Effects of improved water, sanitation, and hygiene and improved complementary feeding on environmental enteric dysfunction in children in rural Zimbabwe: A cluster-randomized controlled trial.
Background Environmental enteric dysfunction (EED) may be an important modifiable cause of child stunting. We described the evolution of EED biomarkers from birth to 18 months in rural Zimbabwe and tested the independent and combined effects of improved water, sanitation, and hygiene (WASH), and imp...
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ftdoajarticles:oai:doaj.org/article:434dd9c1355c42688d99c54e66c533e8 2023-05-15T15:16:25+02:00 Effects of improved water, sanitation, and hygiene and improved complementary feeding on environmental enteric dysfunction in children in rural Zimbabwe: A cluster-randomized controlled trial. Ethan K Gough Lawrence H Moulton Kuda Mutasa Robert Ntozini Rebecca J Stoltzfus Florence D Majo Laura E Smith Gordana Panic Natasa Giallourou Mark Jamell Peter Kosek Jonathan R Swann Jean H Humphrey Andrew J Prendergast Sanitation Hygiene Infant Nutrition Efficacy (SHINE) Trial Team 2020-02-01T00:00:00Z https://doi.org/10.1371/journal.pntd.0007963 https://doaj.org/article/434dd9c1355c42688d99c54e66c533e8 EN eng Public Library of Science (PLoS) https://doi.org/10.1371/journal.pntd.0007963 https://doaj.org/toc/1935-2727 https://doaj.org/toc/1935-2735 1935-2727 1935-2735 doi:10.1371/journal.pntd.0007963 https://doaj.org/article/434dd9c1355c42688d99c54e66c533e8 PLoS Neglected Tropical Diseases, Vol 14, Iss 2, p e0007963 (2020) Arctic medicine. Tropical medicine RC955-962 Public aspects of medicine RA1-1270 article 2020 ftdoajarticles https://doi.org/10.1371/journal.pntd.0007963 2022-12-31T10:07:30Z Background Environmental enteric dysfunction (EED) may be an important modifiable cause of child stunting. We described the evolution of EED biomarkers from birth to 18 months in rural Zimbabwe and tested the independent and combined effects of improved water, sanitation, and hygiene (WASH), and improved infant and young child feeding (IYCF), on EED. Methodology and findings The Sanitation Hygiene Infant Nutrition Efficacy (SHINE) trial was a 2x2 factorial cluster-randomised trial of improved IYCF and improved WASH on child stunting and anaemia at 18 months of age. 1169 infants born to HIV-negative mothers provided plasma and faecal specimens at 1, 3, 6, 12, and 18 months of age. We measured EED biomarkers that reflect all domains of the hypothesized pathological pathway. Markers of intestinal permeability and intestinal inflammation declined over time, while markers of microbial translocation and systemic inflammation increased between 1-18 months. Markers of intestinal damage (I-FABP) and repair (REG-1β) mirrored each other, and citrulline (a marker of intestinal epithelial mass) increased from 6 months of age, suggesting dynamic epithelial turnover and regeneration in response to enteric insults. We observed few effects of IYCF and WASH on EED after adjustment for multiple comparisons. The WASH intervention decreased plasma IGF-1 at 3 months (β:0.89, 95%CI:0.81,0.98) and plasma kynurenine at 12 months (β: 0.92, 95%CI:0.87,0.97), and increased plasma IGF-1 at 18 months (β:1.15, 95%CI:1.05,1.25), but these small WASH effects did not translate into improved growth. Conclusions Overall, we observed dynamic trends in EED but few effects of IYCF or WASH on biomarkers during the first 18 months after birth, suggesting that these interventions did not impact EED. Transformative WASH interventions are required to prevent or ameliorate EED in low-income settings. Article in Journal/Newspaper Arctic Directory of Open Access Journals: DOAJ Articles Arctic PLOS Neglected Tropical Diseases 14 2 e0007963 |
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Directory of Open Access Journals: DOAJ Articles |
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English |
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Arctic medicine. Tropical medicine RC955-962 Public aspects of medicine RA1-1270 |
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Arctic medicine. Tropical medicine RC955-962 Public aspects of medicine RA1-1270 Ethan K Gough Lawrence H Moulton Kuda Mutasa Robert Ntozini Rebecca J Stoltzfus Florence D Majo Laura E Smith Gordana Panic Natasa Giallourou Mark Jamell Peter Kosek Jonathan R Swann Jean H Humphrey Andrew J Prendergast Sanitation Hygiene Infant Nutrition Efficacy (SHINE) Trial Team Effects of improved water, sanitation, and hygiene and improved complementary feeding on environmental enteric dysfunction in children in rural Zimbabwe: A cluster-randomized controlled trial. |
topic_facet |
Arctic medicine. Tropical medicine RC955-962 Public aspects of medicine RA1-1270 |
