RESUMO
To investigate the association between enteric pathogens, fecal microbes, and child growth, we conducted a prospective cohort study of 236 children <5 years of age in rural eastern Democratic Republic of the Congo. We analyzed baseline fecal specimens by quantitative PCR and measured child height and weight at baseline and growth at a 6-month follow-up. At baseline, 66% (156/236) of children had >3 pathogens in their feces. We observed larger increases in height-for-age-z-scores from baseline to the 6-month follow-up among children with Akkermansia muciniphila in their feces (coefficient 0.02 [95% CI 0.0001-0.04]; p = 0.04). Children with Cryptosporidium in their feces had larger declines in weight-for-height/length z-scores from baseline to the 6-month follow-up (coefficient -0.03 [95% CI -0.05 to -0.005]; p = 0.02). Our study showed high prevalence of enteric pathogens among this pediatric cohort and suggests A. muciniphila can potentially serve as a probiotic to improve child growth.
Assuntos
Criptosporidiose , Cryptosporidium , Humanos , Criança , Pré-Escolar , Estudos Prospectivos , República Democrática do Congo/epidemiologiaRESUMO
The objective of the Reducing Enteropathy, Undernutrition, and Contamination in the Environment (REDUCE) program is to identify exposure pathways to fecal pathogens that are significant contributors to morbidity among young children in the Democratic Republic of the Congo (DRC), and on developing and evaluating scalable interventions to reduce fecal contamination from these pathways. This prospective cohort study of 270 children under 5 years of age was conducted in rural South Kivu, DRC, to investigate the association between Escherichia coli in hand rinse, soil, food, object, surface, stored water, and water source samples and child developmental outcomes. Child developmental outcomes were assessed by communication, fine motor, gross motor, personal social, problem-solving, and combined scores measured by the Extended Ages and Stages Questionnaire (EASQ) at a 6-month follow-up. Children having E. coli present in the soil in their play spaces had significantly lower combined EASQ z scores (coefficient: -0.38 (95% CI: -0.73, -0.03)). E. coli on children's hands was associated with lower communication EASQ z scores (-0.37 (95% CI: -0.0.10, -0.01), and E. coli in stored drinking water was associated with lower gross motor EASQ z scores (-0.40 (95% CI: -0.68, -0.12). In the REDUCE cohort study, E. coli in child play spaces, on children's hands, and in stored drinking water was associated with lower developmental outcome scores (communication, gross motor, fine motor, and problem-solving skills). These results suggest the need for interventions to reduce fecal contamination in the household environment to protect the cognitive development of susceptible pediatric populations in rural DRC.
RESUMO
OBJECTIVE: The Reducing Enteropathy, Undernutrition, and Contamination in the Environment (REDUCE) program focuses on identifying exposure pathways to faecal pathogens for young children in the Democratic Republic of the Congo (DRC) and on developing scalable interventions to reduce faecal contamination from these pathways. METHODS: A prospective cohort study of 690 participants was conducted to investigate the association between hand, food, and environmental faecal contamination and diarrhoeal disease prevalence among young children in Walungu Territory, South Kivu, DRC. A total of 1923 hand rinse, soil, food, object, surface, stored water and water source samples were collected during unannounced spot checks after baseline enrolment and analysed for Escherichia coli. Caregiver reports of diarrhoea were obtained from children < 5 years at a 6-month follow-up. RESULTS: E.coli was detected in 73% of child and caregiver hand-rinse samples, 69% of soil samples from child play spaces, 54% of child food samples, 38% of objects and surfaces children were observed putting in their mouths, 74% of stored water samples, and 40% of source water samples. Children < 5 years with E. coli on their hands had significantly higher odds of diarrhoea at the 6-month follow-up (odds ratio: 2.03 (95% confidence interval: 1.05, 3.92)). CONCLUSION: The cohort study findings from the REDUCE program have shown that child hand contamination is associated with diarrhoeal disease in rural DRC, and that there is high faecal contamination in child plays spaces and food. These findings provide evidence demonstrating the urgent need to provide clean play spaces for young children and interventions targeting hand hygiene to reduce paediatric exposure to faecal pathogens.
