{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T06:25:25Z","timestamp":1787034325892,"version":"build-2736575974"},"reference-count":44,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T00:00:00Z","timestamp":1787011200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Public Health"],"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Globally, diarrheal disease is the third leading cause of under-five child mortality. Early-life diarrhea may adversely affect neurodevelopment through nutrient loss, environmental enteropathy, and inflammation; however, longitudinal evidence remains limited. We investigate the relationship between watery diarrhea and neurocognitive development among children under 2\u202fyears old in rural Mirzapur, Bangladesh.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>In this prospective longitudinal study, 138 children aged &amp;lt;24\u202fmonths presenting with WD were enrolled. Neurodevelopment was assessed using the Bayley Scales of Infant and Toddler Development-4 at 2\u202fdays post-recovery and at 90\u202fdays follow-up. Associations between developmental scores (cognitive, language, motor) and diarrheal duration, severity, hospitalization, anthropometry, hygiene practices, home stimulation, and socioeconomic factors were examined using multivariable linear regression models.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The mean age of participants was 10.8\u202f\u00b1\u202f5.9\u202fmonths, and 60.9% were male. Median diarrheal duration was 176\u202fh (IQR: 120\u2013238). At baseline, mean (\u00b1SD) cognitive, language, and motor scores were 97.3\u202f\u00b1\u202f11.0, 97.9\u202f\u00b1\u202f11.5, and 103.8\u202f\u00b1\u202f11.5, respectively. In adjusted analyses, boys consistently demonstrated significantly higher language scores than girls. Children\u2019s age and greater home stimulation were significantly associated with higher cognitive and motor scores soon after recovery, with sustained effects for cognition and language at 90\u202fdays. Diarrheal duration &amp;gt;72\u202fh and lower height-for-age z-scores in Pediatrics were significantly associated with poorer language development, while hospitalization was associated with reduced motor scores shortly after recovery; however, these effects improved by 90\u202fdays. Improved handwashing practices were associated with higher language and motor scores at follow-up.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Watery diarrhea in early childhood was associated with short-term impairments in neurodevelopment, particularly in language and motor domains, with partial recovery by 90\u202fdays. Child sex and age, diarrheal duration, hospitalization, caregiving environment, and hygiene practices influenced recovery. Integrated interventions addressing both diarrhea and the post-diarrheal caregiving environment are essential to support early child development.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fpubh.2026.1835082","type":"journal-article","created":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T05:38:01Z","timestamp":1787031481000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Watery diarrhea in early childhood and neuro-cognitive development: longitudinal follow-up study in Bangladesh"],"prefix":"10.3389","volume":"14","author":[{"given":"Bharati Rani","family":"Roy","sequence":"first","affiliation":[{"name":"International Centre for Diarrheal Disease Research, Mohakhali","place":["Dhaka, Bangladesh"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohammad","family":"Ali","sequence":"additional","affiliation":[{"name":"International Centre for Diarrheal Disease Research, Mohakhali","place":["Dhaka, Bangladesh"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mahbub","family":"Elahi","sequence":"additional","affiliation":[{"name":"International Centre for Diarrheal Disease Research, Mohakhali","place":["Dhaka, Bangladesh"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dilara","family":"Begum","sequence":"additional","affiliation":[{"name":"International Centre for Diarrheal Disease Research, Mohakhali","place":["Dhaka, Bangladesh"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sampa","family":"Dash","sequence":"additional","affiliation":[{"name":"International Centre for Diarrheal Disease Research, Mohakhali","place":["Dhaka, Bangladesh"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eva","family":"Sultana","sequence":"additional","affiliation":[{"name":"International Centre for Diarrheal Disease Research, Mohakhali","place":["Dhaka, Bangladesh"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kaniz","family":"Fatima","sequence":"additional","affiliation":[{"name":"International Centre for Diarrheal Disease Research, Mohakhali","place":["Dhaka, Bangladesh"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shamim