Enteric infections and childhood stunting: a systematic review and meta-analysis across four pathogen domains.

Abstract

Background: Enteric infections have been implicated in childhood growth faltering, but the relative contribution of major enteric pathogen domains to stunting remains unclear.

Methods: MEDLINE (via PubMed), Embase, Scopus, and Web of Science were systematically searched from inception to July 2026 for observational studies evaluating laboratory-confirmed enteric infections and childhood stunting. Random-effects meta-analyses were performed to estimate pooled odds ratios (ORs) and 95% confidence intervals (CIs). Pre-specified subgroup analyses and meta-regression were conducted to investigate potential sources of heterogeneity. Risk of bias was assessed using the Newcastle-Ottawa Scale, and certainty of evidence was evaluated using the GRADE approach.

Results: Nineteen studies were included in the qualitative synthesis, of which 14 independent studies contributed to the quantitative meta-analysis. Overall, enteric infections were associated with significantly increased odds of childhood stunting (OR 1.94, 95% CI 1.33-2.82), although substantial between-study heterogeneity was observed (I² = 85.6%). Pathogen-specific subgroup analyses showed comparable associations across bacterial, viral, protozoal, helminthic, and non-specific parasitic infections, with no significant differences between pathogen domains. Meta-regression identified participant age and adjustment status as significant sources of between-study heterogeneity.

Conclusion: Enteric infections were associated with increased odds of childhood stunting, although the certainty of the evidence was very low.

Impact: Enteric infections were associated with significantly increased odds of childhood stunting among children living in low- and middle-income countries. Associations were strongest among children younger than two years, highlighting the vulnerability of the first 1000 days of life. Although pooled effect estimates varied across pathogen domains, no statistically significant differences were observed between pathogen groups, suggesting that multiple enteric infections may contribute to impaired child growth through shared biological pathways. These findings support integrating infection prevention, sanitation, and nutritional interventions into child stunting reduction programs.