Prevalence of diarrheagenicEscherichia coliand impact on child health in Cap-Haitien, Haiti

Background Diarrheagenic Escherichia coli (DEC) are common pathogens infecting children during their growth and development. Determining the epidemiology and the impact of DEC on child anthropometric measures informs prioritization of prevention efforts. These relationships were evaluated in a novel setting, Cap-Haitien, Haiti. Methods A case-control study of children 6-36 months of age enrolled 99 cases with diarrhea and 96 asymptomatic controls. Assessments were performed at enrollment and one month follow-up. Established PCR methodologies targeted DEC using fecal swabs. The association between pathogens and anthropometric z-scores was determined using multiple linear regression. Results Enterotoxigenic Escherichia coli (ETEC) was identified in 21.9% of cases vs. 16.1% of controls with heat-stable producing ETEC significantly associated with symptomatic disease. Enteroaggregative E. coli (EAEC) was found in 30.2% of cases vs. 27.3% of controls, and typical enteropathogenic E. coli in 6.3% vs. 4.0% of cases and controls, respectively. Multivariate linear regression demonstrated ETEC and EAEC were significantly associated with reduced weight-age z-score (WAZ) and height-age z-score (HAZ) after adjusting for confounders. Conclusions DEC are prevalent in north Haitian children. ETEC, EAEC, household environment, and diet are associated with unfavorable anthropometric measures. Further studies may quantify the contribution of individual pathogens to adverse health outcomes. Author Summary Multiple factors contribute to poor child growth and development including infectious diarrhea, malnutrition, and water, sanitation, and hygiene infrastructure. Efforts to improve child development require prioritization based on their cost and expected benefits. This study contributes to prioritization efforts by determining the local burden of disease in an understudied region, Cap-Haitien, Haiti, and associating this burden with measures of child growth. Moreover, it captures data on social determinants contributing to child growth to control for confounding variables. Unlike prior studies in Haiti, we evaluated children with diarrheal disease in the community instead of the hospital setting. Ultimately, we showed that Enterotoxigenic Escherichia coli and Enteroaggregative E. coli are common and associated with surrogate measures of poor child growth. This result suggests that ETEC vaccination efforts may have a strong effect on improving child health. This work supports the continued investments in the development of ETEC vaccines.