Factors influencing post-diarrhea growth patterns among children under two years old in rural Bangladesh
- 1Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
- 2International Centre for Diarrhoeal Disease Research, Bangladesh, icddr, b, Dhaka, Bangladesh
- 3Kumudini Women’s Medical College and Hospital, Mirzapur, Tangail, Bangladesh
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.
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BibTeX
@article{lewis2026factors,
title = {{Factors influencing post-diarrhea growth patterns among children under two years old in rural Bangladesh}},
author = {Jade Lewis and Yiyi Zhou and Jamie Perin and Sampa Dash and Mohammad Ali and Malathi Ram and Farina Naz and Eva Sultana and Bharati Roy and A. B. M. Ali Hasan and Farzana Ali Afroze and David A. Sack and Fahmida Tofail and Tahmeed Ahmed and A. S. G. Faruque and Subhra Chakraborty},
journal = {PLOS Neglected Tropical Diseases},
year = {2026},
month = nov,
doi = {10.1371/journal.pntd.0014699},
url = {https://journals.plos.org/plosntds/article?id=10.1371/journal.pntd.0014699},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Factors influencing post-diarrhea growth patterns among children under two years old in rural Bangladesh
AU - Jade Lewis
AU - Yiyi Zhou
AU - Jamie Perin
AU - Sampa Dash
AU - Mohammad Ali
AU - Malathi Ram
AU - Farina Naz
AU - Eva Sultana
AU - Bharati Roy
AU - A. B. M. Ali Hasan
AU - Farzana Ali Afroze
AU - David A. Sack
AU - Fahmida Tofail
AU - Tahmeed Ahmed
AU - A. S. G. Faruque
AU - Subhra Chakraborty
PY - 2026
DA - 2026/11/05
JO - PLOS Neglected Tropical Diseases
DO - 10.1371/journal.pntd.0014699
UR - https://journals.plos.org/plosntds/article?id=10.1371/journal.pntd.0014699
AB - 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.
SN - 1935-2735
ER -