The effect of microbial exposure and environmental enteric dysfunction on child growth – evaluation of a combined nutrition and food hygiene intervention in Bangladesh

• Applicants: Professorin Dr. Sabine Gabrysch; Professor Dr. Georg Zeller
• Subject Area: Epidemiology and Medical Biometry/Statistics ; Parasitology and Biology of Tropical Infectious Disease Pathogens ; Public Health, Healthcare Research, Social and Occupational Medicine
• Term: from 2018 to 2024
• Project identifier: Deutsche Forschungsgemeinschaft (DFG) - Project number 413269709

• Final Report Year: 2024

Final Report Abstract

Poor hygiene practices and inadequate diets can contribute to environmental enteric dysfunction (EED) and undernutrition in young children. The aim of the "Food Hygiene to reduce Environmental Enteric Dysfunction" (FHEED) study was to evaluate the impact of a combined nutrition and food hygiene intervention on development of EED in young children, with the ultimate goal to improve child growth. The FHEED study was embedded within the "Food and Agricultural Approaches to Reducing Malnutrition" (FAARM) cluster-randomized trial in Sylhet, Bangladesh which enrolled 2,705 married women and their children younger than 3 years of age in 96 settlements. The intervention clearly improved food hygiene knowledge and practice among caregivers. However, some hygiene behaviors were still seldom practiced, simultaneous practice of several behaviors was rare and behaviors were inconsistently practiced over time. Consequently, the intervention showed no impact on contamination of complementary foods. We also found no intervention effect on diarrhea prevalence, enteropathogen burden, biomarkers of EED, or intestinal microbiota composition. The intervention thus improved caregiver’s food hygiene practices, but this did not result in an improvement of child health outcomes. Independent of intervention allocation, we found that infection with certain enteropathogens was associated with elevated EED biomarkers, and that certain enteropathogens and EED biomarkers were associated with poor child growth outcomes. Elevated EED biomarker levels were also associated with certain changes in the gut microbiome: an increased abundance of species associated with infection and inflammation and a decreased abundance of beneficial species. We did not observe any associations between microbiota composition/maturation and child growth outcomes.

Publications

• FOOD2030 Congress, Poster presentation, Title: "Safe and Nutritious Food: Ideal Family! - A Behavior Change Intervention to Improve Optimal Feeding and Food Hygiene", Stuttgart-Hohenheim, September
  Anna Müller
  
• Agriculture, Nutrition & Health Academy Week, Oral presentation, Title: “Safe and Nutritious Food: Ideal Family! Improving food hygiene behaviors in Bangladesh through emotional drivers”, Hyderabad, India, June
  Tarique Huda
  
• Hidden Hunger Congress, Poster presentation, Title: „Safe and Nutritious Food: Ideal Family! - Improving food hygiene behaviours through emotional drivers”, Stuttgart- Hohenheim, March
  Anna Müller
  
• Agriculture, Nutrition & Health Academy Week, Poster presentation, Title: „Improving food hygiene behaviors: Findings from a behavior change intervention in rural Bangladesh”, online, June
  Shafinaz Sobhan
  
• American Society for Nutrition, NUTRITION 2021 Conference, Poster presentation, Title: „Key Food Hygiene Behaviors to Reduce Microbial Food Contamination in Rural Bangladesh”, online, June
  Anna Müller-Hauser
  
• Design, delivery, and determinants of uptake: findings from a food hygiene behavior change intervention in rural Bangladesh. BMC Public Health, 22(1).
  Sobhan, Shafinaz; Müller-Hauser, Anna A.; Huda, Tarique Md. Nurul; Waid, Jillian L.; Gautam, Om Prasad; Gon, Giorgia; Wendt, Amanda S. & Gabrysch, Sabine
  
• Key Food Hygiene Behaviors to Reduce Microbial Contamination of Complementary Foods in Rural Bangladesh. The American Journal of Tropical Medicine and Hygiene, 107(3), 709-719.
  Müller-Hauser, Anna A.; Sobhan, Shafinaz; Huda, Tarique Md. Nurul; Waid, Jillian L.; Wendt, Amanda S.; Islam, Mohammad Aminul; Rahman, Mahbubur & Gabrysch, Sabine
  
• Effect of a Homestead Food Production and Food Hygiene Intervention on Biomarkers of Environmental Enteric Dysfunction in Children Younger Than 24 Months in Rural Bangladesh: A Cluster-Randomized Controlled Trial. The American Journal of Tropical Medicine and Hygiene, 109(5), 1166-1176.
  Müller-Hauser, Anna A.; Huda, Tarique Md. Nurul; Sobhan, Shafinaz; Lambrecht, Nathalie J.; Waid, Jillian L.; Wendt, Amanda S.; Ali, Shahjahan; Rahman, Mahbubur & Gabrysch, Sabine
  
• Effect of a Homestead Food Production Program on the Prevalence of Diarrhea and Acute Respiratory Infection in Children in Sylhet, Bangladesh: A Cluster-Randomized Controlled Trial. The American Journal of Tropical Medicine and Hygiene, 109(4), 945-956.
  Lambrecht, Nathalie J.; Müller-Hauser, Anna A.; Sobhan, Shafinaz; Schmidt, Wolf-Peter; Huda, Tarique Md. Nurul; Waid, Jillian L.; Wendt, Amanda S.; Kader, Abdul & Gabrysch, Sabine
  
• Effect of a behaviour change intervention on household food hygiene practices in rural Bangladesh: A cluster-randomised controlled trial. International Journal of Hygiene and Environmental Health, 255, 114291.
  Sobhan, Shafinaz; Müller-Hauser, Anna A.; Gon, Giorgia; Nurul, Huda Tarique Md.; Waid, Jillian L.; Wendt, Amanda S.; Rahman, Mahbubur & Gabrysch, Sabine