Cribb, Danielle M

Sarmento, Nevio

Moniz, Almerio

Fancourt, Nicholas S S

Glass, Kathryn

Draper, Anthony D K

Francis, Joshua R

Lay Dos Santos, Milena M

Soares da Silva, Endang

Polkinghorne, Benjamin G

de Lourdes da Conceiҫão, Virginia

da Conceiҫão, Feliciano

da Silva, Paulino

Jong, Joanita

Kirk, Martyn D

Colquhoun, Samantha

2024-02-01

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.

National Centre for Epidemiology and Population Health, Australian National University, Canberra, Australian Capital Territory, Australia.

Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia.

Timor-Leste Ministry of Health, Dili, Timor-Leste.

Northern Territory Centre for Disease Control, Northern Territory Government Department of Health, Darwin, Northern Territory, Australia.

Ministry of Agriculture and Fisheries, Dili, Timor-Leste.

Copyright: © 2024 Cribb et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

PLoS One. 2024 Feb 1;19(2):e0296774. doi: 10.1371/journal.pone.0296774. eCollection 2024.

0000-0002-7200-1227

0000-0002-1772-9960

0000-0002-6330-9588

0000-0001-5432-5984

https://pubmed.ncbi.nlm.nih.gov/38300944/?otool=iaurydwlib

https://hdl.handle.net/10137/12656

19

Infant

Child

Animals

Female

Humans

Pilot Projects

*Child Nutrition Disorders/epidemiology/complications

Birth Cohort

Timor-Leste/epidemiology

*Malnutrition/epidemiology/complications

Diarrhea/epidemiology/etiology

*Severe Acute Malnutrition/complications

Hospitals

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

Journal Article

Publication