Child Mouthing of Soil and Contaminated Fomites and Unimproved Sanitation are Associated with Subsequent Poor Child Developmental Outcomes in Urban Bangladesh (CHoBI7 Program).

Objective To evaluate the relationship between mouthing of soil and living in unsanitary conditions and child neurodevelopment in urban Bangladesh. Study design This prospective cohort study of 224-children under 5-years was conducted in urban Dhaka, Bangladesh. Developmental outcomes were assessed by communication, fine motor, gross motor, personal social, problem solving, and combined developmental scores measured by the Extended Ages and Stages Questionnaire(EASQ) at a 12-month follow-up visit. Results Children who put soil in their mouth at the majority of surveillance visits had significantly lower combined EASQ Z scores (coefficient: -0.53 (95% Confidence Intervals (CI): -0.83, -0.22)) at the 12-month follow-up visit. Children who put visibly dirty objects in their mouths at the majority of visits had significantly lower combined EASQ Z scores(-0.50 (95% CI: -0.79, -0.22)). Children in households with unimproved sanitation had significantly lower combined EASQ Z scores(-0.63 (95% CI: -1.11, -0.16)). Conclusion Children found to put soil and visibly dirty objects in their mouths at the majority of household visits, and those that resided in households using unimproved sanitation, had lower subsequent cognitive developmental outcomes. These findings demonstrate the importance of interventions targeting child mouthing behaviors and sanitation infrastructure to reduce exposure to fecal pathogens and improve child cognitive developmental outcomes.