description |
Background Environmental enteric dysfunction (EED) may be an important modifiable cause of child stunting. We described the evolution of EED biomarkers from birth to 18 months in rural Zimbabwe and tested the independent and combined effects of improved water, sanitation, and hygiene (WASH), and improved infant and young child feeding (IYCF), on EED. Methodology and findings The Sanitation Hygiene Infant Nutrition Efficacy (SHINE) trial was a 2x2 factorial cluster-randomised trial of improved IYCF and improved WASH on child stunting and anaemia at 18 months of age. 1169 infants born to HIV-negative mothers provided plasma and faecal specimens at 1, 3, 6, 12, and 18 months of age. We measured EED biomarkers that reflect all domains of the hypothesized pathological pathway. Markers of intestinal permeability and intestinal inflammation declined over time, while markers of microbial translocation and systemic inflammation increased between 1-18 months. Markers of intestinal damage (I-FABP) and repair (REG-1β) mirrored each other, and citrulline (a marker of intestinal epithelial mass) increased from 6 months of age, suggesting dynamic epithelial turnover and regeneration in response to enteric insults. We observed few effects of IYCF and WASH on EED after adjustment for multiple comparisons. The WASH intervention decreased plasma IGF-1 at 3 months (β:0.89, 95%CI:0.81,0.98) and plasma kynurenine at 12 months (β: 0.92, 95%CI:0.87,0.97), and increased plasma IGF-1 at 18 months (β:1.15, 95%CI:1.05,1.25), but these small WASH effects did not translate into improved growth. Conclusions Overall, we observed dynamic trends in EED but few effects of IYCF or WASH on biomarkers during the first 18 months after birth, suggesting that these interventions did not impact EED. Transformative WASH interventions are required to prevent or ameliorate EED in low-income settings. |
format |
Article in Journal/Newspaper |
author |
Ethan K Gough Lawrence H Moulton Kuda Mutasa Robert Ntozini Rebecca J Stoltzfus Florence D Majo Laura E Smith Gordana Panic Natasa Giallourou Mark Jamell Peter Kosek Jonathan R Swann Jean H Humphrey Andrew J Prendergast Sanitation Hygiene Infant Nutrition Efficacy (SHINE) Trial Team |
author_facet |
Ethan K Gough Lawrence H Moulton Kuda Mutasa Robert Ntozini Rebecca J Stoltzfus Florence D Majo Laura E Smith Gordana Panic Natasa Giallourou Mark Jamell Peter Kosek Jonathan R Swann Jean H Humphrey Andrew J Prendergast Sanitation Hygiene Infant Nutrition Efficacy (SHINE) Trial Team |
author_sort |
Ethan K Gough |
title |
Effects of improved water, sanitation, and hygiene and improved complementary feeding on environmental enteric dysfunction in children in rural Zimbabwe: A cluster-randomized controlled trial. |
title_short |
Effects of improved water, sanitation, and hygiene and improved complementary feeding on environmental enteric dysfunction in children in rural Zimbabwe: A cluster-randomized controlled trial. |
title_full |
Effects of improved water, sanitation, and hygiene and improved complementary feeding on environmental enteric dysfunction in children in rural Zimbabwe: A cluster-randomized controlled trial. |
title_fullStr |
Effects of improved water, sanitation, and hygiene and improved complementary feeding on environmental enteric dysfunction in children in rural Zimbabwe: A cluster-randomized controlled trial. |
title_full_unstemmed |
Effects of improved water, sanitation, and hygiene and improved complementary feeding on environmental enteric dysfunction in children in rural Zimbabwe: A cluster-randomized controlled trial. |
title_sort |
effects of improved water, sanitation, and hygiene and improved complementary feeding on environmental enteric dysfunction in children in rural zimbabwe: a cluster-randomized controlled trial. |
publisher |
Public Library of Science (PLoS) |
publishDate |
2020 |
url |
https://doi.org/10.1371/journal.pntd.0007963 https://doaj.org/article/434dd9c1355c42688d99c54e66c533e8 |
geographic |
Arctic |
geographic_facet |
Arctic |
genre |
Arctic |
genre_facet |
Arctic |
op_source |
PLoS Neglected Tropical Diseases, Vol 14, Iss 2, p e0007963 (2020) |
op_relation |
https://doi.org/10.1371/journal.pntd.0007963 https://doaj.org/toc/1935-2727 https://doaj.org/toc/1935-2735 1935-2727 1935-2735 doi:10.1371/journal.pntd.0007963 https://doaj.org/article/434dd9c1355c42688d99c54e66c533e8 |
op_doi |
https://doi.org/10.1371/journal.pntd.0007963 |
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PLOS Neglected Tropical Diseases |
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14 |
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2 |
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e0007963 |
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