Assessment of environmental enteric dysfunction (eed) in Healthy and undernourished children-a crosstalk between eed and stunting

Undernutrition affects 20% of children under five in the developing world. Stunting is a prevalent form of undernutrition. Global prevalence of stunting in 2019 was 21.4%, while current Tanzania national average is 34%. Ruvuma is one of the regions with highest prevalence of stunting (44%) in Tanzania. This dissertation involved studies on factors responsible for the high prevalence of stunting in Ruvuma and their association with environmental enteric dysfunction (EED) in children. The study included randomly and conveniently sampled children below 5 years of age between April 2019 – January 2020 who attended outpatient clinics at hospitals in Ruvuma. Among children in the cross-sectional survey, 46% were females and 45.6% were stunted, while the case-control study had 42% females, 78% stunted cases, and EED prevalence of 57%. Through bivariate analysis, stunting was associated with gender (χ2 = 6.6759, df = 1, p = 0.009772), hand washing before food (χ2 = 5.1213, df = 1, p = 0.02363), location of hospital (χ2 = 3.851, df = 1, p = 0.04972) and use of Municipal garbage collection system (χ2 = 3.6814, df = 1, p = 0.05502). Moreover, diarrhea was associated with toilet sharing (χ2 = 5.4703, df = 1, p = 0.002), use of household’s toilet (χ2 = 4.0224, df = 1, p = 0.004) and rinsing child feces into toilet (χ2 = 3.6814, df = 1, p < 0.01). Multivariate logistic regression analyses showed that, stunting risk increased with male gender (OR (95%CI) = 1.7945 (1.1944 –2.712), age (OR (95%CI) = 1.3122 (1.1484 –1.507), and decreased with hand washing before meal (OR (95%CI) = 0.5403 (0.3042 –0.940). Finally, diarrhea risk increased with toilet sharing (OR (95%CI) = 2.154 (1.153 –3.953) and decreased with child’s use of toilet (OR (95%CI) = 0.510 (0.259 –0.945). Our study generally revealed important factors that determined observed high prevalence of stunting in Ruvuma. These factors can be modified through health interventions to reduce the observed high prevalence. Nevertheless, the association between EED and stunting is undeniable and needs further assessment in a bigger study.