1
|
Adhikari A, Koju NP, Maharjan B, Khanal L, Upreti M, Kyes RC. Gastro-intestinal parasites of urban rhesus macaques ( Macaca mulatta) in the Kathmandu Valley, Nepal. Int J Parasitol Parasites Wildl 2023; 22:175-183. [PMID: 37915770 PMCID: PMC10615899 DOI: 10.1016/j.ijppaw.2023.10.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 10/10/2023] [Accepted: 10/10/2023] [Indexed: 11/03/2023]
Abstract
Intestinal parasitic infections such as amoebiasis, ascariasis, hookworm infection, and trichuriasis are the most common infections among non-human primates (NHPs). There are always the possibilities of transmission these parasites between humans and NHPs. Multiple groups of rhesus macaques (Macaca mulatta) live in the urban area of Kathmandu Valley near human settlements, however the gastrointestinal (GI) parasitic infections in those macaques are understudied. This study aimed to explore the GI parasites in free-ranging macaques from Pashupatinath, Swayambhunath, Tripureshwor, Nilbarahi temples and a group of captive rhesus macaques in the Central Zoo, Kathmandu. Fecal samples were collected from the macaques between October 2021 to September 2022 and assessed for parasites by the both wet mount method and concentration technique. There is high prevalence of GI parasite infection; out of 121 fecal samples examined, 87.6% of samples were positive. Six species of protozoans and eight species of helminths were identified from the fecal samples including the first report of Iodamoeba butschlii in monkeys of Nepal. Among the protozoan parasites, Entamoeba coli (54.71%) showed the highest prevalence followed by Balantioides coli (44.33%), E. histolytica (19.81%), and Iodamoeba butschlii (10%). Among the helminths, Trichuris spp. (31.13%) and Strongyloides spp. (31.13%) showed the highest prevalence followed by Hookworm (24.52%), and Strongyle spp. (23.58%). The likelihood ratio test suggested that the prevalence differed significantly with the seasons for Iodamoeba butschlii, Giardia spp., Strongyles spp., Hookworm, and Trichostrongylus spp. The prevalence of E. histolytica, E. coli, Iodamoeba. butschlii, Trichuris spp., Trichostrongylus spp., and Unknown spp.1 differed with sampling localities. The high prevalence of GI parasites found in the macaques living in the densely urbanized Kathmandu presents a potential threat to humans and warrants further study as well as increased education of the public and management of the human-macaque interface in the urban landscape of the Valley.
Collapse
Affiliation(s)
- Asmita Adhikari
- Goldengate International College, Tribhuvan University, Nepal
| | - Narayan Prasad Koju
- Center for Postgraduate Studies, Nepal Engineering College, Pokhara University, Nepal
- Department of Psychology, University of Washington. Guthrie Hall (GTH), 119A 98195-1525, Seattle, WA, 98105, USA
| | | | - Laxman Khanal
- Central Department of Zoology, Institute of Science and Technology, Tribhuvan University, Kathmandu, 44618, Nepal
| | - Milan Upreti
- Goldengate International College, Tribhuvan University, Nepal
| | - Randall C. Kyes
- Department of Psychology, University of Washington. Guthrie Hall (GTH), 119A 98195-1525, Seattle, WA, 98105, USA
- Departments of Global Health and Anthropology, Center for Global Field Study, Washington National Primate Research Center, University of Washington. 3018 Western Ave, Seattle, WA, 98121, USA
| |
Collapse
|
2
|
Grant FK, Wanjala R, Low J, Levin C, Cole DC, Okuku HS, Ackatia-Armah R, Girard AW. Association between infection and nutritional status among infants in a cohort study of vitamin A in western Kenya. Front Nutr 2022; 9:921213. [PMID: 36211493 PMCID: PMC9537535 DOI: 10.3389/fnut.2022.921213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Accepted: 08/29/2022] [Indexed: 11/13/2022] Open
Abstract
Background Infection is associated with impaired nutritional status, especially for infants younger than 5 years. Objectives We assessed the impact of infection indicated by both acute phase proteins (APP), C-reactive protein (CRP), and α-1-acid-glycoprotein (AGP), and as reported by maternal recall on the nutritional status of infants. Materials and methods A total of 505 pregnant women were enrolled in a nested longitudinal cohort study of vitamin A (VA). Data from 385 children are reported here. The incidence and severity of respiratory infection and diarrhea (previous 14 days) were assessed by maternal recall; infant/child feeding practices were collected. Infant weight, recumbent length, and heel-prick capillary blood were taken at 9 months postpartum. Indicators of the VA status [retinol binding protein (RBP)], iron status (Hb, ferritin), and subclinical inflammation APP, CRP (>5 mg/L), and AGP (>1 g/L) were determined. Impacts of infection on the infant nutritional status were estimated using logistic regression models. Results Infection prevalence, based on elevated CRP and AGP levels, was 36.7%. For diarrhea reported symptoms, 42.4% of infants at 9 months had no indication of infection as indicated by CRP and AGP; for acute respiratory reported symptoms, 42.6% had no indication of infection. There was a significant positive association with infection among VA-deficient (RBP < 0.83 μmol/L) infants based on maternal reported symptoms but not with iron deficiency (ferritin < 12 μg/L). The odds of having infection, based on increased CRP and AGP, in underweight infants was 3.7 times higher (OR: 3.7; 95% CI: 2.3, 4.5; P = 0.019). Infants with iron deficiency were less likely (OR: 0.40; 95% CI: 0.1, 0.7; P = 0.001) to have infection based on CRP and AGP, while infants with VA deficiency were five times more likely (OR: 5.06; 95% CI: 3.2, 7.1; P = 0.0001) to have infection. Conclusion Acute phase proteins are more useful in defining infection in a population than reported symptoms of illness. Not controlling for inflammation in a population while assessing the nutritional status might result in inaccurate prevalence estimation.
