Article Text
PDF
Abstract
Background Millions of children in low-income and middle-income countries (LMICs) are at risk of not reaching their full cognitive potential. Malnutrition and enteric infections in early life are implicated as risk factors; however, most studies on these risks and their associations with cognitive development have failed to adequately account for confounding factors or the accumulation of putative insults. Here, we examine the interaction between infections and illness on cognitive development in LMIC community settings.
Methods As part of the Etiology, Risk Factors, and Interactions of Enteric Infections and Malnutrition and the Consequences for Child Health and Development (MAL-ED) longitudinal birth cohort study, children from eight LMICs were followed from birth to 24 months to understand the influence of repeated enteric infections on child growth and development. Here, data from six sites were employed to evaluate associations between infection, illness, the home environment, micronutrient intake and status, maternal reasoning, and cognitive development at 24 months.
Results Higher rates of enteropathogen detection and days with illness were associated with lower haemoglobin concentrations, which in turn were associated with lower cognitive scores at 24 months. Children with lower environmental health/safety scores and lower intakes of vitamin B6 and folate had more enteropathogen detections and illness. Strength of associations varied by weight-for-age in the first 17 days of life; lower weight infants were more susceptible to the negative effects of enteropathogens and illness.
Conclusions Enteropathogens were negatively related to child cognitive development. However, other factors were more strongly associated with child cognition. Targeting of interventions to improve cognitive development should include a focus on reducing frequency of illness, improving the safety and healthfulness of the child’s environment, and improving dietary intake.
- child health
- hygiene
- nutrition
- anaemia
- parasitology
This is an open access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY 4.0) license, which permits others to distribute, remix, adapt and build upon this work, for commercial use, provided the original work is properly cited. See: http://creativecommons.org/licenses/by/4.0/
Statistics from Altmetric.com
Footnotes
Handling editor Seye Abimbola
Contributors Five members of the MAL-ED Investigators Network led the analysis and preparation of this manuscript on behalf of the Network. LM-K and LLP devised the model in discussion with LEC and BJJM; LLP conducted the statistical analyses; LEM-K and LLP participated in the interpretation of the results and drafted the manuscript; LEC, BJJM and BAS provided critical feedback to the manuscript. The MAL-ED Network Investigators participated in the design, conduct and analysis of the MAL-ED study and its results.
Funding The Etiology, RiskFactors and Interactions of Enteric Infections and Malnutrition and theConsequences for Child Health and Development Project (MAL-ED) is carried outas a collaborative project supported by the Bill & Melinda GatesFoundation (#OPP47075) , the Foundation for the NIH and the National Institutes ofHealth/Fogarty International Center. The Bill & Melinda Gates Foundation did not play any role in the writing of the manuscript nor did the funders of the study have any role in the study design, data collection, data analysis or interpretation of study results. The corresponding author had full access to all the data in the study and had final responsibility for the decision to submit for publication.
Competing interests None declared.
Patient consent Not required.
Ethics approval The protocol was approved by the institutional review boards at cognizant research institutions, including in each country.
Provenance and peer review Not commissioned; externally peer reviewed.
Data sharing statement The data are not publicly available due to ethical restrictions on participant privacy. Data for this study are available upon request to others in the scientific community. For access, please contact David Spiro at Fogarty International Center (David.spiro@nih.gov).
