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Poor Sanitation and Malnutrition: Experts to Discuss Connections and Correlations, and How Isotope Techniques can Help

Many children in low- and middle-income countries live in unsanitary conditions associated with Environmental Enteric Dysfunction. (Photo: R. Quevenco/IAEA)

Isotopic techniques could be crucial in the diagnosis of a condition associated with poor sanitation that contributes to stunting and poor health, which affects over 200 million children worldwide, mainly in low- and middle-income countries. Researchers, medical practitioners, nutritionists and development experts will meet at the IAEA headquarters in Vienna this week to discuss how the use of stable isotope techniques could help with the diagnosis of Environmental Enteric Dysfunction (EED).

“Isotopic techniques promise to introduce a ground breaking and simplified technique to the arena of nutrition,” said Jennifer Orgle, Program Director of Nutrition at the Center at CARE. “Current techniques to measure gut leakage in children are cumbersome and expensive and therefore often not carried out.” Finding an accessible, reliable and simple way of diagnosing EED in children is the biggest challenge, she added.

EED is an inflammatory disorder of the gut primarily resulting from recurring infection in the small intestine through oral ingestion of faecal particles, causing incomplete absorption and ineffective use of nutrients. It also weakens the immune system, and can undermine the effectiveness of oral vaccines. Children are particularly susceptible, and EED often results in child morbidity and mortality, reduced cognitive development and reduced economic productivity later on in life.

“EED is increasingly seen as an important element in combatting child stunting,” said Alexis Katsis, immunologist and Program Officer in the Enteric and Diarrheal Diseases Team at the Bill and Melinda Gates Foundation. There is a complex interrelationship between EED, poor water, sanitation and hygiene conditions (WASH), and childhood nutrition, health and development, she added.

“What remains to be clarified is the extent and mechanisms of those connections, as well as how much EED, WASH or nutrition contributes to the growth and cognitive development faltering seen in kids,” Katsis said.

Towards improved child development

Addressing EED and its consequences will ultimately result in adequate nutrition and health status.

“We must know more about EED to be successful with the Sustainable Development Goals,” said Mark Manary, Professor of Paediatrics at the Washington University School of Medicine. “Stable isotopes are very powerful as a non-invasive tracer in the human body. I am hopeful they can once again come to the rescue and help in the diagnosis of EED.”

In Zimbabwe, the majority of the population lives in rural areas with poor sanitary conditions, and one in three children under the age of five is stunted, while three in every four are anaemic, said Mduduzi Mbuya, Associate Director at the Zvitambo Institute for Maternal and Child Health Research in Harare. “While it is currently not possible to definitively state how EED is affecting Zimbabwe, our current knowledge of its epidemiology suggests that it affects most rural residents, and that it is likely to be a major contributor of prevalent stunting and anaemia,” he said.

This week’s meeting at the IAEA will provide a platform for experts in the field to discuss and explore current knowledge and gaps on the causes and consequences of EED, and define the next steps to take in addressing challenges, said Cornelia Loechl, Head of the Nutrition Section at the IAEA. “Participants will also focus on main areas where the IAEA, and more specifically stable isotope techniques, can help address problems related to EED,” she said.

The three-day meeting — from 28 to 30 October 2015 — is an opportunity to learn from the findings of others and meet key stakeholders that contribute to fight EED. “I hope to gain some new perspectives on EED and its diagnosis, sequelae and treatment and to identify ways in which the Bill and Melinda Gates Foundation can facilitate partnerships and research in this area,” said Katsis.

Stable isotopes are very powerful as a non-invasive tracer in the human body. I am hopeful they can once again come to the rescue and help in the diagnosis of EED.
Mark Manary, Professor of Paediatrics, Washington University School of Medicine, United States of America
Last update: 10 March 2016