***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: OBJECTIVE To characterise childhood mouthing behaviours and to investigate the association between object-to-mouth and food-to-mouth contacts , diarrhoea prevalence and environmental enteropathy . METHODS A prospect i ve cohort study was conducted of 216 children ≤30 months of age in rural Bangladesh . Mouthing contacts with soil and food and objects with visible soil were assessed by 5-h structured observation . Stool was analysed for four faecal markers of intestinal inflammation : alpha-1-antitrypsin , myeloperoxidase , neopterin and calprotectin . RESULTS Overall 82 % of children were observed mouthing soil , objects with visible soil , or food with visible soil during the structured observation period . Sixty two percent of children were observed mouthing objects with visible soil , 63 % were observed mouthing food with visible soil , and 18 % were observed mouthing soil only . Children observed mouthing objects with visible soil had significantly elevated faecal calprotectin concentrations ( 206.81 μg/g , 95 % confidence interval [ CI ] : 6.27 , 407.36 ) . There was also a marginally significant association between Escherichia coli counts in soil from a child 's play space and the prevalence rate of diarrhoea ( diarrhoea prevalence ratio : 2.03 , 95 % CI 0.97 , 4.25 ) . CONCLUSION These findings provide further evidence to support the hypothesis that childhood mouthing behaviour in environments with faecal contamination can lead to environmental enteropathy in susceptible paediatric population s. Furthermore , these findings suggest that young children mouthing objects with soil , which occurred more frequently than soil directly ( 60 % vs. 18 % ) , was an important exposure route to faecal pathogens and a risk factor for environmental enteropathy BACKGROUND Oral poliovirus vaccine is less immunogenic and effective in low-income countries than in high-income countries , similarly to other oral vaccines . The high prevalence of intestinal pathogens and associated environmental enteropathy has been proposed to explain this problem . Because administration of an antibiotic has the potential to resolve environmental enteropathy and clear bacterial pathogens , we aim ed to assess whether antibiotics would improve oral poliovirus vaccine immunogenicity . METHODS We did a double-blind , r and omised , placebo-controlled trial of the effect of azithromycin on the immunogenicity of serotype-3 monovalent oral poliovirus vaccine given to healthy infants living in 14 blocks of Vellore district , India . Infants were eligible to participate if they were 6 - 11 months old , available for the study duration , and lacked serum neutralising antibodies to serotype-3 poliovirus . Infants were r and omly assigned ( 1:1 ) at enrolment to receive oral 10 mg/kg azithromycin or placebo once daily for 3 days , followed by serotype-3 monovalent oral poliovirus vaccine on day 14 . The primary outcome was detection of serum neutralising antibodies to serotype-3 poliovirus at a dilution of one in eight or more on day 35 and was assessed in the per- protocol population ( ie , all those who received azithromycin or placebo , oral poliovirus vaccine , and provided a blood sample according to the study protocol ) . Safety outcomes were assessed in all infants enrolled in the study . The trial is registered with the Clinical Trials Registry India , number CTRI/2014/05/004588 . FINDINGS Between Aug 5 , 2014 , and March 21 , 2015 , 754 infants were r and omly assigned : 376 to receive azithromycin and 378 to placebo . Of these , 348 ( 93 % ) of 376 in the azithromycin group and 357 ( 94 % ) of 378 infants in the placebo group completed the study per protocol . In the azithromycin group , 175 ( 50 % ) seroconverted to serotype-3 poliovirus compared with 192 ( 54 % ) in the placebo group ( risk ratio 0·94 , 95 % CI 0·81 - 1·08 ; p=0·366 ) . Azithromycin  reduced faecal biomarkers of environmental enteropathy ( calprotectin , myeloperoxidase , α1-antitrypsin ) and the prevalence of bacterial but not viral or eukaryotic pathogens . Viral pathogens were associated with lower seroconversion . Three serious adverse events were reported ( two in the azithromycin group and one in the placebo group ) , but none was considered related to the study interventions . INTERPRETATION Azithromycin did not improve the immunogenicity