Project Overview


One in every five children in the developing world is malnourished and poor nutrition is linked to more than half of all child deaths worldwide. Early childhood malnutrition is considered one of the most prevalent risk factors for morbidity and mortality in children under five and may lead to cognitive and physical deficits later in life. The cycle continues as malnourished mothers give birth to low birth weight children who are at greater risk for childhood disease and malnourishment.

This vicious cycle of malnutrition is compounded by the tremendous enteric infectious disease burden of children in the developing world. These infections alter gut integrity, impair absorption of nutrients resulting in further malnutrition and increased susceptibility to and incidence of further infection and diminished immune response to vaccines. Moreover, high rates of disease, malnutrition, and impaired child development place an enormous and disproportionate social and economic burden on poor families and the countries in which they reside.

About the Project

Increased understanding of the complex inter-relationship between enteric infections and malnutrition is needed to design better intervention strategies to reduce childhood morbidity and mortality. As such, an international group of investigators are collaborating on a project entitled The Interactions of Malnutrition & Enteric Infections: Consequences for Child Health and Development. This project, abbreviated as MAL-ED (pronounced mal a dee), has established a network of sites that focuses on studying populations with a high prevalence of malnutrition and enteric infections.

The investigators at these eight sites, including those in Peru, Brazil, Bangladesh, India, Pakistan, Tanzania, South Africa and Nepal, and their colleagues in the United States are conducting comprehensive studies, using shared and harmonized protocols, to identify and characterize the factors associated with a child’s risk of enteric infection, chronic diarrhea, malnutrition as well with impaired gut function, vaccine response and cognitive and physical development.

These studies will elucidate some of the complex relationships among these factors, leading to more targeted, cost-effective interventions that will further reduce the burden of disease for those living in poverty.


The results of these studies are intended to address the following scientific hypotheses, namely that:

· infection with specific enteropathogens leads to malnutrition by causing intestinal inflammation and/or by altering the barrier and adsorptive functions of the gut; and,

· the combination of enteric infections and malnutrition results in growth and cognitive impairments in young children and may lead to impaired immunity as measured by responses to childhood vaccine.

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