Peer-reviewed article
Environmental enteric dysfunction and child stunting
Sophie Budge, Alison Parker, Paul Hutchings, Camila Garbutt ·
Summary
Written by AI, not yet AICS's view · claude-haiku-4-5-20251001This paper reviews environmental enteric dysfunction (EED), a subclinical intestinal inflammation that occurs in infants in developing countries and is linked to child stunting. The authors argue that traditional water, sanitation and hygiene interventions may be insufficient to address EED because it results from chronic pathogen exposure and has multiple causal pathways. The paper examines the proposed mechanisms connecting poor sanitation, EED, and growth faltering in children, and considers what nutrition and WASH interventions might be needed.
Key points
- An estimated 23% of children under 5 years old worldwide were stunted in 2017
- Environmental enteric dysfunction (EED) is a subclinical state of intestinal inflammation linked to stunting
- EED results from chronic pathogen exposure and presents multiple causal pathways to stunting
- Traditional WASH interventions may have limited effectiveness because they do not address all mechanisms of EED
- The definite pathogenesis of EED and exact mechanisms of stunting remain to be fully defined
Limitations
This is a literature review rather than a primary study, so it does not present new empirical data or test interventions. It cannot tell us which specific interventions are most effective or what the evidence is for different treatment approaches.
Abstract
In 2017, an estimated 1 in every 4 (23%) children aged < 5 years were stunted worldwide. With slow progress in stunting reduction in many regions and the realization that a large proportion of stunting is not due to insufficient diet or diarrhea alone, it remains that other factors must explain continued growth faltering. Environmental enteric dysfunction (EED), a subclinical state of intestinal inflammation, can occur in infants across the developing world and is proposed as an immediate causal factor connecting poor sanitation and stunting. A result of chronic pathogen exposure, EED presents multiple causal pathways, and as such the scope and sensitivity of traditional water, sanitation, and hygiene (WASH) interventions have possibly been unsubstantial. Although the definite pathogenesis of EED and the mechanism by which stunting occurs are yet to be defined, this paper reviews the existing literature surrounding the proposed pathology and transmission of EED in infants and considerations for nutrition and WASH interventions to improve linear growth worldwide.