Antibiotics alone probably cannot overcome the complex factors that cause stunting and perpetuate the cycle of poverty in the developing world, new research suggests.
An international team of researchers – including some from the University of Virginia School of Medicine – had hoped that a combination of antibiotics, vitamin B3, and a medicine to treat diarrhea would lead to better growth in children in the African country of Tanzania. But a randomized, double-blind study of nearly 1,200 children found no benefit – half of the children were still stunted.
This was a disappointing result in an attempt to resolve a crisis plaguing much of the world. But the researchers say the lessons from their work will help focus future efforts in more productive directions.
“We know that the majority of these children carry intestinal pathogens in their gut,” said researcher Dr. Mark DeBoer of UVA Children’s and UVA Child Health Research Center. “But the intervention with periodic antimicrobials did not improve their growth. It seems that a much more holistic approach is needed.
The new study represents a collaboration of researchers from the UVA School of Medicine and Virginia Commonwealth University with colleagues in Tanzania, the United Kingdom and Norway. The scientists wanted to measure the effect of antimicrobials and vitamin supplementation in combating stunted growth, a condition often accompanied by impaired cognitive development and decreased academic performance. These disadvantages then limit the employment opportunities and income potential of children, thus perpetuating the cycle of poverty.
Researchers followed 1,188 mother-child pairs in rural Haydom, Tanzania, from when children were no more than two weeks old until 18 months old. The children were randomly selected to receive the antibiotic azithromycin and the antiparasitic drug nitazoxanide and / or niacin, a form of vitamin B3.
The researchers hoped that vitamin supplementation might help, as the diet in Tanzania relies heavily on maize. Nitazoxanide and azithromycin, on the other hand, can be used to treat diarrhea by targeting the parasites and bacteria that cause it.
Neither approach worked. In a new scientific paper outlining their findings, the researchers suggest that their interventions may not have sufficiently reduced the pathogens that cause diarrhea, that reducing pathogens may not improve growth, or that the interventions were overwhelmed by other complex health issues in the region.
“A more comprehensive set of interventions is needed,” the researchers write, suggesting “potentially providing macronutrient supplementation such as ready-to-eat therapeutic foods in addition to improved hygiene and targeted antimicrobial approaches.”
“Globally, there are over 100 million children left whose infections and poor nutrition lead to stunted growth and suboptimal brain development,” DeBoer said. “We hope that the international community will continue its efforts to find out how these children can overcome their environmental challenges and thrive. “
The researchers have published their findings in the scientific journal PLOS Medicine. The research team consisted of DeBoer, James A. Platts-Mills, Sarah E. Elwood, Rebecca J. Scharf, Joann M. McDermid, Anne W. Wanjuhi, Samwel Jatosh, Siphael Katengu, Tarina C. Parpia, Elizabeth T Rogawski McQuade, Jean Gratz, Erling Svensen, Jonathan R. Swann, Jeffrey R. Donowitz, Paschal Mdoe, Sokoine Kivuyo, Eric R. Houpt and Estomih Mduma.
The study was funded by the Bill & Melinda Gates Foundation, grant OPP1141342.
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