Towards a better understanding and treatment of childhood malnutrition in the developing world


Throughout the world, one out of four children under five years experiences developmental delays. Malnutrition in early childhood leads to diminished physical and mental development, producing poor school performance and, on average, 22% less income in adulthood. Malnutrition is thus a major driver of poverty, for the present generations, as well as for the subsequent ones. Despite decades-long efforts to treat and to reduce malnutrition through nutritional rehabilitation, these programs have been dogged by an apparently unbreakable vicious cycle between malnutrition and infection.

Pediatric Environmental Enteropathy (PEE) is one of the underlying causes of malnutrition and of poor vaccination performance in the developing world. PEE is a chronic inflammatory condition of the gut occurring among children who live in unsanitary conditions. PEE appears to result from young children’s continual exposure to a microbiologically contaminated environment. Recent estimates show that between 75 and 100 percent of all children in the developing world suffer from this syndrome.


PEE and malnutrition are complex syndromes, reflecting a plethora of diverse environmental influences. To tackle this complexity, the Afribiota project brings together a broad range of multi-disciplinary approaches: epidemiology, medical anthropology, microbiology, immunology and nutrition. The current gold standard test of PEE, the lactitol-mannitol test, is heavy and difficult to perform in resource-poor settings. We will therefore evaluate other candidate biomarkers of PEE, enabling us to determine the proportion of children with PEE and to identify one or more alternative, quantifiable, reliable biomarkers. Afribiota will also evaluate socioeconomic, cultural, and environmental risk factors associated with malnutrition and PEE, so as to pinpoint possible entry points for future interventions. Using cutting-edge technologies, we will investigate changes in the ecology of the gut and the immune systems of healthy or diseased children to gain insight into the biological mechanisms that undergird the syndrome. The Afribiota project will be carried out in the Central African Republic and Madagascar, two countries with very high proportions of malnourished children.

Afribiota Collaborators

  • Philippe Sansonetti is, together with Pascale Vonaesch, the coordinator of the Afribiota project.
  • Pascale Vonaesch was in charge of setting up the Afribiota project and is now co-leading the project with Philippe Sansonetti. Her current work is focused on the pathophysiological consequences of PEE under laboratory conditions as well as on the risk factors and physiological consequences of stunting and PEE. She is co-leading with Jean-Marc Collard the gut ecosystem analyses and with Inès Vigan-Womas the immunological analyses.
  • Tamara Giles-Vernick leads the anthropological work of the project.
  • Maria Doria leads the child development aspects of the project.
  • Emna Achouri leads the integration of the different workpackages to develop a new framework for PEE.
  • Laura Schaeffer is the data manager of the project.
  • Rindra Randremanana leads the epidemiological aspects of the project.
  • Jean-Marc Collard, head of the Experimental Bacteriology unit, Institut Pasteur de Madagascar ,co-leads the gut ecosystem analyses in the project with Pascale Vonaesch.
  • Inès Vigan-Womas, head of the “Immunology of Infectious Diseases” Unit, Institut Pasteur de Madagascar, co-leads the immunological analyses in the project with Pascale Vonaesch.
  • Maheninasy Rakotondrainipiana ensures the organization, the coordination of the setting up and the follow-up of the study in Madagascar in the respect of the good clinical practices and deadlines.
  • Serge Ghislain Djorie works in the Epidemiology Service at Institut Pasteur de Bangui, he leads the clinical team of the Afribiota project in the Central African Republic.
  • Alexandre Manirakiza, Head of the Epidemiology Service at Institut Pasteur de Bangui, is responsible for the epidemiological part of Afribiota in the Central African Republic
  • Jean Chrystosome Gody, director of the Bangui Pediatric Center (CPB)is responsible for the clinical aspects of the project at the CPB
  • Louis Bainilago is in charge of the anthropological research of the project in Central African Republic
  • Brett Finlay,  an internationally recognized in the field of host-pathogen and host-microbiome interactions in relation to disease,  acts as a consultant on the microbiota analysis for the Afribiota project
  • Laura Wegener Parfrey, investigates the diversity and distribution of microbial eukaryotes (protists) and bacteria across environments, particularly those that are host-associated.