Site-Specific Analysis of the Incidence Rate of Enterotoxigenic Escherichia coli Infection Elucidates an Association with Childhood Stunting, Wasting, and Being Underweight: A Secondary Analysis of the MAL-ED Birth Cohort

• Type of Material: Article
• Authors: Md Ahshanul Haque, International Centre for Diarrhoeal Disease Research; Sabiha Nasrin, International Centre for Diarrhoeal Disease Research; Parag Palit, International Centre for Diarrhoeal Disease Research; Rina Das, Emory University; Barbie Zaman Wahid, University of Nebraska-Lincoln; Md Amran Gazi, International Centre for Diarrhoeal Disease Research; Mustafa Mahfuz, International Centre for Diarrhoeal Disease Research; Abu Syed Golam Faruque, International Centre for Diarrhoeal Disease Research; Tahmeed Ahmed, International Centre for Diarrhoeal Disease Research
• Language: English
• Date: 2023-04-03
• Publisher: AMERICAN SOCIETY OF TROPICAL MEDICINE AND HYGIENE
• Publication Version: Final Published Version
• Copyright Statement: © The author(s)
• License: Creative Commons Attribution 4.0 International
• Final Published Version (URL): https://doi.org/10.4269/ajtmh.22-0659
• Title of Journal or Parent Work: The American Journal of Tropical Medicine and Hygiene
• Volume: 108
• Issue: 6
• Start Page: 1192
• End Page: 1200
• Grant/Funding Information: This work was supported, in whole or in part, by The Bill & Melinda Gates Foundation (grant OPP47075). Under the grant conditions of the foundation, a Creative Commons Attribution 4.0 Generic License has already been assigned to the Author’s Accepted Manuscript version that might arise from this submission.
• Keywords: Bangladesh; enterotoxigenic Escherichia coli (ETEC); Peru; Nepal; childhood malnutrition; India; Brazil; Pakistan; fecal enteropathogens; birth cohort study; Tanzania; South Africa; TaqMan array card
• Research Categories: Health Sciences, Public Health; Health Sciences, General; Health Sciences, Epidemiology

Abstract

Asymptomatic infection by fecal enteropathogens is a major contributor to childhood malnutrition. Here, we investigated the incidence rate of asymptomatic infection by enterotoxigenic Escherichia coli (ETEC) and assessed its association with childhood stunting, wasting, and being underweight among children under 2 years of age. The Malnutrition and Enteric Disease birth cohort study included 1,715 children who were followed from birth to 24 months of age from eight distinct geographic locations including Bangladesh, Brazil, India, Peru, Tanzania, Pakistan, Nepal, and South Africa. The TaqMan array card assay was used to determine the presence of ETEC in the nondiarrheal stool samples collected from these children. Poisson regression was used to estimate the incidence rate, and multiple generalized estimating equations with binomial family, logit link function, and exchangeable correlation were used to analyze the association between asymptomatic ETEC infection and anthropometric indicators such as stunting, wasting, and being underweight. The site-specific incidence rates of asymptomatic ETEC infections per 100 child-months were also higher at the study locations in Tanzania (54.81 [95% CI: 52.64, 57.07]) and Bangladesh (46.75 [95% CI: 44.75, 48.83]). In the Bangladesh, India, and Tanzania sites, the composite indicator of anthropometric failure was significantly associated with asymptomatic ETEC infection. Furthermore, a significant association between asymptomatic heat-stable toxin ETEC infections and childhood stunting, wasting, and being underweight was found in only the Bangladesh and Tanzania sites.