Abstract
BackgroundThe association between childhood diarrheal disease and linear growth faltering in developing countries is well described. However, the impact attributed to specific pathogens has not been elucidated, nor has the impact of recommended antibiotic treatment.MethodsThe Global Enteric Multicenter Study enrolled children with moderate to severe diarrhea (MSD) seeking healthcare at 7 sites in sub-Saharan Africa and South Asia. At enrollment, we collected stool samples to identify enteropathogens. Length/height was measured at enrollment and follow-up, approximately 60 days later, to calculate change in height-for-age z scores (ΔHAZ). The association of pathogens with ΔHAZ was tested using linear mixed effects regression models.ResultsAmong 8077 MSD cases analyzed, the proportion with stunting (HAZ below −1) increased from 59% at enrollment to 65% at follow-up (P < .0001). Pathogens significantly associated with linear growth decline included Cryptosporidium (P < .001), typical enteropathogenic Escherichia coli (P = .01), and untreated Shigella (P = .009) among infants (aged 0–11 months) and enterotoxigenic E. coli encoding heat-stable toxin (P < .001) and Cryptosporidium (P = .03) among toddlers (aged 12–23 months). Shigella-infected toddlers given antibiotics had improved linear growth (P = .02).ConclusionsLinear growth faltering among children aged 0–23 months with MSD is associated with specific pathogens and can be mitigated with targeted treatment strategies, as demonstrated for Shigella.
Highlights
The association between childhood diarrheal disease and linear growth faltering in developing countries is well-described
Cr trials designed to evaluate the efficacy of pathogen-specific treatment have used short-term clinical s and bacteriologic cure as endpoints [9, 10], while the impact on growth has not been characterized. u The Global Enteric Multicenter Study (GEMS) is a prospective, matched case-control study of the an burden, etiology, and adverse clinical outcomes of moderate-to-severe diarrhea (MSD) in children aged 0-59 months in sub-Saharan Africa and South Asia
We previously demonstrated that among children 0-59 months of age living in low-resource settings in South Asia and sub-Saharan Africa, an episode of MSD was associated with an increased risk of stunting over the ensuing 2-3 months
Summary
The association between childhood diarrheal disease and linear growth faltering in developing countries is well-described. Diarrheal disease is associated with linear growth faltering among young children [1]. Communitybased studies in low-resource settings demonstrate an increasing risk of stunting at age 24 months with each diarrheal episode and each day of diarrhea before that age [2]. T most acute diarrhea is caused by infection, few studies have elucidated the impact of ip specific pathogens on growth, and a limited array of pathogens has been examined [5-8]. Cr trials designed to evaluate the efficacy of pathogen-specific treatment have used short-term clinical s and bacteriologic cure as endpoints [9, 10], while the impact on growth has not been characterized.
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