Kirk Tickell
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A new study by Kirk Tickell, Judd Walson, Patricia Pavlinac, and a team of authors found that enteric pathogens—or bugs associated with diarrhea—become a much greater issue when they infect malnourished children. 

“Acute malnutrition is, pretty simply, being too thin for your height. We see ‘wasting’ very commonly in situations of acute food insecurity like famine or war,” said Tickell, a network research fellow for The CHAIN Network and University of Washington PhD student. 

An initial study by Tickell, Walson and Pavlinac found that acute malnutrition was associated with more severe diarrhea, but their latest work shows its associated with substantial mortality too. They used data from the Global Enteric Multicenter Study, a seminal study of diarrhea among children ages 0-59 months in Bangladesh, India, Kenya, Mali, Mozambique, Pakistan, and Gambia.

They found that two-thirds of the children who passed away after developing moderate or severe diarrhea had acute malnutrition. The study was interested in looking at how certain enteric pathogens interacted with acute malnutrition and were they able to capitalize on the vulnerability of wasted children. They found that, overwhelmingly, the pathogens were in fact able to do that. Tickell pointed out that, “Every infection becomes much worse if you have acute malnutrition, but, as the third finding discovered, if you have either diarrhea or acute malnutrition, you can kind of do okay, but if you have both together you do really poorly.” The combination of those two factors is what necessitates new interventions. 

This study also feeds into ongoing research being conducted by Walson and Pavlinac, who lead the Antibiotics for Children with Severe Diarrhea (ABCD) study at UW, that looks specifically at wasted children with diarrhea, and the CHAIN Consortium that also works with wasted children. Additionally, Tickell and Christine McGrath are working on a study that would prevent children from getting diarrhea in the first place and trying to treat their malnutrition through feeding. 

Tickell notes that the issue of malnutrition will struggle to move forward unless it obtains the requisite resources. 

“It is unfortunate that the times when it gets attention is limited to famines and wars, so then people think it’s only a problem when those circumstances are present,” Tickell said, before addressing another myth about the dangers of malnutrition and where they are found.

“A high prevalence of wasting can be found in almost every low and middle-income country in the world. You can look at politically stable countries, that aren’t prone to famine, you’re still looking at roughly 2 to 4 percent of children with some degree of wasting. Even though the media narrative makes it seem as though all the wasted children are in famine zones, they’re all over the world.”  

“One of the unique things about UW and the Department of Global Health is how collaborative everything is. Being able to combine clinician experience with epidemiologist experience, bringing together that clinician and statistical knowledge into this new data set allows us to move projects forward quite quickly.”

The study, titled “The effect of acute malnutrition on enteric pathogens, moderate-to-severe diarrhoea, and associated mortality in the Global Enteric Multicenter Study cohort: a post-hoc analysis” was published in The Lancet Global Health.