Site-Specific Analysis of the Incidence Rate of Enterotoxigenic Escherichia coli Infection Elucidates an Association with Childhood Stunting, Wasting, and Being Underweight: A Secondary Analysis of the MAL-ED Birth Cohort

Authors

Ahshanul Haque, International Centre for Diarrhoeal Disease Research
Sabiha Nasrin, International Centre for Diarrhoeal Disease Research, University of Massachusetts
Parag Palit, International Centre for Diarrhoeal Disease Research
Rina Das, International Centre for Diarrhoeal Disease Research, Emory University
Barbie Zaman Wahid, International Centre for Diarrhoeal Disease Research, University of Nebraska-LincolnFollow
Amran Gazi, International Centre for Diarrhoeal Disease Research
Mustafa Mahfuz, International Centre for Diarrhoeal Disease Research
Abu Syed Golam Faruque, International Centre for Diarrhoeal Disease Research
Tahmeed Ahmed, International Centre for Diarrhoeal Disease Research

Document Type

Article

Date of this Version

2023

Citation

Am. J. Trop. Med. Hyg., 108(6), 2023, pp. 1192–1200. doi:10.4269/ajtmh.22-0659

Comments

Used by permission.

Abstract

Asymptomatic infection by fecal enteropathogens is a major contributor to childhood malnutrition. Here, we investigated the incidence rate of asymptomatic infection by enterotoxigenic Escherichia coli (ETEC) and assessed its association with childhood stunting, wasting, and being underweight among children under 2 years of age. The Malnutrition and Enteric Disease birth cohort study included 1,715 children who were followed from birth to 24 months of age from eight distinct geographic locations including Bangladesh, Brazil, India, Peru, Tanzania, Pakistan, Nepal, and South Africa. The TaqMan array card assay was used to determine the presence of ETEC in the nondiarrheal stool samples collected from these children. Poisson regression was used to estimate the incidence rate, andmultiple generalized estimating equations with binomial family, logit link function, and exchangeable correlation were used to analyze the association between asymptomatic ETEC infection and anthropometric indicators such as stunting, wasting, and being underweight. The site-specific incidence rates of asymptomatic ETEC infections per 100 child-months were also higher at the study locations in Tanzania (54.81 [95% CI: 52.64, 57.07]) and Bangladesh (46.75 [95% CI: 44.75, 48.83]). In the Bangladesh, India, and Tanzania sites, the composite indicator of anthropometric failure was significantly associated with asymptomatic ETEC infection. Furthermore, a significant association between asymptomatic heat-stable toxin ETEC infections and childhood stunting, wasting, and being underweight was found in only the Bangladesh and Tanzania sites.