Early Childhood Diarrhea Predicts Impaired School Performance

Universidade Federal do Ceará, Ceará, Ceará, Brazil
The Pediatric Infectious Disease Journal (Impact Factor: 2.72). 06/2006; 25(6):513-20. DOI: 10.1097/01.inf.0000219524.64448.90
Source: PubMed


Diarrhea is a leading cause of mortality worldwide; however, its long-term morbidity is poorly understood. Recently, early childhood diarrhea (ECD) has been associated with impaired physical fitness, growth and cognitive function 6 to 9 years later. We studied the effects of ECD on school functioning in a shantytown in northeastern Brazil.
We administered 77 educational surveys. Complete diarrhea surveillance (ie, >90%) in the first 2 years of life and demographic and anthropometric information were available for 73 children. Age at starting school was calculated for 62 children, whereas age appropriateness for the current grade (AFG) was calculated for all 73 children who were >6 years old. Stepwise regression was used to examine the independent effect of ECD on school functioning after controlling for socioeconomic factors, maternal education, breast feeding, growth and cognitive functioning.
ECD correlated with age at starting school (r = 0.55, P = 0.0005) and remained a significant predictor even after controlling for family demographics, days of breast feeding, early growth and TONI-3 test of nonverbal intelligence. This was true despite significant correlations of ECD with growth shortfalls and impaired cognitive functioning. ECD also correlated with AFG (r = 0.38, P = 0.001). Only TONI-3 test scores explained this association, suggesting that ECD may hinder school performance, but only in part school readiness, by impairing cognitive function as measured by performance on the TONI-3 nonverbal intelligence test.
These findings document effects of early childhood diarrhea on later school readiness and performance and hence potential long-term human and economic costs of ECD, which warrant further attention and far greater investment for the control of ECD and its consequences.

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    • "Additional research suggests that by the age of 7 years, children suffering from multiple bouts of diarrhoea can lose up to 8.2 cm in height (Moore et al., 2001). Multiple studies identify the link between repeated episodes of diarrhoea and cognitive deficits, with a measured loss of up to 10 intelligence quotient points and 12 months of schooling by age 9 (Guerrant et al., 1999; Lorntz et al., 2006; Niehaus et al., 2002). Predominant brain myelination and synapse development occur in the first 2 years after birth (Corel, 1975; Rice & Barone, 2000; Thompson & Nelson, 2001). "
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    ABSTRACT: Diarrhoea remains the second leading cause of death in children under 5 years. Moreover, morbidity as a result of diarrhoea is high particularly in marginalised communities. Frequent bouts of diarrhoea have deleterious and irreversible effects on physical and cognitive development. Children are especially vulnerable given their inability to mount an active immune response to pathogen exposure. Biological limitations are exacerbated by the long-term effects of poverty, including reduced nutrition, poor hygiene and deprived home environments. Drawing from available literature, this paper uses syndemic theory to explore the role of adverse biosocial interactions in increasing the total disease burden of enteric infections in low-resources populations and assesses the limitations of recent global calls to action. The syndemic perspective describes situations in which adverse social conditions, including inequality, poverty and other forms of political and economic oppression, play a critical role in facilitating disease-disease interactions. Given the complex micro- and macro-nature of childhood diarrhoea, including interactions between pathogens, disease conditions and social environments, the syndemic perspective offers a way forward. While rarely the focus of health interventions, technologically advanced biomedical strategies are likely to be more effective if coupled with interventions that address the social conditions of disparity.
    Full-text · Article · Jul 2014 · Global Public Health
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    • "This limited access leads to 1.6 million deaths each year of children under 5 years old (WHO 2006). Repeated episodes of early childhood diarrhea (ECD) lead to serious problems such as stunting (Checkley et al. 2008), long-term cognitive deficits (Niehaus et al. 2002), and lower performance in school (Lorntz et al. 2006). It is therefore imperative that community coliform sources and growth mechanisms be assessed in developing world communities to inform the implementation of interventions aimed at alleviating this burden. "
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    ABSTRACT: Resource-limited communities throughout the developing world face significant environmental health problems related to the myriad of coliform sources within those communities. This study comprehensively investigated contamination sources and the biological and chemical mechanisms sustaining them in two adjacent communities in rural Limpopo, South Africa. An 8-month study was conducted of household (n = 14) and source water quality, measurements of biofilm layers on the inside of household water storage containers and water transfer devices, and also hand-based coliforms and hand-washing effectiveness. A 7-day water container incubation experiment was also performed to determine the biological and chemical changes that occur in a household water storage container independent of human interference. Results indicate that household drinking water frequently becomes contaminated after collection but before consumption (197 versus 1,046 colony-forming units/100 mL; n = 266; p < 0.001). The most important contamination sources include biofilm layers on the inside of storage containers (1.85 ± 1.59 colony-forming units/cm(2); n = 44), hands (5,097 ± 2,125 colony-forming units/hand; n = 48), and coliform regrowth resulting from high assimilable organic carbon (AOC) levels during storage. A maximum specific growth rate, μ max, of 0.072 ± 0.003 h(-1) was determined for total coliform bacteria on AOC, and a high correlation between AOC concentrations and the growth potential of total coliform bacteria was observed. These results support the implementation of point-of-use water treatment and other interventions aimed at maintaining the safe water chain and preventing biological regrowth.
    Full-text · Article · Sep 2013 · Journal of Environmental Engineering
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    • "Effects of intestinal flora on the brain and enteric nervous system are now being elucidated. Early childhood enteric disease and malnutrition have been linked with impaired cognitive development (Lorntz et al., 2006; Laus et al., 2011). The profound effect of childhood malnutrition and enteric disease on cognitive function ultimately affects individual productivity in life; moreover , stunting early in life may increase risk for later obesity and possibly other chronic diseases (Guerrant et al., 2008; Victora et al., 2008). "
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    ABSTRACT: Enteric infections and diarrheal diseases constitute pervasive health burdens throughout the world, with rates being highest at the two ends of life. During the first 2-3 years of life, much of the disease burden may be attributed to infection with enteric pathogens including Salmonella, rotavirus, and many other bacterial, viral, and protozoan organisms; however, infections due to Clostridium difficile exhibit steady increases with age. Still others, like Campylobacter infections in industrialized settings are high in early life (<2 years old) and increase again in early adulthood (called the "second weaning" by some). The reasons for these differences undoubtedly reside in part in pathogen differences; however, host factors including the commensal intestinal microbial communities, immune responses (innate and acquired), and age-dependant shifts likely play important roles. Interplay of these factors is illustrated by studies examining changes in human gut microbiota with inflammatory bowel disease and irritable bowel syndrome. Recent gut microbial surveys have indicated dramatic shifts in gut microbial population structure from infants to young adults to the elders. An understanding of the evolution of these factors and their interactions (e.g., how does gut microbiota modulate the "inflamm-aging" process or vice versa) through the human life "cycle" will be important in better addressing and controlling these enteric infections and their consequences for both quality and quantity of life (often assessed as disability adjusted life-years or "DALYs").
    Full-text · Article · Aug 2012 · Frontiers in Cellular and Infection Microbiology
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