Mouthing of Soil Contaminated Objects is Associated with Environmental Enteropathy in Young Children

Tomohiko Morita, Jamie Perin, Lauren Oldja, Shwapon Biswas, R. Bradley Sack, Shahnawaz Ahmed, Rashidul Haque, Nurul Amin Bhuiyan, Tahmina Parvin, Sazzadul Islam Bhuyian, Mahmuda Akter, Kaisar A. Talukder, Mohammad Shahnaij, Abu G. Faruque, Christine Marie George

Research output: Contribution to journalArticlepeer-review

21 Scopus citations


Objective: To characterise childhood mouthing behaviours and to investigate the association between object-to-mouth and food-to-mouth contacts, diarrhoea prevalence and environmental enteropathy. Methods: A prospective cohort study was conducted of 216 children ≤30 months of age in rural Bangladesh. Mouthing contacts with soil and food and objects with visible soil were assessed by 5-h structured observation. Stool was analysed for four faecal markers of intestinal inflammation: alpha-1-antitrypsin, myeloperoxidase, neopterin and calprotectin. Results: Overall 82% of children were observed mouthing soil, objects with visible soil, or food with visible soil during the structured observation period. Sixty two percent of children were observed mouthing objects with visible soil, 63% were observed mouthing food with visible soil, and 18% were observed mouthing soil only. Children observed mouthing objects with visible soil had significantly elevated faecal calprotectin concentrations (206.81 μg/g, 95% confidence interval [CI]: 6.27, 407.36). There was also a marginally significant association between Escherichia coli counts in soil from a child's play space and the prevalence rate of diarrhoea (diarrhoea prevalence ratio: 2.03, 95% CI 0.97, 4.25). Conclusion: These findings provide further evidence to support the hypothesis that childhood mouthing behaviour in environments with faecal contamination can lead to environmental enteropathy in susceptible paediatric populations. Furthermore, these findings suggest that young children mouthing objects with soil, which occurred more frequently than soil directly (60% vs. 18%), was an important exposure route to faecal pathogens and a risk factor for environmental enteropathy.

Original languageEnglish (US)
Pages (from-to)670-678
Number of pages9
JournalTropical Medicine and International Health
Issue number6
StatePublished - Jun 2017


  • child behaviour
  • diarrhoea
  • environmental enteropathy
  • environmental exposure
  • mouthing
  • non-dietary ingestion

ASJC Scopus subject areas

  • Parasitology
  • Public Health, Environmental and Occupational Health
  • Infectious Diseases


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