Al","family":"Mamun","sequence":"additional","affiliation":[{"name":"International Centre for Diarrheal Disease Research, Mohakhali","place":["Dhaka, Bangladesh"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Farina","family":"Naz","sequence":"additional","affiliation":[{"name":"International Centre for Diarrheal Disease Research, Mohakhali","place":["Dhaka, Bangladesh"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Malathi","family":"Ram","sequence":"additional","affiliation":[{"name":"Bloomberg School of Public Health, Johns Hopkins University","place":["Baltimore, MD, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tahmeed","family":"Ahmed","sequence":"additional","affiliation":[{"name":"International Centre for Diarrheal Disease Research, Mohakhali","place":["Dhaka, Bangladesh"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A. S. G.","family":"Faruque","sequence":"additional","affiliation":[{"name":"International Centre for Diarrheal Disease Research, Mohakhali","place":["Dhaka, Bangladesh"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Subhra","family":"Chakraborty","sequence":"additional","affiliation":[{"name":"Bloomberg School of Public Health, Johns Hopkins University","place":["Baltimore, MD, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fahmida","family":"Tofail","sequence":"additional","affiliation":[{"name":"International Centre for Diarrheal Disease Research, Mohakhali","place":["Dhaka, Bangladesh"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,8,18]]},"reference":[{"key":"ref1","volume-title":"Diarrhoeal Disease","year":"2024"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"e0275495","DOI":"10.1371\/journal.pone.0275495","article-title":"Prevalence and predictors of oral rehydration therapy, zinc, and other treatments for diarrhoea among children under-five in sub-Saharan Africa","volume":"17","author":"Ahinkorah","year":"2022","journal-title":"PLoS One"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"e16","DOI":"10.1016\/S2214-109X(23)00496-5","article-title":"Global, regional, and national causes of death in children and adolescents younger than 20 years: an open data portal with estimates for 2000\u201321","volume":"12","author":"Villavicencio","year":"2024","journal-title":"Lancet Glob Health"},{"key":"ref4","volume-title":"Diarrhoea: Diarrhoea Remains a Leading killer of young children, despite the Availability of a simple Treatment","year":"2024"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"04089","DOI":"10.7189\/jogh.13.04089","article-title":"Change in economic burden of diarrhoea in children under-five in Bangladesh: 2007 vs. 2018","volume":"13","author":"Sin","year":"2007","journal-title":"J Glob Health"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"590","DOI":"10.4269\/ajtmh.2002.66.590","article-title":"Early childhood diarrhea is associated with diminished cognitive function 4 to 7 years later in children in a northeast Brazilian shantytown","volume":"66","author":"Niehaus","year":"2002","journal-title":"American J Tropical Med Hygiene"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"1623064","DOI":"10.3389\/fnins.2025.1623064","article-title":"Predictors of neurodevelopment outcomes among children under 5 years old in Nairobi informal settlements","volume":"19","author":"Amboka","year":"2025","journal-title":"Front Neurosci"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"e683","DOI":"10.1093\/cid\/ciaa1938","article-title":"Diarrheal pathogens associated with growth and neurodevelopment","volume":"73","author":"Donowitz","year":"2021","journal-title":"Clin Infect Dis"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"487","DOI":"10.1111\/j.1753-4887.2008.00082.x","article-title":"Malnutrition as an enteric infectious disease with long-term effects on child development","volume":"66","author":"Guerrant","year":"2008","journal-title":"Nutr Rev"},{"key":"ref10","doi-asserted-by":"publisher","DOI":"10.1136\/bmjgh-2018-000752","article-title":"Early childhood cognitive development is affected by interactions among illness, diet, enteropathogens and the home environment: findings from the MAL-ED birth cohort study","volume":"3","author":"Acosta","year":"2018","journal-title":"BMJ Glob Health"},{"key":"ref11","doi-asserted-by":"publisher","DOI":"10.4269\/ajtmh.16-0150","article-title":"Early childhood diarrhea predicts cognitive delays in later childhood independently of malnutrition","volume":"95","author":"Pinkerton","year":"2016","journal-title":"Am J Trop Med Hyg"},{"key":"ref12","doi-asserted-by":"publisher","first-page":"233","DOI":"10.4269\/ajtmh.21-0767","article-title":"Diarrhea prevalence and child growth faltering are associated with subsequent adverse child developmental outcomes in Bangladesh (CHoBI7 program)","volume":"106","author":"George","year":"2021","journal-title":"American J Tropical Med