of oral poliovirus vaccine despite reducing biomarkers of environmental enteropathy and the prevalence of pathogenic intestinal bacteria . Viral interference and innate antiviral immune mechanisms might be more important determinants of the immunogenicity of live-virus oral vaccines . FUNDING Bill & Melinda Gates Foundation Objectives : Environmental enteric dysfunction ( EED ) may inhibit growth and development in low- and middle-income countries , but available assessment method ologies limit its study . In rural Bangladesh , we measured EED using the widely used lactulose mannitol ratio ( L : M ) test and a panel of intestinal and systemic health biomarkers to evaluate convergence among biomarkers and describe risk factors for EED . Methods : In 539 18-month-old children finishing participation in a r and omized food supplementation trial , serum , stool , and urine collected after lactulose and mannitol dosing  were analyzed for biomarkers of intestinal absorption , inflammation , permeability and repair , and systemic inflammation . EED scores for each participant were developed using principal component analysis and partial least squares regression . Associations between scores and L : M and with child sociodemographic and health characteristics were evaluated using regression analysis . Results : EED prevalence ( L : M > 0.07 ) was 39.0 % ; 60 % had elevated acute phase proteins ( C-reactive protein > 5 mg/L or & agr;-1 acid glycoprotein > 100 mg/dL ) . Correlations between intestinal biomarkers were low , with the highest between myeloperoxidase and & agr;-1 antitrypsin ( r = 0.33 , P < 0.01 ) , and biomarker values did not differ by supplementation history . A 1-factor partial least squares model with L : M as the dependent variable explained only 8.6 % of L : M variability . In adjusted models , L : M was associated with child sex and socioeconomic status index , whereas systemic inflammation was predicted mainly by recent illness , not EED . Conclusions : Impaired intestinal health is widespread in this setting of prevalent stunting , but a panel of serum and stool biomarkers demonstrated poor agreement with L : M. Etiologies of intestinal and systemic inflammation are likely numerous and complex in re source -poor setting s , underscoring the need for a better case definition with corresponding diagnostic methods to further the study of EED BACKGROUND The effect of helminth infestation on the nutrition , growth , and physiology of the host is still poorly understood . Anthelmintic treatment of children in developing countries has had varying success in terms of growth improvements . OBJECTIVE The objective of this study was to assess the effect of regular deworming on child growth , physiology , and biochemical status . DESIGN The study was a 12-mo longitudinal intervention in 123 Bangladeshi children aged 2 - 5 y. Treatment ( mebendazole ) or placebo tablets were administered every 2 mo for 8 mo and again at 12 mo . Weight , height , midupper arm circumference , intestinal permeability , plasma albumin , alpha(1)-antichymotrypsin , and total protein concentration were assessed every 2 mo . RESULTS Treatment with mebendazole reduced the prevalence of Ascaris lumbricoides from 78 % to 8 % , of Trichuris trichiura from 65 % to 9 % , and of hookworm from 4 % to 0 % . There was no significant difference in the growth of treated children compared with those given placebo tablets . No changes in intestinal permeability or plasma albumin were observed after deworming . Significant decreases in total protein ( P<0.001 ) and alpha(1)-antichymotrypsin ( P<0.001 ) were observed in the treatment group , indicating possible reductions in inflammation and immunoglobulin concentration after deworming . A significant increase in the prevalence of Giardia intestinalis ( from 4 % to 49 % ) in the treatment group was associated with a short-term reduction in weight ( P = 0.02 ) and higher intestinal permeability ( P < 0.001 ) in infected subjects . No long-term effects of G. intestinalis on growth were observed . CONCLUSION Low-intensity helminth infections , predominantly of A. lumbricoides and T. trichiura , do not contribute significantly to the poor growth and biochemical status of rural Bangladeshi children Background Environmental enteric dysfunction ( EED ) is an acquired syndrome of impaired gastrointestinal mucosal barrier function