Early Childhood Diarrhea Predicts Cognitive Delays in Later Childhood Independently of Malnutrition

Pinkerton, Relana; Oriá, Reinaldo B.; Lima, Aldo A. M.; Rogawski, Elizabeth T.; Oriá, Mônica Oliveira Batista; Patrick, Peter D.; Moore, Sean R.; Wiseman, Benjamin L.; Niehaus, Mark D.; Guerrant, Richard L.

doi:10.4269/ajtmh.16-0150

Cited by 73 publications

(70 citation statements)

References 36 publications

(43 reference statements)

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“… 27 , 28 , 29 , 30 These infections can also hinder cognitive development, with adverse consequences on school performance and economic status. 29 , 31 , 32 , 33 Oral rehydration salts and, when appropriate and available, antimicrobials are used as treatment. 34 The rise of antibiotic-resistant enteric bacteria, 35 , 36 particularly shigella, has made the prevention of infectious diarrhoea, and the need for an effective vaccine, an even greater public health priority.…”

Section: Introductionmentioning

confidence: 99%

Morbidity and mortality due to shigella and enterotoxigenic Escherichia coli diarrhoea: the Global Burden of Disease Study 1990–2016

Khalil

Troeger

Blacker

et al. 2018

The Lancet Infectious Diseases

498

413

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SummaryBackgroundShigella and enterotoxigenic Escherichia coli (ETEC) are bacterial pathogens that are frequently associated with diarrhoeal disease, and are a significant cause of mortality and morbidity worldwide. The Global Burden of Diseases, Injuries, and Risk Factors study 2016 (GBD 2016) is a systematic, scientific effort to quantify the morbidity and mortality due to over 300 causes of death and disability. We aimed to analyse the global burden of shigella and ETEC diarrhoea according to age, sex, geography, and year from 1990 to 2016.MethodsWe modelled shigella and ETEC-related mortality using a Bayesian hierarchical modelling platform that evaluates a wide range of covariates and model types on the basis of vital registration and verbal autopsy data. We used a compartmental meta-regression tool to model the incidence of shigella and ETEC, which enforces an association between incidence, prevalence, and remission on the basis of scientific literature, population representative surveys, and health-care data. We calculated 95% uncertainty intervals (UIs) for the point estimates.FindingsShigella was the second leading cause of diarrhoeal mortality in 2016 among all ages, accounting for 212 438 deaths (95% UI 136 979–326 913) and about 13·2% (9·2–17·4) of all diarrhoea deaths. Shigella was responsible for 63 713 deaths (41 191–93 611) among children younger than 5 years and was frequently associated with diarrhoea across all adult age groups, increasing in elderly people, with broad geographical distribution. ETEC was the eighth leading cause of diarrhoea mortality in 2016 among all age groups, accounting for 51 186 deaths (26 757–83 064) and about 3·2% (1·8–4·7) of diarrhoea deaths. ETEC was responsible for about 4·2% (2·2–6·8) of diarrhoea deaths in children younger than 5 years.InterpretationThe health burden of bacterial diarrhoeal pathogens is difficult to estimate. Despite existing prevention and treatment options, they remain a major cause of morbidity and mortality globally. Additional emphasis by public health officials is needed on a reduction in disease due to shigella and ETEC to reduce disease burden.FundingBill & Melinda Gates Foundation.

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Section: Introductionmentioning

confidence: 99%

Morbidity and mortality due to shigella and enterotoxigenic Escherichia coli diarrhoea: the Global Burden of Disease Study 1990–2016

Khalil

Troeger

Blacker

et al. 2018

The Lancet Infectious Diseases

498

413

View full text Add to dashboard Cite

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“…A third potential pathway is through infectious diseases. Climatic conditions play an important role in the transmission of vector-borne and waterborne diseases such as malaria and cholera (5,43), and exposure to diseases in utero and during early life have been found to negatively impact cognitive development and educational outcomes (44,45). Lastly, prenatal exposure to stress caused by natural disasters has been shown to impact children's cognitive ability, particularly among poor households (46).…”

mentioning

confidence: 99%

Climate change and educational attainment in the global tropics

Randell

Gray

2019

Proc. Natl. Acad. Sci. U.S.A.

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Climate change may negatively impact education among children via exposure to extreme temperature and precipitation conditions. We link census data from 29 countries across the global tropics to high-resolution gridded climate data to understand how climatic conditions experienced in utero and during early childhood affect educational attainment at ages 12 to 16. We show that exposure to higher-than-average temperatures during the prenatal and early-life period is associated with fewer years of schooling in Southeast Asia. In this region, a child who experiences temperatures 2 SDs above average is predicted to attain 1.5 fewer years of schooling than one who experiences average temperatures. In addition, early-life rainfall is positively correlated with attainment in West and Central Africa as well as Southeast Asia, and negatively correlated with attainment in Central America and the Caribbean. While we expected that children from the most educated households would be buffered from these effects, we discover that they tend to experience the greatest educational penalties when exposed to hotter early-life conditions and, in some regions, to drier conditions. For example, among the most educated households in West and Central Africa, predicted schooling is 1.8 years lower for children who experience early-life rainfall 2 SDs below average versus 2 SDs above average, while the difference is just 0.8 years for children from the least educated households. These results suggest that development and educational gains in the tropics could be undermined by climate change, even for better-off households.

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“…11,46–51 However, reduced diarrhea rates observed in more recent studies have made overt diarrhea less useful in predicting growth and developmental outcomes. Despite these reductions, “subclinical” pathogen detection in stools continues to be common in many impoverished settings and has been associated with poor outcomes.…”

Section: Current Definitionsmentioning

confidence: 99%

“…Recognized examples of non-intestinal outcomes associated with enteric infections include associations of toxoplasmosis with birth defects and congenital brain damage (“TORCH” syndrome) 4 and of Campylobacter infections with Guillain-Barré Syndrome. 5 However, as research studies include detection of wider arrays of bacterial, viral, and parasitic pathogens and longer term follow-up, potential effects of enteric infections and enteropathy on vaccine responses, 6,7 child growth, 8,9 cognitive development, 10,11 and even later life obesity, diabetes, and metabolic syndrome are increasingly being recognized. 12–15 Here, we review the evolving challenges to defining EE and enteric infections, current evidence for the magnitude and determinants of its burden, new assessment tools, and relevant interventions.…”

Section: Introductionmentioning

confidence: 99%

The Burden of Enteropathy and “Subclinical” Infections

Rogawski

Guerrant

2017

Pediatric Clinics of North America

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Synopsis Environmental enteropathy is a chronic condition of the small intestine that is associated with increased intestinal permeability, mucosal inflammation, malabsorption, and systemic inflammation. It is commonly accompanied by enteric infections and is misleadingly considered a subclinical disease. Potential effects of enteric infections and enteropathy on vaccine responses, child growth, cognitive development, and even later life obesity, diabetes, and metabolic syndrome are increasingly being recognized. Here, we review the evolving challenges to defining environmental enteropathy and enteric infections, current evidence for the magnitude and determinants of its burden, new assessment tools, and relevant interventions.

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Early Childhood Diarrhea Predicts Cognitive Delays in Later Childhood Independently of Malnutrition

Cited by 73 publications

References 36 publications

Morbidity and mortality due to shigella and enterotoxigenic Escherichia coli diarrhoea: the Global Burden of Disease Study 1990–2016

Morbidity and mortality due to shigella and enterotoxigenic Escherichia coli diarrhoea: the Global Burden of Disease Study 1990–2016

Climate change and educational attainment in the global tropics

The Burden of Enteropathy and “Subclinical” Infections

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