Hygiene"},{"key":"ref13","doi-asserted-by":"publisher","first-page":"2233S","DOI":"10.1093\/jn\/125.suppl_8.2233S","article-title":"A review of studies of the effect of severe malnutrition on mental development","volume":"125","author":"Grantham-McGregor","year":"1995","journal-title":"J Nutr"},{"key":"ref14","doi-asserted-by":"publisher","first-page":"1555","DOI":"10.1093\/jn\/129.8.1555","article-title":"Severity and timing of stunting in the first two years of life affect performance on cognitive tests in late childhood","volume":"129","author":"Mendez","year":"1999","journal-title":"J Nutr"},{"key":"ref15","doi-asserted-by":"publisher","first-page":"890.5","DOI":"10.1096\/fasebj.31.1_supplement.890.5","article-title":"Intestinal dysbiosis during neonatal development alters the microbiota-gut-brain axis in adulthood","volume":"31","author":"Hennessey","year":"2017","journal-title":"FASEB J"},{"key":"ref16","doi-asserted-by":"publisher","first-page":"707","DOI":"10.4269\/ajtmh.1999.61.707","article-title":"Association of early childhood diarrhea and cryptosporidiosis with impaired physical fitness and cognitive function four-seven years later in a poor urban community in Northeast Brazil","volume":"61","author":"Guerrant","year":"1999","journal-title":"American J Tropical Med Hygiene"},{"key":"ref17","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1186\/1471-2431-14-50","article-title":"Febrile illness and pro-inflammatory cytokines are associated with lower neurodevelopmental scores in Bangladeshi infants living in poverty","volume":"14","author":"Jiang","year":"2014","journal-title":"BMC Pediatr"},{"key":"ref18","doi-asserted-by":"publisher","first-page":"60","DOI":"10.1016\/S0140-6736(07)60032-4","article-title":"Developmental potential in the first 5 years for children in developing countries","volume":"369","author":"Grantham-McGregor","year":"2007","journal-title":"Lancet"},{"key":"ref19","doi-asserted-by":"publisher","first-page":"794","DOI":"10.1016\/j.molmed.2018.06.008","article-title":"The impact of systemic inflammation on neurodevelopment","volume":"24","author":"Jiang","year":"2018","journal-title":"Trends Mol Med"},{"key":"ref20","doi-asserted-by":"publisher","first-page":"233","DOI":"10.1080\/092970490911252","article-title":"Limitations in verbal fluency following heavy burdens of early childhood diarrhea in Brazilian shantytown children","volume":"11","author":"Patrick","year":"2005","journal-title":"Child Neuropsychol"},{"key":"ref21","doi-asserted-by":"publisher","first-page":"e47908","DOI":"10.1371\/journal.pone.0047908","article-title":"Does childhood diarrhea influence cognition beyond the diarrhea-stunting pathway?","volume":"7","author":"Fischer Walker","year":"2012","journal-title":"PLoS One"},{"key":"ref22","doi-asserted-by":"publisher","first-page":"513","DOI":"10.1097\/01.inf.0000219524.64448.90","article-title":"Early childhood diarrhea predicts impaired school performance","volume":"25","author":"Lorntz","year":"2006","journal-title":"Pediatr Infect Dis J"},{"key":"ref23","doi-asserted-by":"publisher","first-page":"1677","DOI":"10.3390\/microorganisms12081677","article-title":"The impact of non-dysentery Shigella infection on the growth and health of children over time (INSIGHT)\u2014a prospective case\u2013control study protocol","volume":"12","author":"Chakraborty","year":"2024","journal-title":"Microorganisms"},{"key":"ref24","doi-asserted-by":"publisher","first-page":"23","DOI":"10.3329\/jhpn.v28i1.4520","article-title":"Use of family care indicators and their relationship with child development in Bangladesh","volume":"28","author":"Hamadani","year":"2010","journal-title":"J Health Popul Nutr"},{"key":"ref25","first-page":"241","volume-title":"Advances in Child Development and Behavior","author":"Bradley","year":"1994"},{"key":"ref26","doi-asserted-by":"publisher","first-page":"25","DOI":"10.1046\/j.1475-357X.2003.00073.x","article-title":"The home observation for measurement of the environment revisited","volume":"9","author":"Totsika","year":"2004","journal-title":"Child Adolesc Mental Health"},{"key":"ref27","volume-title":"Bayley Scales Of Infant and Toddler Development","author":"Balasundaram","year":"2025"},{"key":"ref28","doi-asserted-by":"publisher","first-page":"6783","DOI":"10.1016\/j.vaccine.2017.07.036","article-title":"Global burden of diarrheal diseases among children in developing countries: incidence, etiology, and insights from new molecular diagnostic techniques","volume":"35","author":"Kotloff","year":"2017","journal-title":"Vaccine"},{"key":"ref29","doi-asserted-by":"publisher","first-page":"295","DOI":"10.1179\/2046905514Y.0000000141","article-title":"Early childhood diarrhoeal diseases and cognition: are we missing the rest of the iceberg?","volume":"34","author":"MacIntyre","year":"2014","journal-title":"Paediatrics Int Child