Cognitive Effects of Diarrhea, Malnutrition, and Entamoeba Histolytica Infection on School Age Children in Dhaka, Bangladesh

Abstract

Cognitive function was assessed in 191 Bangladeshi children 6-9 years of age using verbal and nonverbal tests. These scores were added to a health surveillance database that was compiled over the four previous years that includes incidence of diarrhea and Entamoeba histolytica infection and nutritional status. The associations of diarrhea, malnutrition, and social factors with cognitive scores were analyzed statistically, and associations between diarrhea and test scores were controlled for the influence of social factors. Cognitive scores were negatively associated with stunting during school age, as well as the height-for-age and weight-for-age scores at study enrollment. Incidence of diarrhea was associated with nonverbal test scores before, but not after, controlling for socioeconomic factors. Generally E. histolytica infection was not found to independently influence scores, except that E. histolytica-associated dysentery was associated with lower test scores while dysentery of any etiology was not. Thus, malnutrition during the school age years, but not diarrhea or E. histolytica infection, was associated with a lower level of cognitive functioning. This suggested that intervention during school age years may be able to mitigate the cognitive deficiencies associated with malnutrition.

Amebic colitis: New insights into pathogenesis and treatment

“…In Hue City, Vietnam, the annual incidence of amebic liver abscesses has been reported to be 21 cases/100,000 inhabitants [2]. Long-term effects of E. histolytica disease have been associated with malnutrition and decreased cognitive abilities in preschool children [3]. In addition, approximately 3% of returning travelers with an acute diarrheal illness requiring medical care have been found to have amebiasis [4].…”

Prevalence and risk factors for intestinal parasite infections in schoolchildren, in the city of Santarém, Pará State, Brazil

“…Most infections caused by intestinal parasites go unnoticed for years, and this is one of the causes of neglect and lack of immediate treatment. The late diagnosed symptoms may cover a number of consequences for the development of these children, which over time can present malnutrition and anemia, leading to growth retardation and low academic achievement [9][10][11][12] .…”

Enteric infections, diarrhea, and their impact on function and development

“…Enteric pathogens that are the cause of most severe acute diarrhea - as assessed by mortality - include rotavirus, Vibrio cholerae, Shigella spp., Salmonella spp., enteropathogenic E. coli (EPEC), and EAEC. Studies linking specific microbes with malnutrition are limited, but currently there are data linking malnutrition and attendant loss of cognitive function to infection with EAEC, enterotoxigenic E. coli (ETEC), Shigella spp., Ascaris lumbricoides, Cryptosporidium spp., Entamoeba histolytica, Giardia lamblia, and Trichuris trichiura (10)(11)(12)(13)(25)(26)(27)(28)(29)(30). Clearly, a better understanding of which enteric pathogens are responsible for how much of the burden of diarrhea morbidity and mortality is required.…”