ArticleTropical medicine & international health : TM & IH2025
Associations of poor water, sanitation, and hygiene and parasite burden with markers of environmental enteric dysfunction in preschool-age children infected with Schistosoma mansoni in Uganda.
Article in Tropical medicine & international health : TM & IH, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 3 papers, 2 of them syntheses that pooled it.
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3 citing papers in PubMed, 2 syntheses or guidelines pooled it.
- Enteric infections and childhood stunting: a systematic review and meta-analysis across four pathogen domains.Pediatric research · 2026Pooled it
- Pooled it
- Schistosoma mansoni Infections Are Associated With Fecal Calprotectin Markers of Gut Inflammation After Accounting for HIV, Hepatitis B, and Malaria.The Journal of infectious diseases · 2026Article
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10 authors.
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Abstract
backgroundEnvironmental enteric dysfunction (EED) is an acquired subclinical condition of the small intestine with lasting health implications for nutritional status, linear growth and development among children. EED is characterised by structural and functional changes to the gut barrier. There are no standardised diagnostic criteria, however, a number of biomarkers have been evaluated to capture EED domains. While the causes of EED are not fully understood, risk factors include poor water, sanitation and hygiene conditions and exposure to enteric pathogens. Very few studies have evaluated the impact of schistosomiasis on EED despite repeated intestinal damage from parasite eggs passing across the gut barrier.
methodsIn a cohort of 354 preschool-aged children aged 12-47 months with Schistosoma mansoni infection recruited from the Lake Albert region of Uganda, we assessed exposure to water, sanitation and hygiene conditions and measured markers from each EED domain: intestinal inflammation (faecal calprotectin), epithelial damage (serum intestinal fatty-acid binding-protein), increased permeability (urine lactulose to mannitol ratio and faecal alpha-1 antitrypsin) and microbial translocation (serum endotoxin core antibody).
resultsIn multivariable linear regression models, we found that children whose drinking water was sourced from Lake Albert had higher concentrations of intestinal fatty-acid binding-protein (β = 0.48, 95% CI 0.20-0.76, p < 0.001), and lack of toilet/latrine access was associated with higher concentrations of calprotectin (β = 0.48, 95% CI 0.18-0.78, p < 0.01). Higher schistosomiasis intensity (eggs per gram of stool) was associated with higher calprotectin (β = 0.10, 95% CI 0.02-0.17, p = 0.01), but not with other EED markers.
conclusionsFew studies have investigated schistosomiasis-related morbidities in very young children infected with schistosomiasis. Our findings from Uganda show that poor water, sanitation and hygiene conditions and heavier schistosomiasis burden are associated with intestinal inflammation and damage, contributing to EED. Improved treatment coverage for preschool-aged children infected with schistosomiasis may reduce the burden from EED and associated long-term morbidities.
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