Collapse
Affiliation(s)
- Frederick K. Grant
- International Potato Center, Dar es Salaam, Tanzania
- *Correspondence: Frederick K. Grant,
| | | | - Jan Low
- International Potato Center, Nairobi, Kenya
| | - Carol Levin
- Department of Global Health, University of Washington, Seattle, WA, United States
| | - Donald C. Cole
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | | | | | - Amy W. Girard
- Rollins School of Public Health, Emory University, Atlanta, GA, United States
| |
Collapse
|
3
|
Saville NM, Cortina-Borja M, De Stavola BL, Pomeroy E, Marphatia A, Reid A, Manandhar DS, Wells JCK. Comprehensive analysis of the association of seasonal variability with maternal and neonatal nutrition in lowland Nepal. Public Health Nutr 2021; 25:1-16. [PMID: 34420531 PMCID: PMC9991647 DOI: 10.1017/s1368980021003633] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 07/26/2021] [Accepted: 08/18/2021] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To provide a comprehensive seasonal analysis of pregnant mothers' eating behaviour and maternal/newborn nutritional status in an undernourished population from lowland rural Nepal, where weather patterns, agricultural labour, food availability and disease prevalence vary seasonally. DESIGN Secondary analysis of cluster-randomised Low Birth Weight South Asia Trial data, applying cosinor analysis to predict seasonal patterns. OUTCOMES Maternal mid-upper arm circumference (MUAC), BMI, dietary diversity, meals per day, eating down and food aversion in pregnancy (≥31 weeks' gestation) and neonatal z-scores of length-for-age (LAZ), weight-for-age (WAZ) and head circumference-for-age (HCAZ) and weight-for-length (WLZ). SETTING Rural areas of Dhanusha and Mahottari districts in plains of Nepal. PARTICIPANTS 2831 mothers aged 13-50 and 3330 neonates. RESULTS We found seasonal patterns in newborn anthropometry and pregnant mothers' anthropometry, meal frequency, dietary diversity, food aversion and eating down. Seasonality in intake varied by food group. Offspring anthropometry broadly tracked mothers'. Annual amplitudes in mothers' MUAC and BMI were 0·27 kg/m2 and 0·22 cm, with peaks post-harvest and nadirs in October when food insecurity peaked. Annual LAZ, WAZ and WLZ amplitudes were 0·125, 0·159 and 0·411 z-scores, respectively. Neonates were the shortest but least thin (higher WLZ) in winter (December/January). In the hot season, WLZ was the lowest (May/June) while LAZ was the highest (March and August). HCAZ did not vary significantly. Food aversion and eating down peaked pre-monsoon (April/May). CONCLUSIONS Our analyses revealed complex seasonal patterns in maternal nutrition and neonatal size. Seasonality should be accounted for when designing and evaluating public heath nutrition interventions.
Collapse
Affiliation(s)
- Naomi M Saville
- Institute for Global Health (IGH), University College London (UCL), London, UK
| | - Mario Cortina-Borja
- Great Ormond Street Institute of Child Health (ICH), University College London (UCL), London, UK
| | - Bianca L De Stavola
- Great Ormond Street Institute of Child Health (ICH), University College London (UCL), London, UK
| | - Emma Pomeroy
- Department of Archaeology, University of Cambridge, Cambridge, UK
| | | | - Alice Reid
- Department of Geography, University of Cambridge, Cambridge, UK
| | | | - Jonathan CK Wells
- Great Ormond Street Institute of Child Health (ICH), University College London (UCL), London, UK
| |
Collapse
|
4
|
Bertoncello C, Amoruso I, Moscardino U, Fonzo M, Maharjan M, Buja A, Baldo V, Cocchio S, Baldovin T. Sex-Biased Prevalence of Intestinal Parasitic Infections and Gender Inequality in Rural Nepal. Int J Infect Dis 2021; 109:148-154. [PMID: 34182133 DOI: 10.1016/j.ijid.2021.06.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 06/17/2021] [Accepted: 06/17/2021] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES Intestinal parasitic infections (IPIs) are related to poverty and socioeconomic disparities. In rural Nepal, IPIs are highly endemic and gender inequality is still deeply rooted. This study provides a novel epidemiological assessment of IPIs in Nepal, juxtaposing spatial, age and sex stratification of prevalence. METHODS A PRISMA and PICO-based systematic review of peer-reviewed and grey literature provided IPI prevalence data for the Nepalese population. Demographic and environmental variables were considered to investigate differences related to dwelling area and sex. Variations among prevalence rates were calculated with 95% CI and significance level for odds ratio evaluated with chi-square test. RESULTS The IPI prevalence rate for the Nepalese general population was 37.6%. Moreover, IPI prevalence (52.3%) was significantly higher in rural areas than in urban areas (32.4%), and school-age girls (55.2%) were more infected than boys (48.6%). CONCLUSIONS The IPI infection rate appeared to be enhanced among young women living in rural Nepal, where they experienced low school attendance and heavy enrolment in agricultural work, as result of gender discrimination. Plausibly, these dynamics affect both girls' environmental exposure and fruition of periodic school-based preventive chemotherapy, thus increasing the chances of IPI infection.
