Pediatric Infectious Diseases, Enteric Health and Malnutrition in Pakistan (PIDEMP) Research Training Program

Project Summary/Abstract
Approximately half of all children in Pakistan are stunted, 15% are wasted, and 40% are underweight. Stunting
serves as a clinical marker for lifelong impairments in physical, immunological (including reduced vaccine
immunogenicity), neurocognitive, and socioeconomic potential. Environmental Enteric Dysfunction (EED) is
thought to be a key factor underlying malnutrition and subsequently stunting in children residing in low-and-
middle income countries (LMICs) such as Pakistan. EED is an acquired, subclinical, small intestinal condition
attributed to a continuous burden of immune stimulation by fecal-oral exposure to enteropathogens leading to a
persistent acute phase response and chronic inflammation. EED is an excellent example of the interplay between
infectious diseases and chronic malnutrition. Limited expertise and a paucity of formal training programs in
pediatric infectious diseases and gastroenterology and nutrition in Pakistan are impeding progress in addressing
this significant burden of disease. Through this proposal, we aim to build sustainable capacity in pediatric
infectious disease and gastroenterology and nutrition research, specifically related to EED and its complications
such as vaccine failure, undernutrition and subsequent growth failure in children residing in Pakistan. Training
through this grant will leverage ongoing collaborative research projects and didactic (doctoral and graduate)
programs currently offered at the Aga Khan University (AKU), Pakistan. We will achieve this via three training
pathways of varying durations. Track I will include a series of short-term courses and workshops to be conducted
on topics covering advanced wet bench laboratory skills, epidemiology, clinical nutrition and bioethics, all with
an infectious diseases focus. Track II will leverage graduate programs (Master’s) in Epidemiology and
Biostatistics and Clinical Research at AKU and in Data Science at the University of Virginia, USA for training
candidates. Track III will produce PhD scholars working in the fields of mucosal immunology, organoids,
developmental origins of health and diseases as well as clinical nutrition. Two prior successful cycles of this
grant have firmly laid the foundation of infectious diseases research at AKU. We plan to leverage this framework
in the next five years by producing a cadre of local, independent scientists studying the interplay of communicable
and non-communicable diseases, which remain a neglected area of research throughout the world, and
particularly in LMICs such as Pakistan. The overall impact of this training program will be to empower in-country
local researchers to significantly reduce the burden of EED with an overarching goal of pediatric infectious
disease and gastroenterology and nutrition research in Pakistan.

Grant Number: 5D43TW007585-15
NIH Institute/Center: NIH
Principal Investigator: Syed Asad Ali