title: Assessment of environmental enteropathy in the MAL-ED cohort study: theoretical and analytic framework.
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.
authors.affiliation: Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland Asociación Benéfica PRISMA, Iquitos, Peru.
authors.forename: Margaret
authors.initials: M
authors.lastname: Kosek
authors.affiliation: Center for Global Health, University of Virginia, Charlottesville.
authors.forename: Richard L
authors.initials: RL
authors.lastname: Guerrant
authors.affiliation: Christian Medical College, Vellore, Tamil Nadu, India.
authors.forename: Gagandeep
authors.initials: G
authors.lastname: Kang
authors.affiliation: Department of Pediatrics and Child Health, Aga Khan University, Karachi, Pakistan.
authors.forename: Zulfiqar
authors.initials: Z
authors.lastname: Bhutta
authors.affiliation: Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland Asociación Benéfica PRISMA, Iquitos, Peru.
authors.forename: Pablo Peñataro
authors.initials: PP
authors.lastname: Yori
authors.affiliation: Center for Global Health, University of Virginia, Charlottesville.
authors.forename: Jean
authors.initials: J
authors.lastname: Gratz
authors.affiliation: Foundation of the National Institutes of Health.
authors.forename: Michael
authors.initials: M
authors.lastname: Gottlieb
authors.affiliation: Foundation of the National Institutes of Health Fogarty International Center, National Institutes of Health, Bethesda, Maryland.
authors.forename: Dennis
authors.initials: D
authors.lastname: Lang
authors.affiliation: Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland Asociación Benéfica PRISMA, Iquitos, Peru.
authors.forename: Gwenyth
authors.initials: G
authors.lastname: Lee
authors.affiliation: Center for Vaccine Sciences, iccdr,b, Dhaka, Bangladesh.
authors.forename: Rashidul
authors.initials: R
authors.lastname: Haque
authors.affiliation: Walter Reed/Armed Forces Research Institute of Medical Sciences Research Unit, Bangkok, Thailand.
authors.forename: Carl J
authors.initials: CJ
authors.lastname: Mason
authors.affiliation: Center for Vaccine Sciences, iccdr,b, Dhaka, Bangladesh.
authors.forename: Tahmeed
authors.initials: T
authors.lastname: Ahmed
authors.affiliation: Federal University of Ceará, Fortaleza, Brazil.
authors.forename: Aldo
authors.initials: A
authors.lastname: Lima
authors.affiliation: Center for Global Health, University of Virginia, Charlottesville.
authors.forename: William A
authors.initials: WA
authors.lastname: Petri
authors.affiliation: Center for Global Health, University of Virginia, Charlottesville.
authors.forename: Eric
authors.initials: E
authors.lastname: Houpt
authors.affiliation: Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland Asociación Benéfica PRISMA, Iquitos, Peru.
authors.forename: Maribel Paredes
authors.initials: MP
authors.lastname: Olortegui
authors.affiliation: Fogarty International Center, National Institutes of Health, Bethesda, Maryland.
authors.forename: Jessica C
authors.initials: JC
authors.lastname: Seidman
authors.affiliation: Haydom Lutheran Hospital, Manraya, Tanzania.
authors.forename: Estomih
authors.initials: E
authors.lastname: Mduma
authors.affiliation: University of Venda, Limpopo Province, South Africa.
authors.forename: Amidou
authors.initials: A
authors.lastname: Samie
authors.affiliation: Christian Medical College, Vellore, Tamil Nadu, India.
authors.forename: Sudhir
authors.initials: S
authors.lastname: Babji
mesh_terms: D002675:Child, Preschool; D003141:Communicable Diseases; D017281:Cost of Illness; D019550:Environmental Medicine; D015340:Epidemiologic Research Design; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007410:Intestinal Diseases; D008137:Longitudinal Studies; D044342:Malnutrition
keywords: environmental enteropathy; infant growth failure; intestinal infections; lactulose mannitol test; tropical enteropathy