Fecal biomarkers of environmental enteric dysfunction and associated factors among children aged 24–59 months in east Dembiya district, northwest Ethiopia
Abstract Background Environmental enteric dysfunction is a subclinical intestinal disorder characterized by gut inflammation accompanied by morphological changes, such as blunted villi and crypt hyperplasia. This is a common illness in low and middle-income countries. However, environmental enteric...
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BMC
2022-04-01
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| Series: | BMC Gastroenterology |
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| Online Access: | https://doi.org/10.1186/s12876-022-02255-4 |
| _version_ | 1811260803766026240 |
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| author | Zemichael Gizaw Alemayehu Worku Yalew Bikes Destaw Bitew Jiyoung Lee Michael Bisesi |
| author_facet | Zemichael Gizaw Alemayehu Worku Yalew Bikes Destaw Bitew Jiyoung Lee Michael Bisesi |
| author_sort | Zemichael Gizaw |
| collection | DOAJ |
| description | Abstract Background Environmental enteric dysfunction is a subclinical intestinal disorder characterized by gut inflammation accompanied by morphological changes, such as blunted villi and crypt hyperplasia. This is a common illness in low and middle-income countries. However, environmental enteric dysfunction evidence is limited in Ethiopia. Accordingly, this study was conducted to measure fecal biomarkers of environmental enteric dysfunction and associated factors among children aged 24–59 months in rural northwest Ethiopia. Methods A community-based cross-sectional study was employed among 235 randomly selected children in a rural setting of the east Dembiya district. Stool samples were collected without fixative and analyzed for fecal biomarkers of environmental enteric dysfunction (Alpha-1-antitrypsin, neopterin, and myeloperoxidase) using commercial enzyme-linked immunosorbent assay kits and analyzed for intestinal parasites using wet mount and Kato-Katz techniques. Child behaviors related with exposure to enteropathogens, condition of the living environment and socio-demographic information were collected using interviewer-administered questionnaire and structure observation. We fitted multivariable linear regression model to assess the association between environmental factors and concentration of fecal biomarkers of environmental enteric dysfunction in the stool. Statistically significant associations were declared based on adjusted betas with the corresponding 95% confidence interval and p-value < 0.05. Results The median concentration of fecal markers of environmental enteric dysfunction was 350 μg/ml for Alpha-1-antitrypsin, 3320.2 ng/ml for myeloperoxidase, and 1562 nmol/l for neopterin. The median concentration of Alpha-1-antitrypsin among 161 (68.5%), myeloperoxidase among 168 (71.5%), and neopterin among 188 (80%) of the stool samples were above the normal values in non-tropical settings. Moreover, 100 (42.6%) of the children had high EED disease activity score (above the median score). The elevated concentrations of fecal biomarkers of gut inflammation and the high EED disease activity score were significantly associated with open defecation practice, mouthing of soil contaminated materials, Escherichia coli (E. coli) contamination of drinking water, E. coli contamination of foods, E. coli contamination of soil, and intestinal parasites. Conclusion Overall, Alpha-1-antitrypsin, myeloperoxidase, and neopterin levels among the children in the studied region were highly elevated in comparison to populations in high-income countries. Moreover, the EED disease activity score in significant proportion of children was high, suggesting widespread intestinal inflammation and increased intestinal permeability. Extensive E. coli contamination of the living environment (drinking water, ready-to-eat foods, and courtyard soil), hygiene and sanitation behaviors (such as open defecation and mouthing of soil contaminated materials), and a high burden of intestinal parasites were identified as factors associated with the elevated concentration of fecal biomarkers of environmental enteric dysfunction. Parental care to children to avoid mouthing of soil contaminated materials and other risky behaviors that increase exposure enteric infections, and protecting the living environment (water, food and soil) from fecal contamination are important. |
| first_indexed | 2024-04-12T18:53:04Z |
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| issn | 1471-230X |
| language | English |
| last_indexed | 2024-04-12T18:53:04Z |
| publishDate | 2022-04-01 |
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| series | BMC Gastroenterology |
