Effects of improved water, sanitation, and hygiene and improved complementary feeding on environmental enteric dysfunction in children in rural Zimbabwe: acluster-randomized controlled trial
Effects of improved water, sanitation, and hygiene and improved complementary feeding on environmental enteric dysfunction in children in rural Zimbabwe: acluster-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 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.
1-29
Gough, Ethan K.
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Moulton, Lawrence H.
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Mutasa, Kuda
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Ntozini, Robert
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Stoltzfus, Rebecca J.
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Majo, Florence D.
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Smith, Laura E.
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Panic, Gordana
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Giallourou, Natasa
b5891ea7-98d4-49d7-b883-2c57ca2d962a
Jamell, Mark
3388c022-b10a-48ab-81a1-a4a6bd853fe5
Kosek, Peter
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Swann, Jonathan R.
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Humphrey, Jean H.
072011d2-f255-491f-8da4-53cc2153ef7a
Prendergast, Andrew J.
7572b0e9-fa3c-40c4-a35d-e15d763b16d1
Sanitation Hygiene Infant Nutrition Efficacy (SHINE) Trial Team
14 February 2020
Gough, Ethan K.
277664d4-2bcd-43fc-9dcc-29ab4287b457
Moulton, Lawrence H.
19ff592d-9f22-45e4-874e-db6e80f552ef
Mutasa, Kuda
5a0b91de-1af1-4b1b-9667-074a2f10d299
Ntozini, Robert
71f8f5a8-d8f7-457a-bee9-de3726b0e308
Stoltzfus, Rebecca J.
f905e1bd-1dac-4c71-a07f-1745f2c544a4
Majo, Florence D.
1462dd8c-2c65-424a-a97a-d6d9a93ba541
Smith, Laura E.
aa723ce4-5132-43f1-9fc5-a69ee6eb7302
Panic, Gordana
e78534c3-1e89-4161-9128-45518d4279de
Giallourou, Natasa
b5891ea7-98d4-49d7-b883-2c57ca2d962a
Jamell, Mark
3388c022-b10a-48ab-81a1-a4a6bd853fe5
Kosek, Peter
764f66d5-3b25-403a-85db-0f4374274214
Swann, Jonathan R.
7c11a66b-f4b8-4dbf-aa17-ad8b0561b85c
Humphrey, Jean H.
072011d2-f255-491f-8da4-53cc2153ef7a
Prendergast, Andrew J.
7572b0e9-fa3c-40c4-a35d-e15d763b16d1
Gough, Ethan K., Moulton, Lawrence H., Mutasa, Kuda, Ntozini, Robert, Stoltzfus, Rebecca J., Majo, Florence D., Smith, Laura E., Panic, Gordana, Giallourou, Natasa, Jamell, Mark, Kosek, Peter, Swann, Jonathan R., Humphrey, Jean H. and Prendergast, Andrew J.
,
Sanitation Hygiene Infant Nutrition Efficacy (SHINE) Trial Team
(2020)
Effects of improved water, sanitation, and hygiene and improved complementary feeding on environmental enteric dysfunction in children in rural Zimbabwe: acluster-randomized controlled trial.
PLoS Neglected Tropical Diseases, 14 (2), , [e0007963].
(doi:10.1371/journal.pntd.0007963).
Abstract
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.
Text
journal.pntd.0007963
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More information
Accepted/In Press date: 27 November 2019
Published date: 14 February 2020
Identifiers
Local EPrints ID: 439737
URI: http://eprints.soton.ac.uk/id/eprint/439737
ISSN: 1935-2727
PURE UUID: 3fb43d80-c097-422e-a1b8-285dfe576934
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Date deposited: 30 Apr 2020 16:35
Last modified: 17 Mar 2024 04:00
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Contributors
Author:
Ethan K. Gough
Author:
Lawrence H. Moulton
Author:
Kuda Mutasa
Author:
Robert Ntozini
Author:
Rebecca J. Stoltzfus
Author:
Florence D. Majo
Author:
Laura E. Smith
Author:
Gordana Panic
Author:
Natasa Giallourou
Author:
Mark Jamell
Author:
Peter Kosek
Author:
Jean H. Humphrey
Author:
Andrew J. Prendergast
Corporate Author: Sanitation Hygiene Infant Nutrition Efficacy (SHINE) Trial Team
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