{ "abstract": "Undernutrition in children is a major global health issue. Diarrhea exacerbates undernutrition, creating a vicious cycle of infection and malnutrition. This longitudinal study examined growth patterns and influencing factors among 138 children following diarrhea. Children under two seeking care for watery diarrhea at a rural hospital in Bangladesh were enrolled and followed for three months of home-based visits. Anthropometric measurements—length-for-age z-score (LAZ), weight-for-age z-score (WAZ), weight-for-length z-score (WLZ), and mid-upper arm circumference (MUAC) were taken at enrollment and follow-ups. Linear mixed-effects models assessed associations of clinical, sociodemographic, sanitation, hygiene, and food security factors with growth outcomes. Overall, LAZ declined over three months (-0.260, SD: 0.408), while WAZ, WLZ, and MUAC improved (0.100, SD: 0.484; 0.249, SD: 0.725; 0.672 cm, SD: 0.476). Children with malnutrition at enrollment strongly predicted persistent malnutrition (LAZ < -2, WAZ < -2, WLZ < -2, MUAC < 12.5 cm) during follow-up compared to new incidence of malnutrition (RR: 3.8, p < 0.001, 95% CI: 1.80, 6.35). Poor growth outcomes were linked to longer diarrhea duration, more vomiting, and hospitalization. Hospitalization was associated with declines in LAZ (-0.095, p = 0.009) and MUAC (-0.098, p = 0.030). Children aged 7–12 months had greater declines in WAZ (-0.109, p = 0.096) and WLZ (-0.181, p = 0.113). Improved sanitation and hygiene supported growth, while household hunger was linked to declines. This study highlights the multifactorial nature of post-diarrhea growth outcomes and emphasizes the need for integrated interventions addressing clinical care, sanitation, hygiene, and food security. Author summary: Diarrheal diseases remain a major cause of illness among young children in low- and middle-income countries and can contribute to poor growth and undernutrition. While many children recover quickly after diarrhea, others experience lasting nutritional consequences that may affect their health and development. Understanding which children are most vulnerable to growth faltering after a diarrheal episode could help guide interventions and improve recovery. We followed children under two years of age in rural Bangladesh for three months after they sought care for acute watery diarrhea. We examined how clinical characteristics, nutritional status, household conditions, food security, sanitation, and hygiene practices were associated with changes in growth after illness. We found that children who were already malnourished at the time of diarrhea were more likely to remain malnourished during follow-up. Several other factors, including longer diarrhea duration, vomiting, hospitalization, household hunger, and poor sanitation and hygiene conditions, were also associated with poorer growth outcomes. Our findings suggest that preventing growth faltering after diarrhea requires more than treating the acute illness. Interventions that address nutrition, food security, and household environmental conditions may help improve recovery and support healthy child growth in vulnerable populations.", "abstract_shown": true, "affiliations": [ "Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America", "International Centre for Diarrhoeal Disease Research, Bangladesh, icddr, b, Dhaka, Bangladesh", "Kumudini Women’s Medical College and Hospital, Mirzapur, Tangail, Bangladesh" ], "article_type": "Research Article", "arxiv": null, "author_total": 16, "authors": [ { "affs": [ 0 ], "name": "Jade Lewis" }, { "affs": [ 1 ], "name": "Yiyi Zhou" }, { "affs": [ 2 ], "name": "Jamie Perin" }, { "name": "Sampa Dash" }, { "name": "Mohammad Ali" }, { "name": "Malathi Ram" }, { "name": "Farina Naz" }, { "name": "Eva Sultana" }, { "name": "Bharati Roy" }, { "name": "A. B. M. Ali Hasan" }, { "name": "Farzana Ali Afroze" }, { "name": "David A. Sack" }, { "name": "Fahmida Tofail" }, { "name": "Tahmeed Ahmed" }, { "name": "A. S. G. Faruque" }, { "name": "Subhra Chakraborty" } ], "bibtex": "https://research.draconitic.com/paper/bxdak1by0d8ay.bib", "cited_by": 0, "doi": "10.1371/journal.pntd.0014699", "fulltext_url": "https://journals.plos.org/plosntds/article?id=10.1371/journal.pntd.0014699", "id": "bxdak1by0d8ay", "issns": [ "1935-2735" ], "landing_url": "https://journals.plos.org/plosntds/article?id=10.1371/journal.pntd.0014699", "language": null, "licence": "CC-BY-4.0", "licence_label": "CC BY 4.0", "licence_source": "journal", "licence_url": "https://creativecommons.org/licenses/by/4.0/", "metadata_licence": null, "native_subjects": [ [ "plos", "/Biology and life sciences/Nutrition" ], [ "plos", "/Biology and life sciences/Nutrition/Diet/Food" ], [ "plos", "/Biology and life sciences/Nutrition/Malnutrition" ], [ "plos", "/Medicine and health sciences/Clinical medicine/Signs and symptoms/Diarrhea" ], [ "plos", "/Medicine and health sciences/Epidemiology/Medical risk factors" ], [ "plos", "/Medicine and health sciences/Gastroenterology and hepatology/Diarrhea" ], [ "plos", "/Medicine and health sciences/Health care/Environmental health/Sanitation" ], [ "plos", "/Medicine and health sciences/Nutrition" ], [ "plos", "/Medicine and health sciences/Nutrition/Diet/Food" ], [ "plos", "/Medicine and health sciences/Nutrition/Malnutrition" ], [ "plos", "/Medicine and health sciences/Public and occupational health/Environmental health/Sanitation" ], [ "plos", "/Medicine and health sciences/Public and occupational health/Hygiene" ], [ "plos", "/People and places/Population groupings/Age groups/Children" ], [ "plos", "/People and places/Population groupings/Families/Children" ] ], "openalex": null, "pdf_url": "https://journals.plos.org/plosntds/article/file?id=10.1371/journal.pntd.0014699&type=printable", "pmcid": null, "pmid": null, "published": "2026-11-05", "publisher": "Public Library of Science", "ris": "https://research.draconitic.com/paper/bxdak1by0d8ay.ris", "sources": [ { "first_seen": "2026-11-06T12:20:42Z", "native_id": "10.1371/journal.pntd.0014699", "source": "plos", "url": "https://journals.plos.org/plosntds/article?id=10.1371/journal.pntd.0014699" } ], "subjects": [ { "field": "medicine", "origin": "plos:epidemiology", "subfield": "epidemiology-public-health" }, { "field": "medicine", "origin": "plos:nutrition", "subfield": "nutrition" } ], "title": "Factors influencing post-diarrhea growth patterns among children under two years old in rural Bangladesh", "title_text": "Factors influencing post-diarrhea growth patterns among children under two years old in rural Bangladesh", "type": "peer-reviewed", "updated_at": "2026-11-07T12:20:24Z", "url": "https://research.draconitic.com/paper/bxdak1by0d8ay", "venue": "PLOS Neglected Tropical Diseases", "versions": [] }