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Water and Infants - Environmental Enteropathy


Image 1: Little girl waiting patiently for her mother to wrap up that day’s market goods (Kitoro, Kampala)
Source: Personal photo

 Take a moment to look at the little girl in the image above and closely examine the environment around her! I had passed by her mother’s stand en route to by some passion fruit in a nearby kiosk and this girl had been sitting outside the plastic container, crawling around the dirt ground to her heart’s delight. Right behind her is a small ditch that is filled with garbage and rainwater from the storms that had rolled in that morning. I’m not exactly sure what particular pathogens are in the ditch but I reckon it’s not sanitary and this toddler's clothes and body are definitely not clean. Fortunately, her mother had placed her in the carton pictured above by the time I’d returned to buy some mangos. But kids at this age always have their hands in their mouths - can you imagine what she’s been putting into her mouth for the duration of market day?

26% of children under the age of five living in resource poor nations are considered underweight. An even more worrisome figure is the percentage of children who die under the age of five due to malnutrition, which is currently at around 21%. The consequences of malnutrition during infancy and into childhood is well observed, but the symptoms of the environmental causes of malnutrition are not.

Unfortunately, not much research has been conducted on the impacts of WASH on an infant’s development, from cognitive and behavioral development to even the growth of sensorimotor complexes throughout childhood. Manifestations of stunting and wasting can be easily discerned in children and infants, but what are the underlying causes that the human eye cannot see? The human microbiome and gut health are very fickle in nature and any imbalances, especially as an infant, may lead to malabsorption of nutrients and chronic inflammation of the gut.

Image 2: Linkages between poor hygiene and childhood development

Environmental enteropathy, sometimes known as tropical enteropathy, is a condition caused by frequent oral exposure to fecal material. The internal intestinal villi become chronically inflamed due to constant exposure to fecal pathogens. At the molecular level, enteric T-cells become hyperstimulated and ultimately become ineffective when the villis have to defend the gut against environmental pathogens. When the structure of the gut changes, its function changes as well; an individual’s ability to uptake nutrients decreases significantly.

For infants and young children, exposure pathways vary across the board. For mobile infants, exposure may occur when the child plays on dirt floors contaminated with livestock and human feces. Infants not yet mobile may be exposed when given powdered formula, water, and fresh foods washed with contaminated water.  

Image result for environmental enteropathy
Image 3: Graphic highlighting intestinal inflammation due to environmental
pathogens such as contaminated fecal matter.

 When micronutrients such as iron, vitamin A, zinc, iodine, and calcium are not well absorbed due to chronic gut inflammation, infants begin to miss important milestones for their projected linear growth and cognitive development. Poor sanitary conditions, especially when it comes to clean water, are the most important risk factors for unwanted microbial ingestion.

In Ngure et al, researchers suggest several ways in which caretakers can guarantee optimal WASH conditions for their young. First, parents must boil all water for consumption, washing food and dishes, and for bathing. Additionally, infants must be secured in play mats or a protective play place away from any sources of fecal matter. Essentially, this is to provide a physical barrier between potential environmental pathogens and infants. I question how this may be feasible in rural, low-income villages especially where infants are tended to by their older siblings. I believe educating communities about the effects of environmental pathogens on infants and children is a sustainable approach to addressing malnutrition but at the end of the day, if there is no clean water, these efforts will be futile. That is why clean water is so important!


Comments

  1. TallulahNovember 28, 2018 at 2:59 PM

    Really interesting post! Quite shocking to learn about the severity of environmental enteropathy (a condition I previously was unaware of) but at the same time, according to the literature you linked to, how poorly understood it is. I also liked the personal story at the beginning and how you saw for yourself how these problems arise. I agree that education on this issue is incredibly important.

    ReplyDelete
    Replies
    1. UnknownDecember 4, 2018 at 4:01 PM

      Thanks for the comment! It's a definitely a huge problem that receives very little international attention so I think education is a good start.

      Delete

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