OBJECTIF: L'étude REDUCE (Réduire l'Entéropathie, la Dénutrition et la Contamination à partir de l'Environnement) se concentre sur l'identification des voies d'exposition aux pathogènes fécaux pour les jeunes enfants en République Démocratique du Congo (RDC) et sur le développement d'interventions évolutives pour réduire la contamination fécale par ces voies. MÉTHODES: Une étude de cohorte prospective de 690 participants a été menée pour étudier l'association entre la contamination fécale des mains, des aliments et de l'environnement et la prévalence des maladies diarrhéiques chez les jeunes enfants dans le Territoire de Walungu, dans le Sud-Kivu, en RDC. Un total de 1.923 échantillons de rinçages des mains, de sol, d'aliments, d'objets, de surfaces, d'eau stockée et de sources d'eau ont été collectés lors de contrôles ponctuels inopinés après l'inscription de base et analysés pour Escherichia coli. Les rapports des soignants concernant la diarrhée ont été obtenus pour les enfants de moins de 5 ans à un suivi de 6 mois. RÉSULTATS: E. coli a été détecté dans 73% des échantillons de rinçage des mains des enfants et des soignants, 69% des échantillons de sol des aires de jeux pour enfants, 54% des échantillons d'aliments pour enfants, 38% des objets et des surfaces que les enfants mettaient en bouche, 74 % des échantillons d'eau stockée et 40% des échantillons de sources d'eau. Les enfants de moins de 5 ans avec E. coli sur leurs mains avaient un risque de diarrhée significativement plus élevé au suivi de 6 mois (rapport de cotes: 2,03 (intervalle de confiance à 95%: 1,05, 3,92)). CONCLUSION: Les résultats de l'étude de cohorte du programme REDUCE ont montré que la contamination des mains des enfants est associée aux maladies diarrhéiques dans les régions rurales de la RDC et à une forte contamination fécale dans les aires de jeux et les aliments pour enfants. Ces résultats fournissent des données démontrant le besoin urgent de fournir des espaces de jeu propres aux jeunes enfants et des interventions ciblant l'hygiène des mains pour réduire l'exposition pédiatrique aux pathogènes fécaux.
Assuntos
Diarreia/epidemiologia , Higiene das Mãos , Solo , Água , Pré-Escolar , República Democrática do Congo/epidemiologia , Escherichia coli/isolamento & purificação , Fezes/microbiologia , Feminino , Humanos , Modelos Logísticos , Masculino , Estudos Prospectivos , População RuralRESUMO
OBJECTIVE: To identify exposure pathways to fecal pathogens that are significant contributors to diarrheal diseases and impaired growth in young children, and to evaluate scalable interventions to reduce fecal contamination from these pathways. STUDY DESIGN: Reducing Enteropathy, Undernutrition, and Contamination in the Environment (REDUCE) was a prospective cohort study of 370 children <5 years of age was conducted in Walungu Territory, South Kivu, Democratic Republic of the Congo. Child mouthing behaviors were assessed through caregiver reports and 5-hour structured observations. Caregiver reports of child contact with animals and child diarrhea were also obtained. Anthropometric measurements were collected at baseline and at a 6-month follow-up. RESULTS: Children observed putting soil in their mouth during structured observation at baseline had a significantly higher odds of diarrhea at the 6-month follow-up (OR, 1.79; 95% CI, 1.04 to 3.07). Children observed mouthing feces during structured observation had a significant reduction in height-for-age z-score (HAZ) from baseline to the 6-month follow-up (ΔHAZ, -0.69; 95% CI, -1.34 to -0.04). A significant reduction in HAZ was also observed for children with caregiver reports of touching guinea pigs (-0.33; 95% CI, -0.58 to -0.08) and rabbits (-0.34; 95% CI, -0.64 to -0.04) and children with feces in their sleeping space during unannounced spot checks (-0.41; 95% CI, -0.74 to -0.09). CONCLUSIONS: These findings emphasize the urgent need for infant water, sanitation, and hygiene interventions targeting child mouthing behaviors, fecal contamination in child living spaces, and child contact with domestic animals to reduce exposure to fecal pathogens among susceptible populations.