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Background: Concurrent losses in biodiversity and human dietary diversity are evident in Madagascar and across many food systems globally. Wild food harvest can mitigate nutrition insecurities but may also pose species conservation concerns. Objectives: This study aimed to examine the association of wild plant and animal species consumption during hunger season with diet diversity and child growth near the Alandraza-Agnalavelo protected forest in Southwestern Madagascar. Second, we studied the conservation status of the consumed wild plants. Methods: Methods from public health nutrition (24-h recall dietary intake, anthropometry using World Health Organization [WHO] Growth Standards), ethnobotany, and forest ecology (ecologic studies of abundance, habitat preference, associated species, food chemistry assays, and species richness) were applied. Results: Malnutrition in children (n = 305) was highly prevalent: stunting (32.3%); wasting (18.8%); and low-dietary diversity (4% meeting WHO minimum dietary diversity threshold). Animal foods were consumed in small quantities, providing <10% of Dietary Reference Intakes for all limiting nutrients. Twenty-two wild plant species were consumed during hunger season, prominently tubers (Dioscoreaceae), and leafy greens (Asteraceae, Blechnaceae, Portulacaceae, and Solanaceae). Eight of the 9 target species were identified as abundant and "Least Concern," whereas Amorphophollus taurostigma was abundant and "Vulnerable." Regression modeling showed wild food consumption was associated with an increased household dietary diversity score [ß = 0.29 (0.06 standard error); P < 0.001], and total wild animal foods positively correlated with height-for-age Z score [ß = 0.14 (0.07 standard error); P = 0.04]. Conclusions: Wild plant and animal foods may be an important element of food systems to support human nutrition while maintaining ecosystem viability.
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BACKGROUND: Diarrheagenic Escherichia coli (DEC) are common pathogens infecting children during their growth and development. Determining the epidemiology and the impact of DEC on child anthropometric measures informs prioritization of prevention efforts. These relationships were evaluated in a novel setting, Cap-Haitien, Haiti. METHODS: We performed pre-specified secondary analysis of a case-control study of community-dwelling children, 6-36 months of age, enrolled 96 cases with diarrhea and 99 asymptomatic controls. Assessments were performed at enrollment and one month later at follow-up. Established endpoint PCR methodologies targeted DEC gDNA isolated from fecal swabs. The association between DEC and anthropometric z-scores at enrollment was determined using multivariate linear regression. Lastly, we assessed the association between specific biomarkers, choline and docosahexaenoic acid (DHA) and diarrheal burden. RESULTS: Enterotoxigenic Escherichia coli (ETEC) was identified in 21.9% of cases vs. 16.1% of controls with heat-stable producing ETEC significantly associated with symptomatic disease. Enteroaggregative E. coli (EAEC) was found in 30.2% of cases vs. 27.3% of controls, and typical enteropathogenic E. coli in 6.3% vs. 4.0% of cases and controls, respectively. Multivariate linear regression, controlled for case or control status, demonstrated ETEC and EAEC were significantly associated with reduced weight-age z-score (WAZ) and height-age z-score (HAZ) after adjusting for confounders. An interaction between ETEC and EAEC was observed. Choline and DHA were not associated with diarrheal burden. CONCLUSIONS: DEC are prevalent in north Haitian children. ETEC, EAEC, household environment, and diet are associated with unfavorable anthropometric measures, with possible synergistic interactions between ETEC and EAEC. Further studies with longer follow up may quantify the contribution of individual pathogens to adverse health outcomes.