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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
Anna A. Müller-Hauser
Anna A. Müller-Hauser
Charité–Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of Public Health, Berlin, Germany;
Research Department 2, Potsdam Institute for Climate Impact Research, (PIK), Member of the Leibniz Association, Potsdam, Germany;
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Research Department 2, Potsdam Institute for Climate Impact Research, (PIK), Member of the Leibniz Association, Potsdam, Germany;
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Tarique Md. Nurul Huda
Tarique Md. Nurul Huda
Department of Public Health, College of Public Health and Health Informatics, Qassim University, Al Bukairiyah, Saudi Arabia;
Environmental Interventions Unit, Infectious Diseases Division, icddr,b, Dhaka, Bangladesh;
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Environmental Interventions Unit, Infectious Diseases Division, icddr,b, Dhaka, Bangladesh;
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Shafinaz Sobhan
Shafinaz Sobhan
Charité–Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of Public Health, Berlin, Germany;
Research Department 2, Potsdam Institute for Climate Impact Research, (PIK), Member of the Leibniz Association, Potsdam, Germany;
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Research Department 2, Potsdam Institute for Climate Impact Research, (PIK), Member of the Leibniz Association, Potsdam, Germany;
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Nathalie J. Lambrecht
Nathalie J. Lambrecht
Charité–Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of Public Health, Berlin, Germany;
Research Department 2, Potsdam Institute for Climate Impact Research, (PIK), Member of the Leibniz Association, Potsdam, Germany;
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Research Department 2, Potsdam Institute for Climate Impact Research, (PIK), Member of the Leibniz Association, Potsdam, Germany;
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Jillian L. Waid
Jillian L. Waid
Research Department 2, Potsdam Institute for Climate Impact Research, (PIK), Member of the Leibniz Association, Potsdam, Germany;
Heidelberg Institute of Global Health, Heidelberg University, Heidelberg, Germany;
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Heidelberg Institute of Global Health, Heidelberg University, Heidelberg, Germany;
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Amanda S. Wendt
Amanda S. Wendt
Research Department 2, Potsdam Institute for Climate Impact Research, (PIK), Member of the Leibniz Association, Potsdam, Germany;
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Shahjahan Ali
Shahjahan Ali
Infectious Diseases Division, icddr,b, Dhaka, Bangladesh;
Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, Colorado
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Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, Colorado
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Mahbubur Rahman
Mahbubur Rahman
Environmental Interventions Unit, Infectious Diseases Division, icddr,b, Dhaka, Bangladesh;
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Sabine Gabrysch
Sabine Gabrysch
Charité–Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of Public Health, Berlin, Germany;
Research Department 2, Potsdam Institute for Climate Impact Research, (PIK), Member of the Leibniz Association, Potsdam, Germany;
Heidelberg Institute of Global Health, Heidelberg University, Heidelberg, Germany;
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Research Department 2, Potsdam Institute for Climate Impact Research, (PIK), Member of the Leibniz Association, Potsdam, Germany;
Heidelberg Institute of Global Health, Heidelberg University, Heidelberg, Germany;
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ABSTRACT.
Poor sanitation and hygiene practices and inadequate diets can contribute to environmental enteric dysfunction (EED). We evaluated the impact of a combined homestead food production and food hygiene intervention on EED biomarkers in young children in rural Bangladesh. The analysis was conducted within the Food and Agricultural Approaches to Reducing Malnutrition (FAARM) cluster-randomized trial in Sylhet, Bangladesh. The FAARM trial enrolled 2,705 married women and their children younger than 3 years of age in 96 settlements (geographic clusters): 48 intervention and 48 control. The 3-year intervention (2015–2018) included training on gardening, poultry rearing, and improved nutrition practices and was supplemented by an 8-month food hygiene behavior change component, implemented from mid-2017. We analyzed data on 574 children age 0 to 24 months with multilevel linear regression. We assessed fecal myeloperoxidase (MPO), neopterin (NEO), and alpha-1-antitrypsin (AAT) as biomarkers of EED, and serum C-reactive protein (CRP) and alpha-1-acid glycoprotein (AGP) as biomarkers of systemic inflammation, using ELISA. There was no intervention effect on NEO, AAT, CRP, and AGP concentrations, but, surprisingly, MPO levels were increased in children of the intervention group (0.11 log ng/mL; 95% CI, 0.001–0.22). This increase was greater with increasing child age and among intervention households with poultry that were not kept in a shed. A combined homestead food production and food hygiene intervention did not decrease EED in children in our study setting. Small-scale poultry rearing promoted by the intervention might be a risk factor for EED.
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Author Notes
Financial support: The German Federal Ministry of Education and Research is the primary funder for the
Disclosure: The FAARM trial protocol was positively reviewed by Heidelberg University in Germany (Ref. S‐121/2014) and the James P. Grant School of Public Health, BRAC University in Bangladesh (Ref. 37A). The FHEED study protocol was positively reviewed by Heidelberg University (Ref. S‐606/2017) and icddr,b in Bangladesh (Ref. PR‐17126). All participants provided informed written consent by signature or thumbprint.
Authors‘ addresses: Anna A. Müller-Hauser, Shafinaz Sobhan, and Nathalie J. Lambrecht, Charité–Universitätsmedizin Berlin, Institute of Public Health, Berlin, Germany, and Research Department 2, Potsdam Institute for Climate Impact Research, Potsdam, Germany, E-mails: anna.mueller-hauser@charite.de, shafinaz.sobhan@charite.de, and nathalie.lambrecht@charite.de. Tarique Md. Nurul Huda, Department of Public Health, College of Public Health and Health Informatics, Qassim University, Al Bukairiyah, Saudi Arabia, and Environmental Interventions Unit, Infectious Diseases Division, icddr,b, Dhaka, Bangladesh, E-mail: t.huda@qu.edu.sa. Jillian L. Waid, Research Department 2, Potsdam Institute for Climate Impact Research, Potsdam, Germany, and Heidelberg Institute of Global Health, Heidelberg University, Heidelberg, Germany, E-mail: waid@pik-potsdam.de. Amanda S. Wendt, Research Department 2, Potsdam Institute for Climate Impact Research, Potsdam, Germany, E-mail: wendt@pik-potsdam.de. Shahjahan Ali, Infectious Diseases Division, icddr,b, Dhaka, Bangladesh, and Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, E-mail: shahjahanjohny@gmail.com. Mahbubur Rahman, Environmental Interventions Unit, Infectious Diseases Division, icddr,b, Dhaka, Bangladesh, E-mail: mahbubr@icddrb.org. Sabine Gabrysch, Charité–Universitätsmedizin Berlin, Institute of Public Health, Berlin, Germany, Research Department 2, Potsdam Institute for Climate Impact Research, Potsdam, Germany, and Heidelberg Institute of Global Health, Heidelberg University, Heidelberg, Germany, E-mail: sabine.gabrysch@pik-potsdam.de.
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1.
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14.
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18.
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