Collapse
Affiliation(s)
- Chiara Bertoncello
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, Unit of Hygiene and Public Health, University of Padua, Padua, Italy
| | - Irene Amoruso
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, Unit of Hygiene and Public Health, University of Padua, Padua, Italy.
| | - Ughetta Moscardino
- Department of Developmental Psychology and Socialisation, University of Padua, Padua, Italy
| | - Marco Fonzo
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, Unit of Hygiene and Public Health, University of Padua, Padua, Italy
| | - Mahendra Maharjan
- Central Department of Zoology, Tribhuvan University, Kirtipur, Nepal
| | - Alessandra Buja
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, Unit of Hygiene and Public Health, University of Padua, Padua, Italy
| | - Vincenzo Baldo
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, Unit of Hygiene and Public Health, University of Padua, Padua, Italy
| | - Silvia Cocchio
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, Unit of Hygiene and Public Health, University of Padua, Padua, Italy
| | - Tatjana Baldovin
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, Unit of Hygiene and Public Health, University of Padua, Padua, Italy
| |
Collapse
|
5
|
Habib A, Andrianonimiadana L, Rakotondrainipiana M, Andriantsalama P, Randriamparany R, Randremanana RV, Rakotoarison R, Vigan-Womas I, Rafalimanantsoa A, Vonaesch P, Sansonetti PJ, Collard JM. High prevalence of intestinal parasite infestations among stunted and control children aged 2 to 5 years old in two neighborhoods of Antananarivo, Madagascar. PLoS Negl Trop Dis 2021; 15:e0009333. [PMID: 33878113 PMCID: PMC8087024 DOI: 10.1371/journal.pntd.0009333] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Revised: 04/30/2021] [Accepted: 03/25/2021] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND This study aimed to compare the prevalence of intestinal parasite infestations (IPIs) in stunted children, compared to control children, in Ankasina and Andranomanalina Isotry (two disadvantaged neighborhoods of Antananarivo, Madagascar), to characterize associated risk factors and to compare IPI detection by real-time PCR and standard microscopy techniques. METHODOLOGY/PRINCIPAL FINDINGS Fecal samples were collected from a total of 410 children (171 stunted and 239 control) aged 2-5 years. A single stool sample per subject was examined by simple merthiolate-iodine-formaldehyde (MIF), Kato-Katz smear and real-time PCR techniques. A total of 96.3% of the children were infested with at least one intestinal parasite. The most prevalent parasites were Giardia intestinalis (79.5%), Ascaris lumbricoides (68.3%) and Trichuris trichiura (68.0%). For all parasites studied, real-time PCR showed higher detection rates compared to microscopy (G. intestinalis [77.6% (n = 318) versus 20.9% (n = 86)], Entamoeba histolytica [15.8% (n = 65) versus 1.9% (n = 8)] and A. lumbricoides [64.1% (n = 263) versus 50.7% (n = 208)]). Among the different variables assessed in the study, age of 4 to 5 years (AOR = 4.61; 95% CI, (1.35-15.77)) and primary and secondary educational level of the mother (AOR = 12.59; 95% CI, (2.76-57.47); AOR = 9.17; 95% CI, (2.12-39.71), respectively) were significantly associated with IPIs. Children drinking untreated water was associated with infestation with G. intestinalis (AOR = 1.85; 95% CI, (1.1-3.09)) and E. histolytica (AOR = 1.9; 95% CI, (1.07-3.38)). E. histolytica was also associated with moderately stunted children (AOR = 0.37; 95% CI, 0.2-0.71). Similarly, children aged between 4 and 5 years (AOR = 3.2; 95% CI (2.04-5.01)) and living on noncemented soil types (AOR = 1.85; 95% CI, (1.18-2.09)) were associated with T. trichiura infestation. CONCLUSIONS/SIGNIFICANCE The prevalence of IPIs is substantial in the studied areas in both stunted and control children, despite the large-scale drug administration of antiparasitic drugs in the country. This high prevalence of IPIs warrants further investigation. Improved health education, environmental sanitation and quality of water sources should be provided.
