Identification of Enteric Pathogen Reservoirs and Transmission Pathways Associated with Short Childhood Stature in the Kolkata Indian Site of the Global Enteric Multicenter Study
Kurt Z. Long,
Inong R. Gunanti,
Chris Stride,
Johanna Sanchez,
Dipika Sur,
Byomkesh Manna,
Thandavarayan Ramamurthy,
Suman Kanungo,
James P. Nataro,
Helen Powell,
Anna Roose,
Dilruba Nasrin,
Halvor Sommerfelt,
Myron Levine,
Karen Kotloff
Affiliations
Kurt Z. Long
Epidemiology and Public Health, Swiss Tropical and Public Health Institute, 4123 Allschwil, Switzerland
Inong R. Gunanti
The Child Health Research Centre, Faculty of Medicine and Biomedical Sciences, The University of Queensland, Brisbane 4101, Australia
Chris Stride
The Institute of Work Psychology, University of Sheffield, Sheffield S10 2TN, UK
Johanna Sanchez
The Child Health Research Centre, Faculty of Medicine and Biomedical Sciences, The University of Queensland, Brisbane 4101, Australia
Dipika Sur
ICMR—National Institute for Research in Bacterial Infections, Kolkata 700010, India
Byomkesh Manna
ICMR—National Institute for Research in Bacterial Infections, Kolkata 700010, India
Thandavarayan Ramamurthy
ICMR—National Institute for Research in Bacterial Infections, Kolkata 700010, India
Suman Kanungo
ICMR—National Institute for Research in Bacterial Infections, Kolkata 700010, India
James P. Nataro
Department of Pediatrics, University of Virginia School of Medicine, Charlottesville, VA 22903, USA
Helen Powell
Department of Pediatrics, Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, MD 21201, USA
Anna Roose
Department of Medicine Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, MD 21201, USA
Dilruba Nasrin
Department of Medicine Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, MD 21201, USA
Halvor Sommerfelt
Centre for Intervention Science in Maternal and Child Health, Centre for International Health, University of Bergen and the Norwegian Institute of Public Health, NO-5020 Bergen, Norway
Myron Levine
Department of Pediatrics, Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, MD 21201, USA
Karen Kotloff
Department of Pediatrics, Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, MD 21201, USA
Age-stratified path analyses modeled associations between enteric pathogen reservoirs, transmission pathways and height-for-age z-scores (HAZ) to identify determinants of childhood growth in the Kolkata, India site of the Global Enteric Multicenter Study (GEMS). Models tested direct associations of potential pathogen reservoirs with HAZ at 60-day follow-up in separate moderate and severe diarrhea (MSD) case and control cohorts or indirectly when mediated by enteric infections. 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 impaired growth through reductions in rotavirus and tEPEC infections. Water storage increased rotavirus and ST-ETEC infection risks, resulting in increased impaired growth, but was reduced with reported child feces disposal. The GII norovirus variant was inversely associated with HAZ among children 12–59 months of age in the control cohort. Reported handwashing before the handling of children reduced GII infections and impaired growth. Boiling water and the disposal of children’s feces mediated by stored water were positively associated with HAZ. The targeting of pathogen-specific reservoirs and transmission pathways may more effectively improve childhood linear growth in South Asian urban communities.