Background. The burden of childhood growth impairment remains high in many South Asian communities. The relationship between enteric pathogen reservoirs, transmission pathways and height-for-age z-scores (HAZ) was modelled to identify critical determinants of childhood growth in the Kolkata, India site of the Global Enteric Multicenter Study (GEMS)
Methods. Bayesian path analyses tested associations of potential household pathogen transmission pathways with children’s growth measures at 60-day follow-up controlling for baseline HAZ in the separate moderate and severe diarrhea (MSD) case and control cohorts. Age-stratified models in each cohort tested whether such pathogen reservoirs as water source and storage, sanitation facilities and compound animals were directly associated with HAZ or mediated by enteric infections thus suggesting their role in pathogen-specific transmission.
Results. In the MSD cohort, rotavirus and typical EPEC (tEPEC) infections among children 0-11 months of age and ST-ETEC infections among children 12 -23 months of age were associated with lower HAZ. Handwashing after defecating and before cooking reduced both rotavirus and tEPEC infections and indirectly reduced impaired growth. Water storage was associated with increased risk of rotavirus and ST-ETEC infections and so indirectly associated with impaired growth. Disposal of child’s feces reduced the association of water storage with ST-ETEC infections and so reduced the association of this pathogen with impaired growth. Among children in the control cohort the GII norovirus variant was inversely associated with HAZ among children 12 – 23 months of age and among children 24 - 59 months of age. Reported handwashing before handling of children was inversely associated with GII norovirus infections and so was positively associated with HAZ in both age groups. Indirect effects of boiling water and disposal of children’s feces was positively associated with HAZ when mediated by stored water in all age groups in this cohort.
Conclusions. Household water sources moderated by water management and child’s feces disposal may predict enteric pathogens transmission and children’s growth impairment in Kolkata, India. Linear growth may be improved in in South Asian urban communities through the development of public health interventions that target specific enteric pathogen reservoirs and transmission pathways.
CORE (COnnecting REpositories)
CORE (COnnecting REpositories)