gut microbial flora in the newborn. Among these challenges are births that occur at home, traditional pre-lacteal feeding of newborns leading to failure to initiate lactation, poor sanitation and water quality, early environmental exposure to, and infection with, enteric or other pathogens, suboptimal breast feeding duration and intensity, deficiencies in weaning and childhood diets contributing to micro- and macro-nutrient deficiencies, and the frequent use of antibiotics. These factors should be considered in the design and implementation of preventive and therapeutic interventions aimed at improving the health and development of these children.

Keywords: child development; developing countries; enteric infections; environmental enteropathy; gut microbiota; probiotics; under-nutrition.

Figures

Fig. 1

Proportion of children stunted during the first two years at MAL-ED sites. Each child was measured every month for the first two years. Green – proportion of children not stunted (>−2 LAZ), Orange – proportion of children stunted (−3 LAZ), Blue – proportion of children severely stunted (

Fig. 2

The number of births occurring at home and at a medical facility in each of the MAL-ED sites.

Fig. 3

Decrease in exclusive breastfeeding at MAL-ED Sites. Survival curves of exclusive breastfeeding are shown for each of the MAL-ED sites. Exclusive breastfeeding is defined as only having received colostrum and breast milk until such time as other liquids such as water, tea, solids are given.

Fig. 4

(a) Proportion of cohort children at each MAL-ED site that have been infected with at least one enteric pathogen. (b) Proportion of cohort children at each MAL-ED site that has experienced at least one diarrhea episode.

Fig. 5

Percent of normal stool samples containing at least one enteric pathogen. Normal stool samples were collected monthly and assayed for all enteric pathogens including bacteria, viruses, and parasites studied in MAL-ED. In the case of norovirus a subset of 10% of subjects were randomly selected from each site to have their normal stool samples assayed. The results for each site are shown as different colors indicated in the legend at the right of the figure.

Fig. 6

(a) Percentage of days during the first two years of life that cohort children at each MAL-ED site received or did not receive antibiotics. (b) Treatment of diarrhea episodes with antibiotics at each MAL-ED site. Gray bars represent the percent of diarrhea episodes for which antibiotics were given. Black hash marks indicate the average number of antibiotics given.