Collaborators MAL-ED Network Investigators: Angel Mendez Acosta, Rosa Rios de Burga, Cesar Banda Chavez, Julian Torres Flores, Maribel Paredes Olotegui, Silvia Rengifo Pinedo, Mery Siguas Salas, Dixner Rengifo Trigoso, Angel Orbe Vasquez (AB PRISMA, Iquitos, Peru); Imran Ahmed, Didar Alam, Asad Ali, Zulfiqar A Bhutta, Shahida Qureshi, Muneera Rasheed, Sajid Soofi, Ali Turab, Anita KM Zaidi (Aga Khan University, Karachi, Pakistan); Ladaporn Bodhidatta, Carl J Mason (Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand); Sudhir Babji, Anuradha Bose, Ajila T George, Dinesh Hariraju, M Steffi Jennifer, Sushil John, Shiny Kaki, Gagandeep Kang, Priyadarshani Karunakaran, Beena Koshy, Robin P Lazarus, Jayaprakash Muliyil, Mohan Venkata Raghava, Sophy Raju, Anup Ramachandran, Rakhi Ramadas, Karthikeyan Ramanujam, Anuradha Bose, Reeba Roshan, Srujan L Sharma, Shanmuga Sundaram E, Rahul J Thomas (Christian Medical College, Vellore, India); William K Pan (Duke University, Durham, North Carolina, USA; Fogarty International Center/National Institutes of Health, Bethesda, Maryland, USA); Ramya Ambikapathi, J Daniel Carreon, Vivek Charu, Viyada Doan, Jhanelle Graham, Christel Hoest, Stacey Knobler (Fogarty International Center/National Institutes of Health, Bethesda, Maryland, USA); Dennis R Lang (Fogarty International Center/National Institutes of Health, Bethesda, Maryland, USA; Foundation for the NIH, Bethesda, Maryland, USA); Benjamin JJ McCormick, Monica McGrath, Mark A Miller, Archana Mohale, Gaurvika Nayyar, Stephanie Psaki, Zeba Rasmussen, Stephanie A Richard, Jessica C Seidman, Vivian Wang (Fogarty International Center/National Institutes of Health, Bethesda, Maryland, USA); Rebecca Blank, Michael Gottlieb, Karen H Tountas (Foundation for the NIH, Bethesda, Maryland, USA); Caroline Amour, Eliwaza Bayyo, Estomih R Mduma, Regisiana Mvungi, Rosemary Nshama, John Pascal, Buliga Mujaga Swema, Ladislaus Yarrot (Haydom Lutheran Hospital, Haydom, Tanzania); Tahmeed Ahmed, AM Shamsir Ahmed, Rashidul Haque, Iqbal Hossain, Munirul Islam, Mustafa Mahfuz, Dinesh Mondal, Fahmida Tofail (icddr,b, Dhaka, Bangladesh); Ram Krishna Chandyo, Prakash Sunder Shrestha, Rita Shrestha, Manjeswori Ulak (Institute of Medicine, Tribhuvan University, Kathmandu, Nepal); Aubrey Bauck, Robert E Black, Laura E Caulfield (Johns Hopkins University, Baltimore, Maryland, USA); William Checkley (Johns Hopkins University, Baltimore, Maryland, USA; Fogarty International Center/National Institutes of Health, Bethesda, Maryland, USA); Margaret N Kosek, Gwenyth Lee, Kerry Schulze, Pablo Peñataro Yori (Johns Hopkins University, Baltimore, Maryland, USA); Laura E Murray-Kolb (The Pennsylvania State University, University Park, Pennsylvania, USA); A Catharine Ross (The Pennsylvania State University, University Park, Pennsylvania, USA); Barbara Schaefer (The Pennsylvania State University, University Park, Pennsylvania, USA; Fogarty International Center/National Institutes of Health, Bethesda, Maryland, USA); Suzanne Simons (The Pennsylvania State University, University Park, Pennsylvania, USA); Laura Pendergast (Temple University, Philadelphia, Pennsylvania, USA); Cláudia B Abreu, Hilda Costa, Alessandra Di Moura (Universidade Federal do Ceara, Fortaleza, Brazil); José Quirino Filho (Universidade Federal do Ceara, Fortaleza, Brazil; Fogarty International Center/National Institutes of Health, Bethesda, Maryland, USA); Alexandre Havt, Álvaro M Leite, Aldo AM Lima, Noélia L Lima, Ila F Lima, Bruna LL Maciel, Pedro HQS Medeiros, Milena Moraes, Francisco S Mota, Reinaldo B Oriá (Universidade Federal do Ceara, Fortaleza, Brazil); Josiane Quetz, Alberto M Soares, Rosa MS Mota (Universidade Federal do Ceara, Fortaleza, Brazil); Crystal L Patil (University of Illinois, Chicago, Illinois, USA); Pascal Bessong, Cloupas Mahopo, Angelina Maphula, Emanuel Nyathi, Amidou Samie (University of Venda, Thohoyandou, South Africa); Leah Barrett, Rebecca Dillingham, Jean Gratz, Richard L Guerrant, Eric Houpt, William A Petri, Jr, James Platts-Mills, Rebecca Scharf (University of Virginia, Charlottesville, Virginia, USA); Binob Shrestha, Sanjaya Kumar Shrestha (Walter Reed/AFRIMS Research Unit, Kathmandu, Nepal); Tor Strand (Walter Reed/AFRIMS Research Unit, Kathmandu, Nepal; University of Bergen, Norway); Erling Svensen (Haukeland University Hospital, Bergen, Norway; Haydom Lutheran Hospital, Haydom, Tanzania).