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This is a common illness in low and middle-income countries. However, environmental enteric dysfunction evidence is limited in Ethiopia. Accordingly, this study was conducted to measure fecal biomarkers of environmental enteric dysfunction and associated factors among children aged 24\u201359\u00a0months in rural northwest Ethiopia.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Methods<\/jats:title>\n                <jats:p>A community-based cross-sectional study was employed among 235 randomly selected children in a\u00a0rural setting of the east Dembiya district. Stool samples were collected without fixative and analyzed for fecal biomarkers of environmental enteric dysfunction (Alpha-1-antitrypsin, neopterin, and myeloperoxidase) using commercial enzyme-linked immunosorbent assay kits and analyzed for intestinal parasites using wet mount and Kato-Katz techniques. Child behaviors related with exposure to enteropathogens, condition of the living environment and socio-demographic information were collected using interviewer-administered questionnaire and structure observation. We fitted multivariable linear regression model to assess the association between environmental factors and concentration of fecal biomarkers of environmental enteric dysfunction in the stool. Statistically significant associations were declared based on adjusted betas with the corresponding 95% confidence interval and <jats:italic>p<\/jats:italic>-value\u2009&lt;\u20090.05.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>The median concentration of fecal markers of environmental enteric dysfunction was 350\u00a0\u03bcg\/ml for Alpha-1-antitrypsin, 3320.2\u00a0ng\/ml for myeloperoxidase, and 1562\u00a0nmol\/l for neopterin. The median concentration of Alpha-1-antitrypsin among 161 (68.5%), myeloperoxidase among 168 (71.5%), and neopterin among 188 (80%) of the stool samples were above the normal values in non-tropical settings. Moreover, 100 (42.6%) of the children had high EED disease activity score (above the median score). The elevated concentrations of fecal biomarkers of gut inflammation and the\u00a0high EED disease activity score were significantly associated with open defecation practice, mouthing of soil contaminated materials, <jats:italic>Escherichia coli\u00a0(E. coli)\u00a0<\/jats:italic> contamination of drinking water, <jats:italic>E. coli<\/jats:italic> contamination of foods, <jats:italic>E. coli<\/jats:italic> contamination of soil, and intestinal parasites.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusion<\/jats:title>\n                <jats:p>Overall, Alpha-1-antitrypsin, myeloperoxidase, and neopterin levels among the children in the studied region were highly elevated in comparison to populations in high-income countries. Moreover, the EED disease activity score in significant proportion of children was high, suggesting widespread intestinal inflammation and increased intestinal permeability. Extensive <jats:italic>E. coli<\/jats:italic> contamination of the living environment (drinking water, ready-to-eat foods, and courtyard soil), hygiene and sanitation behaviors (such as open defecation and mouthing of soil contaminated materials), and a high burden of intestinal parasites were identified as factors associated with the\u00a0elevated concentration of fecal biomarkers of environmental enteric dysfunction. Parental care to children to avoid mouthing of soil contaminated materials and other risky behaviors that increase exposure enteric infections, and protecting the living environment (water, food and soil) from fecal contamination are important.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1186\/s12876-022-02255-4","type":"journal-article","created":{"date-parts":[[2022,4,8]],"date-time":"2022-04-08T14:05:14Z","timestamp":1649426714000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["Fecal biomarkers of environmental enteric dysfunction and associated factors among children aged 24\u201359 months in east Dembiya district, northwest Ethiopia"],"prefix":"10.1186","volume":"22","author":[{"given":"Zemichael","family":"Gizaw","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alemayehu Worku","family":"Yalew","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bikes Destaw","family":"Bitew","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jiyoung","family":"Lee","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Bisesi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2022,4,8]]},"reference":[{"issue":"1_suppl1","key":"2255_CR1","doi-asserted-by":"publisher","first-page":"S76","DOI":"10.1177\/15648265150361S113","volume":"36","author":"RJ Crane","year":"2015","unstructured":"Crane RJ, Jones KD, Berkley JA. 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There were no risks due to participation and the collected data were used only for this research purpose with complete confidentiality. Written informed consent was obtained from mothers or care givers. All the methods were carried out in accordance with relevant guidelines and regulations. We advised mothers or care givers to take the children with diarrhea, intestinal parasites, and elevated concentration of fecal biomarkers of gut inflammation to health facilities for treatment or management.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"This manuscript does not contain any individual person\u2019s data.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare that there is no conflict of interest or financial disclosure about this publication.","order":5,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interest"}}],"article-number":"172"}}