Collapse
Affiliation(s)
- Azimdine Habib
- Unité de Bactériologie Expérimentale, Institut Pasteur de Madagascar, Antananarivo, Madagascar
- * E-mail:
| | - Lova Andrianonimiadana
- Unité de Bactériologie Expérimentale, Institut Pasteur de Madagascar, Antananarivo, Madagascar
| | | | - Prisca Andriantsalama
- Unité d’Epidémiologie et de Recherche Clinique, Institut Pasteur de Madagascar, Antananarivo, Madagascar
| | - Ravaka Randriamparany
- Unité d’Epidémiologie et de Recherche Clinique, Institut Pasteur de Madagascar, Antananarivo, Madagascar
| | | | - Rado Rakotoarison
- Unité d’Immunologie des Maladies Infectieuses, Institut Pasteur de Madagascar, Antananarivo, Madagascar
| | - Inès Vigan-Womas
- Unité d’Immunologie des Maladies Infectieuses, Institut Pasteur de Madagascar, Antananarivo, Madagascar
| | | | - Pascale Vonaesch
- Unité de Pathogénie Microbienne Moléculaire, Institut Pasteur Paris, France
| | | | - Jean-Marc Collard
- Unité de Bactériologie Expérimentale, Institut Pasteur de Madagascar, Antananarivo, Madagascar
| | | |
Collapse
|
6
|
Sürmeli A, Tolunay T, Yasin Y, Kusoglu H, Arcan A, Jaiswal A, Gökmen B, Acharya B, Arslan B, Baka BE, Imamoglu GS, Ökke L, Sahiner M, Yildiz P, Altinayak R, Pokharel S, Yaylaci S, Arikan S, Yolcu YU, Kurt Ö. Child health, parasites and lower socioeconomic status: Outcomes of a long-term screening, intervention and training study by health volunteers in rural Nepal. Acta Trop 2020; 202:105263. [PMID: 31711749 DOI: 10.1016/j.actatropica.2019.105263] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2018] [Revised: 09/19/2019] [Accepted: 11/07/2019] [Indexed: 01/01/2023]
Abstract
BACKGROUND Nepal is a developing country with limited resources for health provision due to its geographic difficulties and frequent natural disasters, such as floods and earthquakes. Children are at risk of growth retardation due to inadequate food intake and unhealthy environment. Lower back pain is common among the adults and causes limitations in daily activities. MATERIAL/METHODS A group of voluntary Turkish medical students, doctors and civil members conducted a field study, together with Nepalese doctors (MDs) and local volunteers, concerned with health-screening, intervention practices and on-site training in rural Nepal between 2013 and 2015. Physical examination of participants, together with stool examinations for parasites were done and those for whom treatment was indicated were referred to MDs who also ran a field pharmacy containing donated medications. RESULTS Totally, 1148 individuals-725 children and 423 adults-were screened between 2013 and 2015. Musculoskeletal problems and upper respiratory tract infections were primary complaints among adults and sick children, respectively. Three-quarters of 203 collected stools had ≥ 1 parasite(s). CONCLUSIONS Growth retardation in children observed during the study, the burden of intestinal parasites on Nepalese children and unavailability of effective health services for citizens in rural areas should direct local authorities to allocate greater resources for country's health infrastructure improvement and to provide a higher standard of childhood nutrition.
Collapse
Affiliation(s)
- Aral Sürmeli
- Acibadem Mehmet Ali Aydinlar University Faculty of Medicine (ACUFoM), Kerem Aydinlar Kampüsü, Kayisdagi Cad. No: 32, Istanbul 34752, Turkey; Medical Rescue Association of Turkey (MEDAK), Istanbul, Turkey
| | - Tuana Tolunay
- Acibadem Mehmet Ali Aydinlar University Faculty of Medicine (ACUFoM), Kerem Aydinlar Kampüsü, Kayisdagi Cad. No: 32, Istanbul 34752, Turkey; Medical Rescue Association of Turkey (MEDAK), Istanbul, Turkey
| | - Yesim Yasin
- ACUFoM, Department of Public Health, Istanbul, Turkey
| | - Hülya Kusoglu
- ACUFoM, Department of Infectious Diseases, Istanbul, Turkey
| | - Abdullah Arcan
- Acibadem Mehmet Ali Aydinlar University Faculty of Medicine (ACUFoM), Kerem Aydinlar Kampüsü, Kayisdagi Cad. No: 32, Istanbul 34752, Turkey; Medical Rescue Association of Turkey (MEDAK), Istanbul, Turkey
| | | | - Beril Gökmen
- Acibadem Mehmet Ali Aydinlar University Faculty of Medicine (ACUFoM), Kerem Aydinlar Kampüsü, Kayisdagi Cad. No: 32, Istanbul 34752, Turkey
| | | | - Burcu Arslan
- Medical Rescue Association of Turkey (MEDAK), Istanbul, Turkey
| | - Büsra Ecem Baka
- ACU Faculty of Health Sciences, Physical Therapy and Rehabilitation, Istanbul, Turkey
| | - Gizem Söylemez Imamoglu
- Acibadem Mehmet Ali Aydinlar University Faculty of Medicine (ACUFoM), Kerem Aydinlar Kampüsü, Kayisdagi Cad. No: 32, Istanbul 34752, Turkey
| | - Larissa Ökke
- Medical Rescue Association of Turkey (MEDAK), Istanbul, Turkey; ACU Faculty of Health Sciences, Physical Therapy and Rehabilitation, Istanbul, Turkey
| | - Melike Sahiner
- ACUFoM, Department of Medical Education, Istanbul, Turkey
| | - Piril Yildiz
- Acibadem Mehmet Ali Aydinlar University Faculty of Medicine (ACUFoM), Kerem Aydinlar Kampüsü, Kayisdagi Cad. No: 32, Istanbul 34752, Turkey; Medical Rescue Association of Turkey (MEDAK), Istanbul, Turkey
| | | | | | - Serpil Yaylaci
- ACUFoM, Department of Emergency Medicine, Istanbul, Turkey
| | - Silasu Arikan
- Medical Rescue Association of Turkey (MEDAK), Istanbul, Turkey
| | - Yagiz Ugur Yolcu
- Acibadem Mehmet Ali Aydinlar University Faculty of Medicine (ACUFoM), Kerem Aydinlar Kampüsü, Kayisdagi Cad. No: 32, Istanbul 34752, Turkey
| | - Özgür Kurt
- Acibadem LABMED Clinical Laboratories, Istanbul, Turkey; ACUFoM, Department of Medical Microbiology, Istanbul, Turkey; European Society of Clinical Microbiology and Infectious Diseases (ESCMID) Clinical Parasitology Study Group, Switzerland.
