Journal Article

A pilot study using hospital surveillance and a birth cohort to investigate enteric pathogens and malnutrition in children, Dili, Timor-Leste

Danielle M. Cribb, Joshua R. Francis, Joanita Jong, Benjamin G. Polkinghorne, Paulino da Silva, Kathryn Glass, Virginia de Lourdes da Conceiҫão, Martyn D. Kirk, Samantha Colquhoun, Milena M. Lay dos Santos, Almerio Moniz, Endang Soares da Silva, Nevio Sarmento, Nicholas S. S. Fancourt, Feliciano da Conceiҫão, Anthony D. K. Draper

2024

Overview

In low-to-middle-income countries (LMICs), enteric pathogens contribute to child malnutrition, affecting nutrient absorption, inducing inflammation, and causing diarrhoea. This is a substantial problem in LMICs due to high disease burden, poor sanitation and nutritional status, and the cyclical nature of pathogen infection and malnutrition. This relationship remains understudied in Timor-Leste. In our pilot study of enteric pathogens and malnutrition in Dili, Timor-Leste (July 2019–October 2020), we recruited 60 infants in a birth cohort from Hospital Nacional Guido Valadares (HNGV) with up to four home visits. We collected faecal samples and details of demographics, anthropometrics, diet and food practices, and animal husbandry. Additionally, we collected faecal samples, diagnostics, and anthropometrics from 160 children admitted to HNGV with a clinical diagnosis of severe diarrhoea or severe acute malnutrition (SAM). We tested faeces using the BioFire® FilmArray® Gastrointestinal Panel. We detected high prevalence of enteric pathogens in 68.8% (95%CI 60.4–76.2%) of infants at home, 88.6% of SAM cases (95%CI 81.7–93.3%) and 93.8% of severe diarrhoea cases (95%CI 67.7–99.7%). Diarrhoeagenic Escherichia coli and Campylobacter spp. were most frequently detected. Pathogen presence did not significantly differ in birth cohort diarrhoeal stool, but hospital data indicated associations between Salmonella and Shigella and diarrhoea. We observed wasting in 18.4% (95%CI 9.2–32.5%) to 30.8% (95%CI 17.5–47.7%) of infants across home visits, 57.9% (95%CI 34.0–78.9%) of severe diarrhoea cases, and 92.5% (95%CI 86.4–96.2%) of SAM cases. We associated bottle feeding with increased odds of pathogen detection when compared with exclusive breastfeeding at home (OR 8.3, 95%CI 1.1–62.7). We detected high prevalence of enteric pathogens and signs of malnutrition in children in Dili. Our pilot is proof of concept for a study to fully explore the risk factors and associations between enteric pathogens and malnutrition in Timor-Leste.

• Publisher: Public Library of Science (PLoS),Public Library of Science
• Subject: Analysis / Animal culture / Animals / Biology and Life Sciences / Birth Cohort / Breast feeding / Child / Child Nutrition Disorders - complications / Child Nutrition Disorders - epidemiology / Control / Diarrhea - epidemiology / Diarrhea - etiology / Escherichia coli / Female / Hospitals / Humans / Identification and classification / Infant / Infants / Infection / Investigations / Malnutrition - complications / Malnutrition - epidemiology / Malnutrition in children / Medical research / Medicine / Medicine and Health Sciences / Medicine, Experimental / Pathogenic microorganisms / People and Places / Pilot Projects / Prevention / Q / R / Research and Analysis Methods / Research Article / Risk factors / Sanitation / Science / Severe Acute Malnutrition - complications / Timor-Leste - epidemiology