MAL-ED: Illuminating the linkages between childhood malnutrition and diarrhoeal diseases, 2014 | Source: icddr,b News, Nov 2014
MAL-ED, a long term, multinational project to which icddr,b is contributing, takes a uniquely comprehensive approach to investigating the complex relationships between under-nutrition and enteric diseases and their impact on early childhood development.
Under-nutrition affects 20% of children in developing countries. It not only contributes to half the total number of deaths in children under five years of age around the world, it has negative and often severe long term impacts on children’s growth, immune function and cognitive development. This in turn undermines children’s future earning potential and hampers the economic development of communities. Moreover, under-nourished mothers are more likely to give birth to children with low birth weight who are at greater risk of illness and malnutrition, thus perpetuating the vicious cycle.
While it is long recognised that diarrhoeal diseases are closely linked with childhood under-nutrition – diarrhoea causes under-nutrition, and malnourished children are more susceptible to the infections causing diarrhoeal disease – the specific relationships between the two are remarkably poorly understood. In order to address knowledge gaps in this area and to improve scientific understanding of the complex relationship between enteric infections and under-nutrition and its effects on childhood development, the MAL-ED project was established in 2009. MAL-ED, which stands for “The Etiology, Risk Factors, and Interactions of Enteric Infections and Malnutrition and the Consequences for Child Health,” is a large multinational study spanning eight developing countries that aims to help develop solutions to childhood under-nutrition by providing unprecedented level of detail on its underlying causes.
Bangladesh is one of the countries represented in MAL-ED, and icddr,b is leading the local study. Research has been ongoing since 2009, with the final findings expected in 2017. Full information about the MAL-ED project, each of its eight field sites and methodological approaches are detailed in a new
supplement in
Clinical Infectious Diseases.
MAL-ED is complementary to previous studies on under-nutrition, say the authors, but it also attempts to overcome shortcomings in scope and approach present in earlier work. For example, previous studies on how pathogens cause gut infections and contribute to malnutrition or diminished immune response have been limited by small sample sizes, narrow geographic scope or lack of robust diagnostic tests. Previous studies have also often focused narrowly on a single pathogen that causes infection, without taking into account the wider context of risks that patients are exposed to, therefore ignoring any relationship and interdependence between the various factors that contribute to under-nutrition.
MAL-ED, in contrast, takes a uniquely comprehensive approach to investigating the factors behind under-nutrition. It utilises the large and diverse study populations present in eight poor countries in three continents: Bangladesh, Brazil, India, Nepal, Peru, Pakistan, South Africa and Tanzania. It includes both urban and rural communities with a history of high incidence of diarrhoeal disease and malnutrition. At least 200 children were enrolled per site and followed for the first 24 months of their lives. Observing the children over a long period of time in their communities (as opposed to a hospital setting) offers a unique opportunity to investigate relationships between enteric infections, gut function, diet, response to vaccines, physical growth and cognitive development. The project will not only draw broad lessons for developing countries, but also generate insights tailored to the specific environmental and biological characteristics of different populations.
In Bangladesh the MAL-ED study is led by Dr Tahmeed Ahmed, director of the
Centre for Nutrition and Food Security at icddr,b. Dr Rashidul Haque, head of the Parasitology Laboratory in icddr,b’s Laboratory Sciences Division is the co-principal investigator. The study site is located in the neighbourhood of Mirpur, an urban slum in the capital, Dhaka, which has one of the highest rates of diarrhoeal, respiratory and enteric disease. The Bangladesh team is leading analysis on the determinants of stunting, one of MAL-ED’s priority research areas. Data collected from this site have already enabled researchers to
uncover that damage to essential gut bacteria in children can lead to chronic malnutrition.
Tagged as:
B,
ICDDR
Comments on this entry are closed.