| spelling | doaj.art-a4c477a5c8014ae6a4c30045c61e2db52022-12-22T03:20:24ZengBMCBMC Gastroenterology1471-230X2022-04-0122111110.1186/s12876-022-02255-4Fecal biomarkers of environmental enteric dysfunction and associated factors among children aged 24–59 months in east Dembiya district, northwest EthiopiaZemichael Gizaw0Alemayehu Worku Yalew1Bikes Destaw Bitew2Jiyoung Lee3Michael Bisesi4Department of Environmental and Occupational Health and Safety, Institute of Public Health, College of Medicine and Health Sciences, University of GondarSchool of Public Health, Addis Ababa UniversityDepartment of Environmental and Occupational Health and Safety, Institute of Public Health, College of Medicine and Health Sciences, University of GondarDivision of Environmental Health Sciences, College of Public Health, The Ohio State UniversityDivision of Environmental Health Sciences, College of Public Health, The Ohio State UniversityAbstract Background Environmental enteric dysfunction is a subclinical intestinal disorder characterized by gut inflammation accompanied by morphological changes, such as blunted villi and crypt hyperplasia. This is a common illness in low and middle-income countries. However, environmental enteric dysfunction evidence is limited in Ethiopia. Accordingly, this study was conducted to measure fecal biomarkers of environmental enteric dysfunction and associated factors among children aged 24–59 months in rural northwest Ethiopia. Methods A community-based cross-sectional study was employed among 235 randomly selected children in a rural setting of the east Dembiya district. Stool samples were collected without fixative and analyzed for fecal biomarkers of environmental enteric dysfunction (Alpha-1-antitrypsin, neopterin, and myeloperoxidase) using commercial enzyme-linked immunosorbent assay kits and analyzed for intestinal parasites using wet mount and Kato-Katz techniques. Child behaviors related with exposure to enteropathogens, condition of the living environment and socio-demographic information were collected using interviewer-administered questionnaire and structure observation. We fitted multivariable linear regression model to assess the association between environmental factors and concentration of fecal biomarkers of environmental enteric dysfunction in the stool. Statistically significant associations were declared based on adjusted betas with the corresponding 95% confidence interval and p-value < 0.05. Results The median concentration of fecal markers of environmental enteric dysfunction was 350 μg/ml for Alpha-1-antitrypsin, 3320.2 ng/ml for myeloperoxidase, and 1562 nmol/l for neopterin. The median concentration of Alpha-1-antitrypsin among 161 (68.5%), myeloperoxidase among 168 (71.5%), and neopterin among 188 (80%) of the stool samples were above the normal values in non-tropical settings. Moreover, 100 (42.6%) of the children had high EED disease activity score (above the median score). The elevated concentrations of fecal biomarkers of gut inflammation and the high EED disease activity score were significantly associated with open defecation practice, mouthing of soil contaminated materials, Escherichia coli (E. coli) contamination of drinking water, E. coli contamination of foods, E. coli contamination of soil, and intestinal parasites. Conclusion Overall, Alpha-1-antitrypsin, myeloperoxidase, and neopterin levels among the children in the studied region were highly elevated in comparison to populations in high-income countries. Moreover, the EED disease activity score in significant proportion of children was high, suggesting widespread intestinal inflammation and increased intestinal permeability. Extensive E. coli contamination of the living environment (drinking water, ready-to-eat foods, and courtyard soil), hygiene and sanitation behaviors (such as open defecation and mouthing of soil contaminated materials), and a high burden of intestinal parasites were identified as factors associated with the elevated concentration of fecal biomarkers of environmental enteric dysfunction. Parental care to children to avoid mouthing of soil contaminated materials and other risky behaviors that increase exposure enteric infections, and protecting the living environment (water, food and soil) from fecal contamination are important.https://doi.org/10.1186/s12876-022-02255-4Environmental enteric dysfunctionFecal biomarkersGut inflammationEnzyme-linked immunosorbent assayChildrenEast Dembiya district |
| spellingShingle | Zemichael Gizaw Alemayehu Worku Yalew Bikes Destaw Bitew Jiyoung Lee Michael Bisesi Fecal biomarkers of environmental enteric dysfunction and associated factors among children aged 24–59 months in east Dembiya district, northwest Ethiopia BMC Gastroenterology Environmental enteric dysfunction Fecal biomarkers Gut inflammation Enzyme-linked immunosorbent assay Children East Dembiya district |
| title | Fecal biomarkers of environmental enteric dysfunction and associated factors among children aged 24–59 months in east Dembiya district, northwest Ethiopia |
| title_full | Fecal biomarkers of environmental enteric dysfunction and associated factors among children aged 24–59 months in east Dembiya district, northwest Ethiopia |
| title_fullStr | Fecal biomarkers of environmental enteric dysfunction and associated factors among children aged 24–59 months in east Dembiya district, northwest Ethiopia |
| title_full_unstemmed | Fecal biomarkers of environmental enteric dysfunction and associated factors among children aged 24–59 months in east Dembiya district, northwest Ethiopia |
| title_short | Fecal biomarkers of environmental enteric dysfunction and associated factors among children aged 24–59 months in east Dembiya district, northwest Ethiopia |
| title_sort | fecal biomarkers of environmental enteric dysfunction and associated factors among children aged 24 59 months in east dembiya district northwest ethiopia |
| topic | Environmental enteric dysfunction Fecal biomarkers Gut inflammation Enzyme-linked immunosorbent assay Children East Dembiya district |
| url | https://doi.org/10.1186/s12876-022-02255-4 |
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