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Pediatr Infect Dis J. 2014 Oct;33(10):1004-9. doi: 10.1097/INF.0000000000000351.

Effects of Shigella-, Campylobacter- and ETEC-associated diarrhea on childhood growth.

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From the *Department of International Health, the Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; †Asociaciόn Benéfica Proyectos de Informática, Salud, Medicina, y Agricultura (A.B. PRISMA), Iquitos, Peru; ‡Naval Medical Research Center, Bethesda, MD; §Duke Global Health Institute and Nicholas School of Environment, Duke University, Durham, NC; and ¶Department of Bacteriology, US Naval Medical Research Unit Six, Lima, Peru.



Studies examining the etiology-specific effects of diarrheal disease on growth are limited and variable in their analytic methods, making comparisons difficult and priority setting based on these findings challenging. A study by Black et al (Black RE, Brown KH, Becker S. Effects of diarrhea associated with specific enteropathogens on the growth of children in rural Bangladesh. Pediatrics. 1984;33:1004-1009.) examined the association between Shigella and enterotoxigenic Escherichia coli-related disease and weight gain and linear growth in Bangladeshi children aged 0-5 years. We estimated similar associations in a 2002 cohort of 0- to 6-year-old children in the Peruvian Amazon.


Diarrheal surveillence was conducted using household visits 3 times per week. Anthropometry was collected monthly. Mixed-effect models were used to estimate the association between Shigella, ETEC and Campylobacter diarrhea and weight gain in a 2-month period and linear growth over a 9-month period. Diarrheal disease burdens and growth intervals were quantified so as to be as comparable as possible to the original report.


Shigella- and ETEC-associated diarrhea were not associated with diminished weight gain, although the association between ETEC diarrhea and weight gain (-4.5 g/percent of days spent with ETEC, P = 0.098) was twice that of other etiologic agents, as well as similar in magnitude to the original report. Shigella-associated diarrhea was associated with decreased linear growth (0.055 cm less growth/percent days, P = 0.008), also similar to the original study.


Our findings suggest that associations between enteropathogen-specific diarrheal episodes and growth, particularly Shigella, are comparable across geographic and epidemiological contexts.

[Indexed for MEDLINE]

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