Health"},{"key":"ref30","doi-asserted-by":"publisher","first-page":"953","DOI":"10.1097\/MPG.0000000000001978","article-title":"Markers of environmental enteric dysfunction are associated with neurodevelopmental outcomes in Tanzanian children","volume":"66","author":"Etheredge","year":"2018","journal-title":"J Pediatr Gastroenterol Nutr"},{"key":"ref31","doi-asserted-by":"publisher","first-page":"129","DOI":"10.1111\/j.1740-8709.2011.00357.x","article-title":"Early child growth: how do nutrition and infection interact?","volume":"7","author":"Dewey","year":"2011","journal-title":"Matern Child Nutr"},{"key":"ref32","doi-asserted-by":"publisher","first-page":"1386","DOI":"10.3329\/brc.v10i1.70667","article-title":"Long-term developmental assessment of children recovered from hypernatremia","volume":"10","author":"Huq","year":"2024","journal-title":"Biores Commun"},{"key":"ref33","doi-asserted-by":"publisher","first-page":"e0121743","DOI":"10.1371\/journal.pone.0121743","article-title":"Diarrhea, stimulation and growth predict neurodevelopment in young north Indian children","volume":"10","author":"Kvestad","year":"2015","journal-title":"PLoS One"},{"key":"ref34","doi-asserted-by":"publisher","first-page":"e0278618","DOI":"10.1371\/journal.pone.0278618","article-title":"Associations between early childhood poverty and cognitive functioning throughout childhood and adolescence: a 14-year prospective longitudinal analysis of the Mauritius child health project","volume":"18","author":"Strau\u00df","year":"2023","journal-title":"PLoS One"},{"key":"ref35","doi-asserted-by":"publisher","first-page":"202","DOI":"10.1186\/1471-2458-8-202","article-title":"Determinants of cognitive function in childhood: a cohort study in a middle-income context","volume":"8","author":"Santos","year":"2008","journal-title":"BMC Public Health"},{"key":"ref36","doi-asserted-by":"publisher","first-page":"652","DOI":"10.1186\/s12889-016-3288-2","article-title":"Adaptation and standardization of a Western tool for assessing child development in a non-Western low-income context","volume":"16","author":"Abessa","year":"2016","journal-title":"BMC Public Health"},{"key":"ref37","doi-asserted-by":"publisher","first-page":"1083","DOI":"10.1186\/s12889-021-11147-3","article-title":"Developmental trends in early childhood and their predictors from an Indian birth cohort","volume":"21","author":"Koshy","year":"2021","journal-title":"BMC Public Health"},{"key":"ref38","doi-asserted-by":"publisher","first-page":"8318","DOI":"10.3390\/ijerph19148318","article-title":"Gender differences in fundamental motor skills proficiency in children aged 3\u20136 years: a systematic review and meta-analysis","volume":"19","author":"Zheng","year":"2022","journal-title":"Int J Environ Res Public Health"},{"key":"ref39","doi-asserted-by":"publisher","first-page":"984","DOI":"10.1037\/a0023819","article-title":"Gender differences in cognitive development","volume":"47","author":"Ardila","year":"2011","journal-title":"Dev Psychol"},{"key":"ref40","doi-asserted-by":"publisher","first-page":"713","DOI":"10.1353\/sof.2001.0102","article-title":"Gender differences in mathematical trajectories","volume":"80","author":"Leahey","year":"2001","journal-title":"Soc Forces"},{"key":"ref41","doi-asserted-by":"publisher","first-page":"145","DOI":"10.1016\/S0140-6736(07)60076-2","article-title":"Child development: risk factors for adverse outcomes in developing countries","volume":"369","author":"Walker","year":"2007","journal-title":"Lancet (London, England)"},{"key":"ref42","doi-asserted-by":"publisher","first-page":"77","DOI":"10.1016\/S0140-6736(16)31389-7","article-title":"Early childhood development coming of age: science through the life course","volume":"389","author":"Black","year":"2017","journal-title":"Lancet"},{"key":"ref43","volume-title":"Nutritional Management of acute Diarrhea in Infants and children","year":"1985"},{"key":"ref44","doi-asserted-by":"publisher","first-page":"1006","DOI":"10.18203\/2349-3291.ijcp20222759","article-title":"Dyselectrolytemia in under-five children with acute diarrhoea-induced dehydration: a cross-sectional study in a south-east Nigerian hospital","volume":"9","author":"Ezuruike","year":"2022","journal-title":"Int J Contemp Pediatr"}],"container-title":["Frontiers in Public Health"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2026.1835082\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T05:38:03Z","timestamp":1787031483000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2026.1835082\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,18]]},"references-count":44,"alternative-id":["10.3389\/fpubh.2026.1835082"],"URL":"https:\/\/doi.org\/10.3389\/fpubh.2026.1835082","relation":{},"ISSN":["2296-2565"],"issn-type":[{"value":"2296-2565","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,18]]},"article-number":"1835082"}}