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New insights into environmental enteric dysfunction
  1. Indi Trehan1,2,
  2. Paul Kelly3,4,
  3. Nurmohammad Shaikh1,
  4. Mark J Manary1,5,6
  1. 1Department of Pediatrics, Washington University in St Louis, St Louis, Missouri, USA
  2. 2Department of Paediatrics and Child Health, University of Malawi, Blantyre, Malawi
  3. 3Blizard Institute, Barts and The London School of Medicine, Queen Mary University of London, London, UK
  4. 4TROPGAN Group, Department of Internal Medicine, University of Zambia, Lusaka, Zambia
  5. 5Department of Community Health, University of Malawi, Blantyre, Malawi
  6. 6Children's Nutrition Research Center, Baylor College of Medicine, Houston, USA
  1. Correspondence to Professor Mark Manary, Department of Pediatrics, One Children's Place, Campus Box 8116, Saint Louis, MO 63110, USA; manary{at}


Environmental enteric dysfunction (EED) has been recognised as an important contributing factor to physical and cognitive stunting, poor response to oral vaccines, limited resilience to acute infections and ultimately global childhood mortality. The aetiology of EED remains poorly defined but the epidemiology suggests a multifactorial combination of prenatal and early-life undernutrition and repeated infectious and/or toxic environmental insults due to unsanitary and unhygienic environments. Previous attempts at medical interventions to ameliorate EED have been unsatisfying. However, a new generation of imaging and ‘-omics’ technologies hold promise for developing a new understanding of the pathophysiology of EED. A series of trials designed to decrease EED and stunting are taking novel approaches, including improvements in sanitation, hygiene and nutritional interventions. Although many challenges remain in defeating EED, the global child health community must redouble their efforts to reduce EED in order to make substantive improvements in morbidity and mortality worldwide.

  • Gastroenterology
  • environmental enteropathy
  • environmental enteric dysfunction
  • Tropical Paediatrics

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