| |
Collapse
|
7
|
Baldovin T, Amoruso I, Zangrando D, Cocchio S, Maharjan M, Lazzari R, Buja A, Baldo V, Bertoncello C. Soil-transmitted helminthiases in Nepal: Transmission boundaries and implications for local communities and international travelers. Acta Trop 2019; 196:155-164. [PMID: 30991017 DOI: 10.1016/j.actatropica.2019.04.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Revised: 04/02/2019] [Accepted: 04/12/2019] [Indexed: 12/28/2022]
Abstract
Soil transmitted helminthiasis (STHs) are endemic in Nepal but since the country territory is extremely heterogeneous, a multidisciplinary assessment is required to evaluate the risk of infection in different areas. Prevalence data were retrieved with systematic literature search and geographical coordinates were assigned to each survey site. Spatial stratification was then implemented considering land use and ecological parameters. STH transmission boundaries were tested after reference criteria and elevation was evaluated as additional predictor: the elevation threshold of 3057 m above sea level is demarking the STH transmission limit. Areas above this threshold are safe, but since lodging in at-risk sites is a compulsory stopover for international travelers, STH risk exposure should be considered for every travel to the country.
Collapse
|
8
|
Vilcins D, Sly PD, Jagals P. Environmental Risk Factors Associated with Child Stunting: A Systematic Review of the Literature. Ann Glob Health 2018. [PMID: 30779500 PMCID: PMC6748290 DOI: 10.29024/aogh.2361] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Stunting, a form of malnutrition characterized by impaired linear growth in the first two years of life, affects one quarter of children globally. While nutritional status remains the key cause of stunting, there is evidence that environmental risk factors are associated with stunting. OBJECTIVE The objective of this review is to explore the current literature and compile the environmental risk factors that have been associated with stunting. Further, we seek to discover which risk factors act independently of nutritional intake. METHODS A systematic search of the literature was performed using PubMed, EMBASE, Scopus, TOXNET, and CINAHL. A search of the grey literature was conducted. Papers were included in this review if they examined an association between childhood stunting and exposure to environmental risk factors. FINDINGS We included 71 reports in the final analysis. The included studies showed that foodborne mycotoxins, a lack of adequate sanitation, dirt floors in the home, poor quality cooking fuels, and inadequate local waste disposal are associated with an increased risk of childhood stunting. Access to safe water sources was studied in a large number of studies, but the results remain inconclusive due to inconsistent study findings. Limited studies were available for arsenic, mercury, and environmental tobacco, and thus their role in stunting remains inconclusive. The identified research did not control for nutritional intake. A causal model identified solid fuel use and foodborne mycotoxins as being environmental risk factors with the potential to have direct effects on childhood growth. CONCLUSIONS A diverse range of environmental risk factors are, to varying degrees, associated with stunting, demonstrating the importance of considering how the environment interacts with nutrition. Health promotion activities may be more effective if they consider environmental factors alongside nutritional interventions.
Collapse
Affiliation(s)
- Dwan Vilcins
- Child Health Research Centre, The University of Queensland, Center for Children's Health Research, South Brisbane.,School of Public Health, University of Queensland, AU
| | - Peter D Sly
- Child Health Research Centre, The Universit of Queensland, Center for Children's Health Research South Brisbane, AU
| | - Paul Jagals
- Child Health Research Centre, The University of Queensland, Center for Children's Health Research South Brisbane, AU
| |
Collapse
|
9
|
Vilcins D, Sly PD, Jagals P. Environmental Risk Factors Associated with Child Stunting: A Systematic Review of the Literature. Ann Glob Health 2018; 84:551-562. [PMID: 30779500 PMCID: PMC6748290 DOI: 10.9204/aogh.2361] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Stunting, a form of malnutrition characterized by impaired linear growth in the first two years of life, affects one quarter of children globally. While nutritional status remains the key cause of stunting, there is evidence that environmental risk factors are associated with stunting. OBJECTIVE The objective of this review is to explore the current literature and compile the environmental risk factors that have been associated with stunting. Further, we seek to discover which risk factors act independently of nutritional intake. METHODS A systematic search of the literature was performed using PubMed, EMBASE, Scopus, TOXNET, and CINAHL. A search of the grey literature was conducted. Papers were included in this review if they examined an association between childhood stunting and exposure to environmental risk factors. FINDINGS We included 71 reports in the final analysis. The included studies showed that foodborne mycotoxins, a lack of adequate sanitation, dirt floors in the home, poor quality cooking fuels, and inadequate local waste disposal are associated with an increased risk of childhood stunting. Access to safe water sources was studied in a large number of studies, but the results remain inconclusive due to inconsistent study findings. Limited studies were available for arsenic, mercury, and environmental tobacco, and thus their role in stunting remains inconclusive. The identified research did not control for nutritional intake. A causal model identified solid fuel use and foodborne mycotoxins as being environmental risk factors with the potential to have direct effects on childhood growth. CONCLUSIONS A diverse range of environmental risk factors are, to varying degrees, associated with stunting, demonstrating the importance of considering how the environment interacts with nutrition. Health promotion activities may be more effective if they consider environmental factors alongside nutritional interventions.
