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Clin Infect Dis. 2014 Nov 1;59 Suppl 4:S239-47. doi: 10.1093/cid/ciu457.

Assessment of environmental enteropathy in the MAL-ED cohort study: theoretical and analytic framework.

Author information

1
Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland Asociación Benéfica PRISMA, Iquitos, Peru.
2
Center for Global Health, University of Virginia, Charlottesville.
3
Christian Medical College, Vellore, Tamil Nadu, India.
4
Department of Pediatrics and Child Health, Aga Khan University, Karachi, Pakistan.
5
Foundation of the National Institutes of Health.
6
Foundation of the National Institutes of Health Fogarty International Center, National Institutes of Health, Bethesda, Maryland.
7
Center for Vaccine Sciences, iccdr,b, Dhaka, Bangladesh.
8
Walter Reed/Armed Forces Research Institute of Medical Sciences Research Unit, Bangkok, Thailand.
9
Federal University of Ceará, Fortaleza, Brazil.
10
Fogarty International Center, National Institutes of Health, Bethesda, Maryland.
11
Haydom Lutheran Hospital, Manraya, Tanzania.
12
University of Venda, Limpopo Province, South Africa.

Abstract

Individuals in the developing world live in conditions of intense exposure to enteric pathogens due to suboptimal water and sanitation. These environmental conditions lead to alterations in intestinal structure, function, and local and systemic immune activation that are collectively referred to as environmental enteropathy (EE). This condition, although poorly defined, is likely to be exacerbated by undernutrition as well as being responsible for permanent growth deficits acquired in early childhood, vaccine failure, and loss of human potential. This article addresses the underlying theoretical and analytical frameworks informing the methodology proposed by the Etiology, Risk Factors and Interactions of Enteric Infections and Malnutrition and the Consequences for Child Health and Development (MAL-ED) cohort study to define and quantify the burden of disease caused by EE within a multisite cohort. Additionally, we will discuss efforts to improve, standardize, and harmonize laboratory practices within the MAL-ED Network. These efforts will address current limitations in the understanding of EE and its burden on children in the developing world.

KEYWORDS:

environmental enteropathy; infant growth failure; intestinal infections; lactulose mannitol test; tropical enteropathy

PMID:
25305293
PMCID:
PMC4204611
DOI:
10.1093/cid/ciu457
[Indexed for MEDLINE]
Free PMC Article

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