Early-Life Enteric Pathogen Exposure, Socioeconomic Status, and School-Age Cognitive Outcomes

Abstract

Early-life experiences of enteric infections and diarrheal illness are common in low-resource settings and are hypothesized to affect child development. However, longer-term associations of enteric infections with school-age cognitive outcomes are difficult to estimate due to lack of long-term studies. The objective of this study was to examine the relationship between enteropathogen exposure in the first 2 years of life with school-age cognitive skills in a cohort of children followed from birth until 6 to 8 years in low-resource settings in Brazil, Tanzania, and South Africa. The study included participants from three sites from the Etiology, Risk Factors, and Interactions of Enteric Infections and Malnutrition and the Consequences for Child Health Study who were enrolled just after birth and followed for enteric infections, diarrheal illness, and cognitive development until 2 years of age. When the children were school-age, further data were collected on reasoning skills and semantic/phonemic fluency. We estimated associations between the burden of specific enteric pathogens and etiology-specific diarrhea from 0 to 2 years with cognitive test scores at 6 to 8 years using linear regression and adjusting for confounding variables. In this study, children who carried more enteric pathogens in the first 2 years of life showed overall decreases in school-age cognitive abilities, particularly children who carried protozoa, although this was not statistically significant in this sample. Socioeconomic factors such as maternal education and income were more closely associated with school-age cognitive abilities. Early-life enteric pathogens may have a small, lasting influence on school-age cognitive outcomes, although other socioeconomic factors likely contribute more significantly.

Figure 1.

Associations between early enteric pathogen infections and cognitive outcomes and growth at school-age. Effect of one additional pathogen detected on average from 0 to 24 months of age. Adjusted for percent exclusive breastfed, age, enrollment weight (birthweight proxy), socioeconomic status, maternal height, maternal education, sex, and research site.

Figure 2.

Associations between early specific enteric pathogen infections and cognitive outcomes at school-age. All models adjusted for percent exclusive breastfed, age, enrollment weight (birthweight proxy), socioeconomic status, maternal height, maternal education, sex, and research site.