Sociodemographic factors of Environmental Enteropathy among Egyptian infants and children; A Retrospective Case-Control Study.

Abstract

Background: There is substantial evidence that nutritional rehabilitation does not effectively resolve growth faltering in low- and middle-income countries, suggesting that environmental enteropathy (EE) may be a key underlying factor. EE is a chronic, subclinical condition associated with poor environmental conditions and limited resources in these regions. It is marked by pathological changes in the small intestine that impair the absorption of both macronutrients and micronutrients, ultimately contributing to growth faltering. Objective: To assess the sociodemographic factors underlying the EE among infants and children with faltering growth (FG) in our community. Patients and methods: This retrospective case control study enrolled 200 cases of primary faltering growth infants and children aged from 6 months to 5 years old after exclusion of secondary cases. Enrolled patients were divided into refractory cases and responsive cases to nutritional rehabilitation programs and sociodemographic factors were assessed among the 2 groups. No routine endoscopy was done nor existing histopathology findings were available. Results: The results of this study revealed that out of the 200 enrolled patients 170 responded to the tailored nutritional program (responsive controls), while 30 patients were considered as refractory cases. On comparing the two groups, there were significantly higher frequencies of housewife mothers, non-skilled manual worker fathers, rural and slum residency, and low socioeconomic status among the refractory cases with p-values of 0.024, 0.002, 0.022, and 0.045 respectively. Conclusion: Malnutrition is a complex condition with multifactorial causes, including socioeconomic factors besides the deficiencies in protein, energy, and essential micronutrients. In developing countries, EE is recognized as a significant contributor to the burden of malnutrition percolating their response to the nutritional rehabilitation program. Non-responders to nutritional rehabilitation program should be referred for endoscopy to confirm the diagnosis of EE.