Tag Archives: environmental enteropathy

Small Intestine Bacterial Overgrowth and Environmental Enteropathy in Bangladeshi Children

Small Intestine Bacterial Overgrowth and Environmental Enteropathy in Bangladeshi Children. mBio, Jan 2016

Authors: Jeffrey R. Donowitz, Rashidul Haque, et al.

Recent studies suggest small intestine bacterial overgrowth (SIBO) is common among developing world children. SIBO’s pathogenesis and effect in the developing world are unclear. Our objective was to determine the prevalence of SIBO in Bangladeshi children and its association with malnutrition. Secondary objectives included determination of SIBO’s association with sanitation, diarrheal disease, and environmental enteropathy.

The strongest predictors of SIBO were decreased length-for-age Z score since birth (odds ratio [OR], 0.13; 95% confidence interval [CI], 0.03 to 0.60) and an open sewer outside the home (OR, 4.78; 95% CI, 1.06 to 21.62). Recent or frequent diarrheal disease did not predict SIBO. The markers of intestinal inflammation fecal Reg 1β (116.8 versus 65.6 µg/ml; P = 0.02) and fecal calprotectin (1,834.6 versus 766.7 µg/g; P = 0.004) were elevated in SIBO-positive children. Measures of intestinal permeability and systemic inflammation did not differ between the groups.

These findings suggest linear growth faltering and poor sanitation are associated with SIBO independently of recent or frequent diarrheal disease. SIBO is associated with intestinal inflammation but not increased permeability or systemic inflammation.

A Disease That Could Render the Oral Polio Vaccine Ineffective

A Disease That Could Render the Oral Polio Vaccine Ineffective. Source: The Wire, India, Jan 6 2016.

A tough-to detect and alarmingly common intestinal disease may have a lot to do with India’s stunted children and their susceptibility to polio and rotavirus infections.

In 2011, a team of scientists from the USA, the Netherlands and Bangladesh began a study to answer one mystery: More than 95% of children who contract paralytic polio in India have received more than 3 doses of the Oral Polio Vaccine. In Bangladesh, the oral rotavirus vaccine has shown to be effective only 43% of the time compared to 95% in Europe. What could be causing this vaccine inefficacy?

env-enter

Credit: cdcglobal/Flickr, CC BY 2.0

An infant receiving an oral polio vaccine.

One hypothesis claims that oral polio vaccines and rotavirus vaccines are less likely to work in children suffering from a type of intestinal damage called environmental enteropathy (EE), thought to be common in developing nations. The group built a strategy to test this.

Characterised by inflamed small intestines, resulting in faulty nutrient absorption, EE is believed to result out of repeated exposure to harmful pathogens. In low-income countries, where sanitation is often inadequate, EE is thought to be pretty common, but being a subclinical disease, it does not always show symptoms and hence has proved difficult to study.

The only foolproof way to identify EE patients would be via a biopsy, but since invasive techniques are not an option for large-scale studies on young subjects, the investigators made do with what they felt was the next best thing. The scientists of the Performance of Rotavirus and Oral Polio Vaccines in Developing Countries (PROVIDE) study diagnosed EE based on whether certain compounds were present in the subjects’ stool samples. These compounds, or biomarkers, have shown to be indicative of intestinal inflammation.

Read the complete article.

Will better sanitaton and nutrition reduce stunting?

Zimbabwe SHINE trial - Cornell University

Photo: Cornell University

A trial is underway in Zimbabwe to measure the independent and combined effects of improved sanitation and hygiene (WASH) and improved infant diet on stunting and anemia among children 0-18 months old [Cornell University CENTIR Group blog].

The Sanitation, Hygiene and Infant Nutrition Efficacy (SHINE) Trial is led by the Zvitambo Institute for Maternal and Child Health Research in Harare, Zimbabwe in collaboration with the Ministry of Health and Child Care/Government of Zimbabwe. Other contracted experts include Sandy Cairncross, Val Curtis and Peter Morgan.

The SHINE Trial is being undertaken in Chirumanzu and Shurugw, two districts with high HIV prevalence. Besides investigating the effects of sanitation and nutrition, SHINE will also test whether Environmental Enteric Dysfunction (EED)is a major cause of a major cause of child undernutrition. EED, also called environmental enteropathy, is a condition believed to be due to frequent intestinal infections.

SHINE is being being funded by the Bill & Melinda Gates Foundation and the UK Department for International Development (DFID). There are additional contributions from Wellcome Trust, National Institutes of Health, and the Swiss Development Cooperation.

A special open access supplement of Clinical Infectious Diseases is devoted to SHINE containing the following articles:

  • The Sanitation Hygiene Infant Nutrition Efficacy (SHINE) Trial Team, doi:10.1093/cid/civ844
  • Design of an Intervention to Minimize Ingestion of Fecal Microbes by Young Children in Rural Zimbabwe, doi:10.1093/cid/civ845
  • The SHINE Trial Infant Feeding Intervention: Pilot Study of Effects on Maternal Learning and Infant Diet Quality in Rural Zimbabwe, doi:10.1093/cid/civ846
  • Using Geographic Information Systems and Spatial Analysis Methods to Assess Household Water Access and Sanitation Coverage in the SHINE Trial, doi:10.1093/cid/civ847
  • Assessment of Environmental Enteric Dysfunction in the SHINE Trial: Methods and Challenges, doi:10.1093/cid/civ848
  • The Potential Role of Mycotoxins as a Contributor to Stunting in the SHINE Trial, doi:10.1093/cid/civ849
  • Assessing the Intestinal Microbiota in the SHINE Trial, doi:10.1093/cid/civ850
  • Assessing Maternal Capabilities in the SHINE Trial: Highlighting a Hidden Link in the Causal Pathway to Child Health, doi:10.1093/cid/civ851
  • Theory-Driven Process Evaluation of the SHINE Trial Using a Program Impact Pathway Approach, doi:10.1093/cid/civ716

WASH, Nutrition and Early Childhood Development: New Evidence in ECD and Findings from the Field

Presenters for this June 25, 2014 webinar:

  • Jenny Orgle, Program Director for the Nutrition at the Center Program at CARE USA, will talk about “Addressing Environmental Enteropathy in CARE’s Nutrition at the Center Program.”
  • Maureen Black, Ph.D., Professor, Department of Pediatrics, University of Maryland School of Medicine, will talk about “New Evidence Linking Nutrition and Early Child Development” and its connection to WASH.
  • Moderated by Helen Petach, USAID, Bureau for Global Health, Office of Health Infectious Diseases and Nutrition

Download/view the presentation slides

USAID Webinar on Environmental Enteropathy and WASH!

Thank you to all who attended the USAID Webinar on Environmental Enteropathy and WASH!

You can find a recording of the webinar and materials from our presenters, Laura Smith from Cornell University and Helen Petach from USAID, at www.fsnnetwork.orgusaid2

Are you interested in opportunities to continue the discussion on integrated programming opportunities for WASH, nutrition and food security? Then consider joining the Community of Practice: The Nexus between WASH, Nutrition and Feed the Future. Contact Dan Campbell (dacampbell@fhi360.org)

This event was sponsored by the USAID Community of Practice: The Nexus between WASH, Nutrition and Feed the Future with support from the USAID-funded TOPS program and WASHplus project.