Abstract
Non-typhoidal Salmonella (NTS) is one of the less focused on infections and is often associated with faulty child nutrition in the developing world. This study aimed to evaluate the association of NTS infection with growth faltering among children under the age of five. We analyzed data from 378 fecal NTS positive children with both moderate-to-severe diarrhea (MSD) and asymptomatic infection from the seven countries of South Asia and sub-Saharan Africa during enrolment and on day 60 follow up in the Global Enteric Multicenter Study (GEMS) for the period of December 2007 to March 2011. Children not associated with fecal NTS (n = 1134) were randomly selected from the same dataset (1:3 ratio) as a comparison group. The association between an explanatory variable and the outcome variable was longitudinally tested using generalized estimating equations (GEE), where the dependent variables were height-for-age (HAZ), weight-for-age (WAZ), and weight-for-height (WHZ) z-score, and the independent variable was the presence of fecal NTS. The GEE multivariable model identified a negative association between fecal NTS and WAZ (coefficient: −0.19; 95% CI (confidence interval): −0.33, −0.04, and p value = 0.010), WHZ (coef: −0.19; 95% CI: −0.34, −0.05, and p value = 0.007), and HAZ (coef: −0.13; 95% CI: −0.27, −0.01, and p value = 0.073) after adjusting for age, gender, diarrhea, breastfeeding status, mothers’ education, number of children under the age of five, household size by the number of people regularly sleep at the home, handwashing practice, source of drinking water, wealth index, presence of co-pathogens, comorbidity, and study sites. In the GEMS, where children were followed during 50–90 days of enrolment, the presence of fecal NTS harmed the child’s anthropometric outcomes. Minimizing potential exposure to NTS is needed to curb worsening child undernutrition.
Highlights
An approximate 3.4 million global invasive enteritis cases per year are caused by nontyphoidal Salmonella (NTS) infection [1]
We enrolled a total of 1512 children (378 fecal NTS positives and 1134 NTS negative controls) from Global Enteric Multicenter Study (GEMS)
About 41.4% were breastfed; half of the children had moderate-to-severe diarrhea; 14.6% reported the presence of blood in the stool; and, in the case of Bangladesh site, almost half of the children reported visible blood in the stool and 50% were febrile during enrollment, while vomiting ≥3 times/day was observed less often during enrollment
Summary
An approximate 3.4 million global invasive enteritis cases per year are caused by nontyphoidal Salmonella (NTS) infection [1]. NTS is a gram-negative bacterium responsible for illness in both humans and animals worldwide. It causes self-limiting illness, which is usually asymptomatic. In the case of acutely symptomatic individuals present with diarrhea, NTS can affect nutritional status due to anorexia causing reduced intake, less absorption, and excess energy expenditure. It is responsible for an estimated 150,000 human deaths worldwide annually [2].
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