{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,8]],"date-time":"2026-09-08T00:46:05Z","timestamp":1788828365255,"version":"build-2803163510"},"reference-count":38,"publisher":"American Society of Tropical Medicine and Hygiene","issue":"6","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2018,12,5]]},"abstract":"<jats:p>Environmental enteric dysfunction (EED), a subclinical disorder of the small intestine, and poor growth are associated with living in poor water, sanitation, and hygiene (WASH) conditions, but specific risk factors remain unclear. Nested within a birth cohort study, this study investigates relationships among water quality, EED, and growth in 385 children living in southwestern Uganda. Water quality was assessed using a portable water quality test when children were 6 months, and safe water was defined as lacking <jats:italic>Escherichia coli<\/jats:italic> contamination. Environmental enteric dysfunction was assessed using the lactulose:mannitol (L:M) test at 12\u201316 months. Anthropometry and covariate data were extracted from the cohort study, and associations were assessed using linear and logistic regression models. Less than half of the households (43.8%) had safe water, and safe versus unsafe water did not correlate with improved versus unimproved water source. In adjusted linear regression models, children from households with safe water had significantly lower log-transformed (ln) L:M ratios (\u03b2: \u22120.22, 95% confidence interval (CI): \u22120.44, \u22120.00) and significantly higher length-for-age (\u03b2: 0.29, 95% CI: 0.00, 0.58) and weight-for-age (\u03b2: 0.20, 95% CI: 0.05, 0.34) <jats:italic>Z<\/jats:italic>-scores at 12\u201316 months. Furthermore, in adjusted linear regression models, ln L:M ratios at 12\u201316 months significantly decreased with increasing length-for-age <jats:italic>Z<\/jats:italic>-scores at birth, 6 months, and 9 months (\u03b2: \u22120.05, 95% CI: \u22120.10, \u22120.004; \u03b2: \u22120.06, 95% CI: \u22120.11, \u22120.006; and \u03b2: \u22120.05, 95% CI: \u22120.09, \u22120.005, respectively). Overall, our data suggest that programs seeking to improve nutrition should address poor WASH conditions simultaneously, particularly related to household drinking water quality.<\/jats:p>","DOI":"10.4269\/ajtmh.18-0143","type":"journal-article","created":{"date-parts":[[2018,10,23]],"date-time":"2018-10-23T07:01:00Z","timestamp":1540278060000},"page":"1606-1612","source":"Crossref","is-referenced-by-count":22,"title":["Unsafe Drinking Water Is Associated with Environmental Enteric Dysfunction and Poor Growth Outcomes in Young Children in Rural Southwestern Uganda"],"prefix":"10.4269","volume":"99","author":[{"given":"Jacqueline M.","family":"Lauer","sequence":"first","affiliation":[{"name":"Gerald J. and Dorothy R. Friedman School of Nutrition Science and Policy, Tufts University, Boston, Massachusetts;"},{"name":"United States Agency for International Development (USAID) Feed the Future Innovation Lab for Nutrition, Tufts University, Boston, Massachusetts;"},{"name":"Division of Gastroenterology, Hepatology and Nutrition, Boston Children\u2019s Hospital, Boston, Massachusetts;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher P.","family":"Duggan","sequence":"additional","affiliation":[{"name":"United States Agency for International Development (USAID) Feed the Future Innovation Lab for Nutrition, Tufts University, Boston, Massachusetts;"},{"name":"Division of Gastroenterology, Hepatology and Nutrition, Boston Children\u2019s Hospital, Boston, Massachusetts;"},{"name":"Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lynne M.","family":"Ausman","sequence":"additional","affiliation":[{"name":"Gerald J. and Dorothy R. Friedman School of Nutrition Science and Policy, Tufts University, Boston, Massachusetts;"},{"name":"United States Agency for International Development (USAID) Feed the Future Innovation Lab for Nutrition, Tufts University, Boston, Massachusetts;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeffrey K.","family":"Griffiths","sequence":"additional","affiliation":[{"name":"Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, Massachusetts;"},{"name":"Tufts University Cummings School of Veterinary Medicine, Tufts University School of Engineering, Medford, Massachusetts;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Patrick","family":"Webb","sequence":"additional","affiliation":[{"name":"Gerald J. and Dorothy R. Friedman School of Nutrition Science and Policy, Tufts University, Boston, Massachusetts;"},{"name":"United States Agency for International Development (USAID) Feed the Future Innovation Lab for Nutrition, Tufts University, Boston, Massachusetts;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bernard","family":"Bashaasha","sequence":"additional","affiliation":[{"name":"Department of Agribusiness and Natural Resource Economics, Makerere University, Kampala, Uganda;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Edgar","family":"Agaba","sequence":"additional","affiliation":[{"name":"United States Agency for International Development (USAID) Feed the Future Innovation Lab for Nutrition, Tufts University, Boston, Massachusetts;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Florence M.","family":"Turyashemererwa","sequence":"additional","affiliation":[{"name":"School of Food Technology and Nutrition, Makerere University, Kampala, Uganda"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shibani","family":"Ghosh","sequence":"additional","affiliation":[{"name":"Gerald J. and Dorothy R. Friedman School of Nutrition Science and Policy, Tufts University, Boston, Massachusetts;"},{"name":"United States Agency for International Development (USAID) Feed the Future Innovation Lab for Nutrition, Tufts University, Boston, Massachusetts;"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"2795","reference":[{"key":"b1","series-title":"Global Database on Child Growth and Malnutrition. Joint Child Malnutrition Estimates. 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