Collapse
Affiliation(s)
- Dwan Vilcins
- Child Health Research Centre, The University of Queensland, Center for Children’s Health Research South Brisbane, Queensland, AU
- School of Public Health, University of Queensland, Brisbane, Queensland, AU
| | - Peter D. Sly
- Child Health Research Centre, The University of Queensland, Center for Children’s Health Research South Brisbane, Queensland, AU
| | - Paul Jagals
- Child Health Research Centre, The University of Queensland, Center for Children’s Health Research South Brisbane, Queensland, AU
| |
Collapse
|
10
|
Ives R, Humphrey L. Endochondral growth disruption during vitamin D deficiency rickets in a mid-19th century series from Bethnal Green, London, UK. AMERICAN JOURNAL OF PHYSICAL ANTHROPOLOGY 2018; 167:585-601. [DOI: 10.1002/ajpa.23687] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Revised: 06/23/2018] [Accepted: 07/02/2018] [Indexed: 11/12/2022]
Affiliation(s)
- Rachel Ives
- Department of Earth Sciences; Natural History Museum; London The United Kingdom
- AOC Archaeology Group; Twickenham The United Kingdom
| | - Louise Humphrey
- Department of Earth Sciences; Natural History Museum; London The United Kingdom
| |
Collapse
|
11
|
Pratomo FA. RELATIONSHIP BETWEEN GROWTH RATE AND DIFFERENT TYPES OF INFECTION IN CHILDREN UNDER 5 YEARS ON WEST PAPUA. INDONESIAN JOURNAL OF TROPICAL AND INFECTIOUS DISEASE 2017. [DOI: 10.20473/ijtid.v6i5.5180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Malnutrition is still a significant problem in the world and in Indonesia. Among the factors underlying it, the role of growth faltering is often underestimated. Considering infection as a factor that affects growth and that Indonesia is endemic to various different infectious diseases, to understand its role, a study on infants is conducted using using longitudinal study design in the Sumuri District, Bintuni Bay Regency, West Papua Province. A total of 138 children aged 6 months to 5 years is followed for 6 months in February to August 2014. Weight gain data and frequency of infection is collected, with the infections divided into four category of disease: upper respiratory tract infection, skin infection, gastroenteritis, and malaria. These data are gathered by Puskesmas daily and monthly records followed by home visit. This study found that the prevalence of malnutrition for the area covered by Puskesmas Tanah Merah is 15.9% for moderate malnutrition and 2.9% for severe malnutrition, with the mean SD value in the beginning of the study -1.15 and at the end of study -1.12, with the difference of SD value calculated as weight gain. Total incidence of infections and mean duration of each infection is then compiled and calculated with weight gain data using linear regression method statistical test to understand the difference of role of each infection to weight gain. The result of the study shows that gastroenteritis has a significant negative effect to weight gain and upper respiratory tract infection has a negative effect to weight gain on children in the villages handled by Puskesmas Tanah Merah West Papua.
Collapse
|
12
|
Ives R, Humphrey L. Patterns of long bone growth in a mid-19th century documented sample of the urban poor from Bethnal Green, London, UK. AMERICAN JOURNAL OF PHYSICAL ANTHROPOLOGY 2017; 163:173-186. [DOI: 10.1002/ajpa.23198] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Revised: 02/09/2017] [Accepted: 02/13/2017] [Indexed: 01/03/2023]
Affiliation(s)
- Rachel Ives
- Department of Earth Sciences; Natural History Museum; London SW7 5BD United Kingdom
- AOC Archaeology Group; Twickenham TW1 1JS United Kingdom
| | - Louise Humphrey
- Department of Earth Sciences; Natural History Museum; London SW7 5BD United Kingdom
| |
Collapse
|
13
|
Zonta ML, Oyhenart EE, Navone GT. Socio‐environmental variables associated with malnutrition and intestinal parasitoses in the child population of Misiones, Argentina. Am J Hum Biol 2014; 26:609-16. [DOI: 10.1002/ajhb.22570] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2014] [Revised: 05/03/2014] [Accepted: 05/20/2014] [Indexed: 11/09/2022] Open
Affiliation(s)
- María L. Zonta
- Centro de Estudios Parasitológicos y de Vectores (CEPAVE), UNLP‐CCT CONICETLa Plata Argentina
| | - Evelia E. Oyhenart
- Cátedra de Antropología Biológica IVFacultad de Ciencias Naturales y Museo, UNLPLa Plata Argentina
- Instituto de Genética Veterinaria “Ing. Fernando Noel Dulout” (IGEVET), FCV, UNLP‐CCT CONICETLa Plata Argentina
| | - Graciela T. Navone
- Centro de Estudios Parasitológicos y de Vectores (CEPAVE), UNLP‐CCT CONICETLa Plata Argentina
| |
Collapse
|
14
|
Schlaudecker EP, Steinhoff MC, Moore SR. Interactions of diarrhea, pneumonia, and malnutrition in childhood: recent evidence from developing countries. Curr Opin Infect Dis 2011; 24:496-502. [PMID: 21734569 PMCID: PMC5454480 DOI: 10.1097/qco.0b013e328349287d] [Citation(s) in RCA: 82] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
PURPOSE OF REVIEW This review highlights recent progress toward understanding complex interactions between diarrhea, pneumonia, and undernutrition among children in low-income and middle-income countries. RECENT FINDINGS New studies parallel earlier reports that diarrhea and pneumonia impair children's growth and that underlying malnutrition is a major risk factor for these conditions. Episodes of diarrhea may predispose to pneumonia in undernourished children. Additional studies support breastfeeding and micronutrient supplementation for the prevention and control of diarrhea and pneumonia. Malnutrition may partially account for the reduced efficacy of oral rotavirus vaccines in low-income countries. Immunization of pregnant women against influenza also appears to reduce intrauterine growth retardation. Immunization of infants against Streptococcus pneumoniae may improve their growth. New genetic studies indicate that polymorphisms in apolipoprotein E or the leptin receptor modulate children's risk for diarrhea and Entamoeba histolytica infection, respectively, thereby linking two genes important for lipid metabolism to enteric infections. SUMMARY Significant advances have been made in understanding the vicious cycle of malnutrition, diarrhea, and pneumonia in developing countries. Future challenges will be to translate this progress into effective and widely accessible public health measures.
