Abstract

Poor linear growth over the first few years of life, resulting in growth stunting, remains a major issue in low- and middle-income countries (LMICs) including Indonesia. Exposure to poor water, sanitation and hygiene (WASH) conditions resulting in clinical infections and diarrhoea has long been recognised as a key driver of poor growth, particularly amongst infants. However, emerging research suggests diarrhoea alone does not fully explain the link between poor WASH and stunting. Rather, chronic exposure to faecal pathogens, both harmful and non-harmful, is believed to drive functional and morphological changes to the small-intestinal architecture resulting in chronic low-grade inflammation. This sub-clinical condition is termed environmental enteric dysfunction (EED) and is one of the most abundant but poorly understood ‘silent’ condition of infants in LMICs, driving growth stunting and impaired cognitive development. Little research pertains to EED amongst infants in Indonesia, the world’s fourth most populated country. This thesis reports results from a combination of secondary data analysis, systematic review, and a longitudinal field study of EED amongst infants in rural Central Java, Indonesia. Fieldwork results are discussed in the context of a systematic review of associations between EED biomarkers and linear growth outcomes, and a secondary data analysis highlights the ongoing linear growth faltering experienced by Indonesian infants despite recent reductions in stunting prevalence.

Speaker

Mr Callum Lowe is a PhD Candidate at the National Centre for Epidemiology and Population Health at the Australian National University and a research assistant at QIMR Berghofer Medical Research Institute. He holds a bachelor’s degree with honours in Global Public Health. He has experience in the analysis of infection and nutrition data in the global health context and the conduct of primary fieldwork in rural settings in Indonesia.