Undernutrition is one of the most important health issues in Kenya. Children who are
chronically undernourished do not reach their full potential and are at increased risk of
infectious disease. Stunting occurs in a third of Kenyan children and has severe and
long-term consequences in terms of health, development, and poverty. Several studies have
shown that stunting is frequently associated with subclinical inflammation of the bowel, a
condition referred to as Environmental Enteropathy (EE), previously known as 'tropical sprue'
or 'tropical enteropathy'. EE is clinically similar to childhood inflammatory bowel diseases
(IBD), including Crohn's disease. The treatment of IBD routinely involves provision of gut
immunomodulatory agents, but this approach has never been tried in EE.
This proposal outlines a pilot double-blind randomised placebo-controlled trial of mesalamine
(also called mesalazine - the safest immunomodulator used in IBD with least systemic
activity) in treatment of severely malnourished children with EE.