Collapse
Affiliation(s)
- Elizabeth P. Schlaudecker
- Division of Infectious Diseases, Cincinnati Children’s Hospital Medical Center, University of Cincinnati, Cincinnati, Ohio, USA
- Center for Global Child Health, Cincinnati Children’s Hospital Medical Center, University of Cincinnati, Cincinnati, Ohio, USA
| | - Mark C. Steinhoff
- Division of Infectious Diseases, Cincinnati Children’s Hospital Medical Center, University of Cincinnati, Cincinnati, Ohio, USA
- Center for Global Child Health, Cincinnati Children’s Hospital Medical Center, University of Cincinnati, Cincinnati, Ohio, USA
| | - Sean R. Moore
- Division of Gastroenterology, Hepatology, and Nutrition, Cincinnati Children’s Hospital Medical Center, University of Cincinnati, Cincinnati, Ohio, USA
- Center for Global Child Health, Cincinnati Children’s Hospital Medical Center, University of Cincinnati, Cincinnati, Ohio, USA
| |
Collapse
|
15
|
Petri WA, Mondal D, Peterson KM, Duggal P, Haque R. Association of malnutrition with amebiasis. Nutr Rev 2010; 67 Suppl 2:S207-15. [PMID: 19906225 DOI: 10.1111/j.1753-4887.2009.00242.x] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Observation of a cohort of preschool children in Dhaka, Bangladesh, is beginning to reveal the contributions of environment, host, and parasite to amebiasis. Reviewed here are the associations and interactions of malnutrition, IgA and interferon-gamma, human leukocyte antigen alleles, and parasite genotypes to the outcome of infection. Future efforts aimed at understanding the mechanisms of these effects are described.
Collapse
Affiliation(s)
- William A Petri
- Division of Infectious Diseases and International Health, Department of Medicine, University of Virginia Health System, Charlottesville, Virginia, USA.
| | | | | | | | | |
Collapse
|
16
|
Pathways leading to early growth faltering: an investigation into the importance of mucosal damage and immunostimulation in different socio-economic groups in Nepal. Br J Nutr 2008; 101:558-67. [PMID: 18662426 DOI: 10.1017/s000711450802744x] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Early childhood growth retardation persists in developing countries despite decades of nutritional interventions. Adequate food is necessary, but not sufficient, to ensure normal growth where there is ubiquitous exposure to infection. Pathways associated with infection, small intestinal mucosal damage and chronic immunostimulation remain largely undemonstrated in countries other than The Gambia. We conducted a longitudinal study of one squatter and one middle-class group (n 86, 3-18 month olds) to assess these relationships in Nepal. Growth, mucosal damage index (MDI; urinary lactose:creatinine ratio adjusted for body weight), morbidity reports, and blood concentrations of albumin, alpha-1-acid glycoprotein, IgG and Hb, were recorded monthly. Growth status worsened dramatically from 6 to 18 months, with squatters more stunted (height-for-age Z-score (HAZ), P<0.001) and underweight (weight-for-age Z-score (WAZ), P=0.009) than middle class. IgG increased with age, was elevated in squatter children, and negatively related to WAZ (P=0.034). MDI showed significant negative associations with growth performance, explaining 9 and 19% of height and weight deficits (DeltaHAZ, P=0.004; DeltaWAZ, P<0.001). Unexpectedly, these associations were weaker in squatter children, namely in the group which showed poorer growth, elevated morbidity, greater pathogen exposure (IgG) and higher MDI (P<0.001). In Nepal, as in The Gambia, children exhibit poor growth, mucosal damage and immunostimulation. The relative impact of pathways associated with infection and undernutrition may, however, differ across socio-economic groups: in poorer children, the impact of mucosal damage and immunostimulation could be masked by nutritional constraints. This has important implications for public health interventions.
