A pilot study using hospital surveillance and a birth cohort to investigate enteric pathogens and malnutrition in children, Dili, Timor-Leste

Danielle M Cribb; Nevio Sarmento; Almerio Moniz; Nicholas S S Fancourt; Kathryn Glass; Anthony D K Draper; Joshua R Francis; Milena M Lay Dos Santos; Endang Soares da Silva; Benjamin G Polkinghorne; Virginia de Lourdes da Conceiҫão; Feliciano da Conceiҫão; Paulino da Silva; Joanita Jong; Martyn D Kirk; Samantha Colquhoun

doi:10.1371/journal.pone.0296774

A pilot study using hospital surveillance and a birth cohort to investigate enteric pathogens and malnutrition in children, Dili, Timor-Leste

PLoS One. 2024 Feb 1;19(2):e0296774. doi: 10.1371/journal.pone.0296774. eCollection 2024.

Authors

Danielle M Cribb¹, Nevio Sarmento^{2

3}, Almerio Moniz¹, Nicholas S S Fancourt², Kathryn Glass¹, Anthony D K Draper^{1

2

4}, Joshua R Francis², Milena M Lay Dos Santos³, Endang Soares da Silva³, Benjamin G Polkinghorne¹, Virginia de Lourdes da Conceiҫão^{2

3}, Feliciano da Conceiҫão⁵, Paulino da Silva², Joanita Jong⁵, Martyn D Kirk¹, Samantha Colquhoun¹

Affiliations

¹ National Centre for Epidemiology and Population Health, Australian National University, Canberra, Australian Capital Territory, Australia.
² Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia.
³ Timor-Leste Ministry of Health, Dili, Timor-Leste.
⁴ Northern Territory Centre for Disease Control, Northern Territory Government Department of Health, Darwin, Northern Territory, Australia.
⁵ Ministry of Agriculture and Fisheries, Dili, Timor-Leste.

Abstract

In low-to-middle-income countries (LMICs), enteric pathogens contribute to child malnutrition, affecting nutrient absorption, inducing inflammation, and causing diarrhoea. This is a substantial problem in LMICs due to high disease burden, poor sanitation and nutritional status, and the cyclical nature of pathogen infection and malnutrition. This relationship remains understudied in Timor-Leste. In our pilot study of enteric pathogens and malnutrition in Dili, Timor-Leste (July 2019-October 2020), we recruited 60 infants in a birth cohort from Hospital Nacional Guido Valadares (HNGV) with up to four home visits. We collected faecal samples and details of demographics, anthropometrics, diet and food practices, and animal husbandry. Additionally, we collected faecal samples, diagnostics, and anthropometrics from 160 children admitted to HNGV with a clinical diagnosis of severe diarrhoea or severe acute malnutrition (SAM). We tested faeces using the BioFire® FilmArray® Gastrointestinal Panel. We detected high prevalence of enteric pathogens in 68.8% (95%CI 60.4-76.2%) of infants at home, 88.6% of SAM cases (95%CI 81.7-93.3%) and 93.8% of severe diarrhoea cases (95%CI 67.7-99.7%). Diarrhoeagenic Escherichia coli and Campylobacter spp. were most frequently detected. Pathogen presence did not significantly differ in birth cohort diarrhoeal stool, but hospital data indicated associations between Salmonella and Shigella and diarrhoea. We observed wasting in 18.4% (95%CI 9.2-32.5%) to 30.8% (95%CI 17.5-47.7%) of infants across home visits, 57.9% (95%CI 34.0-78.9%) of severe diarrhoea cases, and 92.5% (95%CI 86.4-96.2%) of SAM cases. We associated bottle feeding with increased odds of pathogen detection when compared with exclusive breastfeeding at home (OR 8.3, 95%CI 1.1-62.7). We detected high prevalence of enteric pathogens and signs of malnutrition in children in Dili. Our pilot is proof of concept for a study to fully explore the risk factors and associations between enteric pathogens and malnutrition in Timor-Leste.

Copyright: © 2024 Cribb et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

MeSH terms

Animals
Birth Cohort
Child
Child Nutrition Disorders* / complications
Child Nutrition Disorders* / epidemiology
Diarrhea / epidemiology
Diarrhea / etiology
Female
Hospitals
Humans
Infant
Malnutrition* / complications
Malnutrition* / epidemiology
Pilot Projects
Severe Acute Malnutrition* / complications
Timor-Leste / epidemiology

Grants and funding

This study was funded by the Australian Centre for International Agricultural Research (project number LS/2018/184v1). DMC is funded by an Australian Government Research Training Program (AGRTP) Scholarship. MDK is supported by a National Health and Medical Research Council fellowship (GNT1145997). The funder (ACIAR) did not have a role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.