that is thought to play a key role in the pathogenesis of stunting in early life . It has been conceptualized as an adaptive response to excess environmental pathogen exposure . However , it is clinical ly similar to other inflammatory enteropathies , which result from both host and environmental triggers , and for which immunomodulation is a cornerstone of therapy . Methods In this pilot double-blind r and omized placebo-controlled trial , 44 children with severe acute malnutrition and evidence of EED were assigned to treatment with mesalazine or placebo for 28 days during nutritional rehabilitation . Primary outcomes were safety and acceptability of the intervention . Results Treatment with mesalazine was safe : there was no excess of adverse events , evidence of deterioration in intestinal barrier integrity or impact on nutritional recovery . There were modest reductions in several inflammatory markers with mesalazine compared to placebo . Depression of the growth hormone - insulin-like growth factor-1 axis was evident at enrollment and associated with inflammatory activation . Increases in the former and decreases in the latter correlated with linear growth . Conclusions Intestinal inflammation in EED is non-essential for mucosal homeostasis and is at least partly maladaptive . Further trials of gut-specific immunomodulatory therapies targeting host inflammatory activation in order to optimize the growth benefits of nutritional rehabilitation and to address stunting are warranted . Funded by The Wellcome Trust . Trial registration Registered at Clinical trials.gov NCT01841099 BACKGROUND & AIMS Environmental enteropathy ( EE ) is a sub clinical condition among children in the developing world , characterized by T-cell infiltration of the small-bowel mucosa and diffuse villous atrophy . EE leads to macronutrient and micronutrient malabsorption and stunting , with a result ant increased risk for infection and reduced cognitive development . We tested the hypothesis that zinc and albendazole treatments would reduce the severity of EE in rural African children . METHODS In a r and omized , double-blind , placebo-controlled trial in rural southern Malawi , asymptomatic children , 1 to 3 years old and at high risk for EE , received either a single dose of albendazole , a 14-day course of 20 mg zinc sulfate , or a placebo . Subjects were given the dual-sugar absorption test , and the ratio of lactulose to mannitol ( L : M ) in urine was used to determine the severity of EE at baseline and 34 days after completion of the assigned regimen . The primary outcome was the change in the L : M. RESULTS A complete set of urine sample s was obtained from 222 of 234 children enrolled and analyzed . The mean baseline L : M was 0.32 ± 0.18 among all children and did not differ among groups ( normal L : M range , < 0.12 ) . At the end of the study , the L : M ratio had increased more in the placebo group ( 0.12 ± 0.31 ) than in the zinc group ( 0.03 ± 0.20 ; P < .03 ) or the albendazole group ( 0.04 ± 0.22 ; P < .04 ) . CONCLUSIONS Treatment with zinc or albendazole protects against a significant increase in the L : M ratio , a biomarker for EE , in asymptomatic rural Malawian children . These findings could provide insight into the etiology and pathogenesis of EE . Clinical trials.gov Number : NCT01440608 Objective : Environmental enteric dysfunction ( EED ) can be assessed by the lactulose : mannitol ( L : M ) test . Our objective was to determine if selected host fecal transcripts were correlated with EED , and whether transcripts and clinical characteristics could be used to predict EED in rural African children . Methods : Demographic and sanitation characteristics , along with L : M testing and host fecal transcript analyses from 798 asymptomatic Malawian children aged 12 to 61 months were compared with linear growth over the subsequent 3 months . Fecal host m 
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RESULTS There was little evidence to support the pathway from intestinal permeability to microbial translocation and from microbial translocation to stunting , but stronger support existed for the link between intestinal inflammation and systemic inflammation and for intestinal inflammation and stunting .
There was conflicting evidence for the pathways from intestinal damage to intestinal permeability and intestinal damage to stunting .