Geophagy is Associated with Environmental Enteropathy and Stunting in Children in Rural Bangladesh

Abstract

Abstract. There is a growing body of literature indicating an association between stunting and environmental enteropathy (EE), a disorder thought to be caused by repeated exposures to enteric pathogens. To investigate the relationship between exposure to enteric pathogens through geophagy, consumption of soil, EE, and stunting, we conducted a prospective cohort study of 216 children under 5 years of age in rural Bangladesh. Geophagy was assessed at baseline using 5 hour structured observation and caregiver reports. Stool was analyzed for fecal markers of intestinal inflammation: alpha-1-antitrypsin, myeloperoxidase, neopterin (all three combined to form an EE disease activity score), and calprotectin. Eighteen percent of children had observed geophagy events by structured observation and 28% had caregiver reported events in the past week. Nearly all households had Escherichia coli (97%) in soil, and 14% had diarrheagenic E. coli. Children with caregiver-reported geophagy had significantly higher EE scores (0.72 point difference, 95% confidence interval [CI]: 0.01, 1.42) and calprotectin concentrations (237.38 μg/g, 95% CI: 12.77, 462.00). Furthermore, at the 9-month follow-up the odds of being stunted (height-for-age z-score −2) was double for children with caregiver-reported geophagy (odds ratio [OR]: 2.27, 95% CI: 1.14, 4.51). These findings suggest that geophagy in young children may be an important unrecognized risk factor for EE and stunting.

Soil Ingestion is Associated with Child Diarrhea in an Urban Slum of Nairobi, Kenya

“…This adds to the growing body of knowledge that existing WASH interventions that target improving water access, toilet/latrine access, and handwashing may not eliminate children's exposure to fecal contamination in the domestic environment. 9,10,22,23 Reported soil ingestion was the highest among children aged 6-24 months, which is consistent with previous studies evaluating child geophagy 10 and child mouthing behavior. 24 In addition, no soil ingestion was reported for children younger than 6 months, which is likely due to children being relatively inactive at this age.…”

“…This question was asked because caregiver reported soil ingestion/geophagy events have been previously found to show good agreement with soil ingestion events observed during structured observation in Bangladesh. 10 Soil sampling. Soil samples were collected from outdoor locations near each household entrance, for a total of 28 samples.…”

“…6,7 Beyond the learned behaviors of geophagy, soil ingestion is also an involuntary behavior as part of mouthing and exploration in young children. There are few studies related to exploratory soil ingestion by young children in low-income countries, but recent evidence 9,10 suggests that it may be an important exposure point for fecal contamination leading to child illness.…”

“…11 Soil ingestion by young children has also been linked to negative health outcomes and was found to be associated with increased risk of diarrhea in rural Kenya, 12 and with environmental enteropathy and stunting in rural Bangladesh. 10 However, these studies linking soil ingestion with negative health outcomes for young children were conducted in rural areas and do not provide a comprehensive understanding of the consequences of soil ingestion. Little is known about the prevalence and effects of exploratory soil ingestion in young children in urban areas.…”

Assessing Stunting and Predisposing Factors Among Children

“…In this study, high prevalence of stunting (51%), almost thrice the times higher (OR=2.9), was observed in children habitual of soil eating in contrast to (26%) prevalence of stunting among children not habitual of soil eating. Moreover, previous study asserted a significant relation between geophagy in children and stunting [31] and it depicted 2 times higher odds of stunting in soil eating children, hence, the previous study [31] supported the findings of present study and delineates an important correlation between soil eating habit and stunting among children.…”