Association Between Biomarkers of Environmental Enteric Dysfunction and Early Child Development Amongst Infants in Rural Central Java, Indonesia

Environmental enteric dysfunction (EED) may be associated with poor cognitive and overall early child development (ECD) independent of linear growth. This may serve as an opportunity to improve ECD with water, sanitation, and hygiene (WASH) interventions. This study aimed to measure the association between EED and ECD amongst 119 infants aged 11–24 months from five villages in rural Wonosobo, Indonesia. Data collection at baseline (September–October 2024) and follow-up (February–March 2025) involved a quantitative questionnaire, anthropometric measurements, measurement of three EED stool biomarkers, alpha-1-antitrypsin (AAT), neopterin (NEO), and myeloperoxidase (MPO), and assessment of ECD using the Caregiver Reported Early Development Instruments (CREDI) z-scores for the cognitive and overall category performed at follow-up. Linear regression modelled the association between EED biomarkers and CREDI cognitive and overall z-score. The associations between MPO and ECD were generally weak and insignificant. MPO above the 75th percentile at baseline was associated with lower cognitive z-score (β = −0.63, 95% CI = −0.99 to −0.26, p < 0.001) but, at follow-up, was associated with higher cognitive z-score (β = 0.41, 95% CI = 0.03 to 0.79, p < 0.05). Associations between AAT and NEO with cognitive and development z-scores were not statistically significant. These findings show that the relationships between EED and early child development are complex and weakly explained by these biomarkers.