{
  "abstract": "Introduction Globally, enteric pathogens have been associated with poor child growth and development. Our aim was to assess for predictors, consequences and potential mechanisms of enteric pathogen burden morbidity among children in rural Tanzania.Methods We performed a secondary data analysis of 1140 children from the Early-Life Interventions for Childhood Growth and Development in Tanzania (ELICIT) study, assessing stool samples from ages 6, 12 and 18 months using TaqMan Array Cards for enteric pathogens. We examined risk factors for infections and associations of pathogen burden with serum biomarkers of nutrition and inflammation and anthropometry and cognitive development outcomes (using the Malawi Developmental Assessment Tool, MDAT).Results Over the three time points, children had median (IQR) pathogen counts of 2 (0–7) at 6 months, 3 (0–8) at 12 months and 2 (0–8) at 18 months—for an overall mean of 7.79 total pathogen detections (SD 2.64, range 1–18). Assessed as an outcome, pathogen burden was associated with lower socioeconomic status, higher household occupancy and housing chickens. Assessed as a predictor (and adjusted for sex, socioeconomic status, birth month and age), each additional pathogen was associated with 0.03 lower length-for-age z-scores (p=0.008) and 0.04 lower weight-for-age z-scores (WAZ) (p<0.0001) by 18 months—with multiple individual pathogens analysed separately also being associated with lower WAZ. Pathogen burden was not associated with 18-month MDAT scores. In evaluating for possible mechanisms of growth suppression, pathogen burden was positively associated with serum C reactive protein and FGF21 and inversely associated with Collagen X and IGF-1 at 12 and 18 months—associations that were also all noted with Shigella infections individually.Conclusions Despite the ubiquity of pathogen carriage, we noted important predictors and outcomes of greater pathogen burden—underscoring ongoing importance of identifying interventions to reduce pathogen exposure among children in developing areas.Trail registration number NCT03268902.",
  "authors": [
    {
      "affiliations": [
        "Pediatrics, University of Virginia School of Medicine, Charlottesville, Virginia, USA"
      ],
      "name": "Mark D DeBoer"
    },
    {
      "affiliations": [
        "Medicine, University of Virginia School of Medicine, Charlottesville, Virginia, USA"
      ],
      "name": "Sarah E Elwood"
    },
    {
      "affiliations": [
        "Haydom Global Health Research Centre, Haydom Lutheran Hospital, Mbulu, Manyara, Tanzania, United Republic of"
      ],
      "name": "Godfrey Guga"
    },
    {
      "affiliations": [
        "Haydom Global Health Research Centre, Haydom Lutheran Hospital, Mbulu, Manyara, Tanzania, United Republic of"
      ],
      "name": "Samwel Jatosh"
    },
    {
      "affiliations": [
        "Pediatrics, University of Virginia School of Medicine, Charlottesville, Virginia, USA"
      ],
      "name": "Rebecca J Scharf"
    },
    {
      "affiliations": [
        "Medicine, University of Virginia School of Medicine, Charlottesville, Virginia, USA"
      ],
      "name": "Jie Liu"
    },
    {
      "affiliations": [
        "Department of Epidemiology, Emory University, Atlanta, Georgia, USA"
      ],
      "name": "Elizabeth T Rogawski McQuade"
    },
    {
      "affiliations": [
        "Haydom Global Health Research Centre, Haydom Lutheran Hospital, Mbulu, Manyara, Tanzania, United Republic of"
      ],
      "name": "Estomih R Mduma"
    },
    {
      "affiliations": [
        "Medicine, University of Virginia School of Medicine, Charlottesville, Virginia, USA"
      ],
      "name": "Eric Houpt"
    },
    {
      "affiliations": [
        "Medicine, University of Virginia Health System, Charlottesville, Virginia, USA"
      ],
      "name": "James A Platts-Mills"
    }
  ],
  "title": "Enteric pathogen carriage in early childhood is associated with elevated CRP, lower IGF-1 and linear growth deficits: the ELICIT study in rural Tanzania",
  "uid": "f484d482-9790-5912-940e-422e65b751a7"
}