Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Randomized Controlled Trial
. 2020 Feb 14;70(5):738-747.
doi: 10.1093/cid/ciz291.

Effects of Water, Sanitation, Handwashing, and Nutritional Interventions on Environmental Enteric Dysfunction in Young Children: A Cluster-randomized, Controlled Trial in Rural Bangladesh

Audrie Lin  1 , Shahjahan Ali  2 , Benjamin F Arnold  1 , Md Ziaur Rahman  2 , Mohammad Alauddin  3 , Jessica Grembi  4 , Andrew N Mertens  1 , Syeda L Famida  2 , Salma Akther  2 , Md Saheen Hossen  2 , Palash Mutsuddi  2 , Abul K Shoab  2 , Zahir Hussain  2 , Mahbubur Rahman  2 , Leanne Unicomb  2 , Sania Ashraf  2 , Abu Mohd Naser  2 , Sarker M Parvez  2 , Ayse Ercumen  1 , Jade Benjamin-Chung  1 , Rashidul Haque  2 , Tahmeed Ahmed  5 , Md Iqbal Hossain  5 , Nuzhat Choudhury  5 , Kaniz Jannat  2 , Sarah T Alauddin  3 , Sandra G Minchala  3 , Rabije Cekovic  3 , Alan E Hubbard  1 , Christine P Stewart  6 , Kathryn G Dewey  6 , John M Colford  1 , Stephen P Luby  4
Affiliations
Randomized Controlled Trial

Effects of Water, Sanitation, Handwashing, and Nutritional Interventions on Environmental Enteric Dysfunction in Young Children: A Cluster-randomized, Controlled Trial in Rural Bangladesh

Audrie Lin et al. Clin Infect Dis. .

Abstract

Background: We hypothesized that drinking water, sanitation, handwashing (WSH), and nutritional interventions would improve environmental enteric dysfunction (EED), a potential contributor to stunting.

Methods: Within a subsample of a cluster-randomized, controlled trial in rural Bangladesh, we enrolled pregnant women in 4 arms: control, WSH, child nutrition counseling plus lipid-based nutrient supplements (N), and nutrition plus WSH (N+WSH). Among the birth cohort, we measured biomarkers of gut inflammation (myeloperoxidase, neopterin), permeability (alpha-1-antitrypsin, lactulose, mannitol), and repair (regenerating gene 1β) at median ages 3, 14, and 28 months. Analysis was intention-to-treat.

Results: We assessed 1512 children. At age 3 months, compared to controls, neopterin was reduced by nutrition (-0.21 log nmol/L; 95% confidence interval [CI], -.37, -.05) and N+WSH (-0.20 log nmol/L; 95% CI, -.34, -.06) interventions; similar reductions were observed at 14 months. At 3 months, all interventions reduced lactulose and mannitol (-0.60 to -0.69 log mmol/L). At 28 months, myeloperoxidase was elevated in the WSH and nutrition arms (0.23-0.27 log ng/mL) and lactulose was higher in the WSH arm (0.30 log mmol/L; 95% CI, .07, .53).

Conclusions: Reductions in permeability and inflammation at ages 3 and 14 months suggest that the interventions promoted healthy intestinal maturation; however, by 28 months, the WSH and nutrition arms showed elevated EED biomarkers. These results underscore the importance of developing a better understanding of EED pathophysiology and targeting interventions early in childhood, when they are likely to have the largest benefit to intestinal health.

Clinical trials registration: NCT01590095.

Keywords: early childhood intervention; environmental enteric dysfunction; environmental enteropathy; nutrition; water sanitation hygiene trial.

PubMed Disclaimer

Publication types

Associated data