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September 8, 2026Tropical Medicine and Infectious DiseaseOpen Access

Elevated Levels of Environmental Enteric Dysfunction Biomarkers Among Rural Indonesian Infants: Associations with Water, Sanitation, Hygiene and Linear Growth

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Authors

CLCallum LoweTAT. ArjunaMHMubasyir Hasanbasri

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Overview

Longitudinal study reveals high gut inflammation biomarker rates linked to sanitation exposures in rural infants, indicating complex, bidirectional associations with linear growth.

Key Points

  • To investigate the burden of environmental enteric dysfunction (EED) and evaluate its associations with water, sanitation, hygiene (WASH) exposures, and infant linear growth.
  • Conducted a longitudinal study of 119 infants aged 5–19 months across five villages in Wonosobo District, Central Java, Indonesia.
  • Assessed infant anthropometry and collected stool samples at baseline and 5-month follow-up to measure alpha-1-antitrypsin (AAT), neopterin (NEO), and myeloperoxidase (MPO) levels.
  • Applied linear mixed-effects regression models to examine associations between WASH variables, height-for-age z-scores (HAZ), and log-transformed EED biomarkers.
  • At follow-up, elevated biomarker levels were observed in 68.7% of infants for AAT, 79.0% for NEO, and 71.4% for MPO.
  • Higher AAT was associated with playing on soiled surfaces >30 minutes daily (β = 0.11, p < 0.05), while NEO was elevated with diarrhea (β = 1.04, p < 0.05), municipal water (β = 0.71, p < 0.05), and mouthing soiled fomites weekly (β = 0.55, p < 0.05).
  • Stunted infants at baseline had lower follow-up AAT (β = -0.39, p < 0.05) than infants at risk of stunting, baseline HAZ was positively associated with follow-up NEO (β = 0.36, p < 0.05), and follow-up MPO was higher in infants with HAZ > -1 (β = 0.59, p < 0.05).

Cite This Study

Lowe et al. (2026) studied this question.

synapsesocial.com/papers/6a9fd70a58e84d0ff5b4589fhttps://doi.org/10.3390/tropicalmed11090251
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Also Consider

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