Collapse
|
17
|
Nakahara S, Poudel KC, Lopchan M, Ichikawa M, Poudel-Tandukar K, Jimba M, Wakai S. Availability of childcare support and nutritional status of children of non-working and working mothers in urban Nepal. Am J Hum Biol 2006; 18:169-81. [PMID: 16493631 DOI: 10.1002/ajhb.20481] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
In many developing countries, poor women have multiple roles, and often their time constraints are so severe that their participation in income-generating activities results in reduced childcare time, which in turn affects child health. Previous studies have tended to investigate how childcare support influences nutrition of children with working mothers' based on comparisons with non-working mothers. However, non-working mothers are not a homogeneous group, and we therefore need to distinguish between those who need not work and those who wish to but cannot, for example, due to a lack of substitute caregivers. We examined the association between availability of childcare support and the nutritional status of children of both non-working and working mothers in poor areas of Pokhara, a sub-metropolitan city in Nepal. We recruited 150 children of age 10-24 months from the waiting lists of 17 daycare centers and measured their weights and heights. Those with height-for-age and weight-for-age Z scores of less than -2 were defined as stunted and underweight, respectively. To collect information on childcare practices and socioeconomic characteristics, mothers were interviewed using a pre-tested structured questionnaire. Unavailability of adult childcare support was associated with increased risk of malnutrition among children of both non-working and working mothers. Peer childcare was not significantly associated with child malnutrition among children of non-working mothers, but it was associated with an increased risk of malnutrition among children of working mothers. Although further longitudinal research is required, we suggest that childcare support from adult substitute caregivers is essential for children of non-working mothers with limited resources.
Collapse
Affiliation(s)
- Shinji Nakahara
- Department of International Community Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
| | | | | | | | | | | | | |
Collapse
|
18
|
Mondal D, Petri WA, Sack RB, Kirkpatrick BD, Haque R. Entamoeba histolytica-associated diarrheal illness is negatively associated with the growth of preschool children: evidence from a prospective study. Trans R Soc Trop Med Hyg 2006; 100:1032-8. [PMID: 16730764 DOI: 10.1016/j.trstmh.2005.12.012] [Citation(s) in RCA: 80] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2005] [Revised: 12/19/2005] [Accepted: 12/19/2005] [Indexed: 11/29/2022] Open
Abstract
The enteric protozoa, Cryptosporidium, Giardia and Entamoeba histolytica, cause diarrhea in children. We investigated the association of enteric protozoan-associated diarrheal illness with the nutritional status and growth of preschool children in Dhaka, Bangladesh. The subjects were 221 children aged 2-5 years who were followed prospectively for diarrheal illness for 3 years. The weight and height of the children were measured at entry and at 4-month intervals. Cryptosporidium and E. histolytica were diagnosed with commercially available stool antigen detection kits. Giardia was diagnosed by conventional microscopy. Cryptosporidium- and Giardia-associated diarrheal illness was not associated with the growth of the children. Children with E. histolytica-associated diarrheal illness had lower weight for age Z-score changes (-0.103+/-0.120 vs. 0.176+/-0.052, P=0.038). Similarly, the change in height for age Z-score was lower in children with E. histolytica-associated diarrheal illness (-0.348+/-0.186 vs. 0.142+/-0.08, P=0.018). Children with E. histolytica-associated diarrheal illness were 2.93 times (95% CI 1.01-8.52, P=0.047) more likely to be malnourished and 4.69 times (95% CI 1.55-14.18, P=0.006) more prone to be stunted. Entamoeba histolytica-associated diarrheal illness was negatively associated with the growth of preschool children.
Collapse
Affiliation(s)
- Dinesh Mondal
- International Centre for Diarrhoeal Disease Research, Bangladesh, G.P.O. Box 128, Dhaka-1000, Bangladesh
| | | | | | | | | |
Collapse
|
19
|
Soeters PB, van de Poll MCG, van Gemert WG, Dejong CHC. Amino Acid Adequacy in Pathophysiological States. J Nutr 2004; 134:1575S-1582S. [PMID: 15173433 DOI: 10.1093/jn/134.6.1575s] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Amino acid utilization and, therefore, demand differ between the healthy state and various disease states. In the healthy state most circulating amino acids are derived from dietary proteins that are stored and broken down in the gut and released gradually into the portal circulation, and from continuous turnover of body protein. In disease states, the amino acid composition of amino acids derived from periferal protein breakdown and released in the circulation, is different, for example because a substantial part of the branched-chain amino acids is broken down to yield glutamine and alanine, which are released in the circulation. It appears to be advantageous to mimic this continuous autoinfusion in patients, dependent of parenteral of enteral tube feeding. In disease, different endpoints should be used to assess the adequacy of the administered amino acid mix. Maintenance of a positive nitrogen balance and growth is less important than support of wound healing and immune function. Several amino acids such as glutamine, cysteine, and taurine are shown or suggested to be conditionally essential in disease, and to form substrate in the stressed patient for anabolic processes in liver, immune system, and injured sites. Amino acid toxicity is rare, and protein restriction for patients with renal or liver failure is obsolete because this only aggravated malnutrition. A true example of protein toxicity consists of gastrointestinal hemorrhage that precipitates hepatic encephalopathy in liver insufficiency, most likely because hemoglobin is an unbalanced protein because it lacks the essential amino acid isoleucine.
Collapse
Affiliation(s)
- Peter B Soeters
- Department of Surgery, Maastricht University, 6200 MD, Maastricht, The Netherlands.
| | | | | | | |
Collapse
|
20
|
Himes JH, Jacobs DR. Food-based nutrition education and hygiene can improve the growth of stunted children. Br J Nutr 2004; 91:657-9. [PMID: 15137916 DOI: 10.1079/bjn20041127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- J H Himes
- University of Minnesota, School of Public Health, 1300 South Second Street, Minneapolis, MN 55454, USA
| | | |
Collapse
|