Childhood undernutrition is linked to more than 50% of child deaths worldwide. Undernutrition of a degree that results in stunting is associated with lifelong deficits in work capacity and cognitive deficits, with important social and economic consequences for individuals and communities. A key aspect of malnutrition that does not receive adequate attention is the role of environmental enteric dysfunction, in which exposure to enteropathogens alters intestinal integrity and metabolic state.  This condition is widespread in children in developing countries. It can reduce a child’s ability to absorb
nutrients, posing a significant risk factor in its own right and compounding risks associated with undernutrition. More effective control of enteric infectious disease (EID), including timely dissemination of targeted vaccines and infrastructure and education interventions to reduce infection risk, offers an opportunity to reduce the global burden of childhood malnutrition and the loss of human potential associated with stunting.
 
EID transmission is environmentally mediated, and many EID exhibit some form of seasonality or other environmental sensitivity. This suggests a strong potential for environmentally-informed risk monitoring and early warning, but almost no such systems exist for EID. In large part this is because it is difficult to obtain reliable, high frequency estimates of pathogen-specific EID infection rate. Without this information it is difficult to generate or evaluate skillful models. Indeed, even the basic characterization of seasonality, range, total burden, and primary environmental sensitivities is lacking for many important EID pathogens.   
 
With this in mind, the Interactions of Malnutrition & Enteric Infections: Consequences for Child Health and Development project (MAL-ED) established an unprecedented coordinated cohort study at sites in eight countries across three continents. The study tracks the incidence of EID exposure and nutritional status of infants and young children with state of the art molecular diagnostics over time, paired with detailed field and laboratory analysis that can characterize details about the nature of EID and associated risk factors. MAL-ED offers an opportunity to build understanding of the role that environment plays in spatial and temporal variability of a range of EID. But the power of MAL-ED is limited by lack of emphasis on environmental observation. Study sites are not always near a consistent and reliable weather station, for example, and there is no Earth Observation (EO) component to leverage the diversity of environmental estimates that are supported by current satellite platforms, models, and data assimilation systems. Moreover, the MAL-ED sites are point locations, and there is no systematic effort to identify coherent representative regions that might show consistent profiles in the relationship between environment, the incidence and distribution of disease caused by specific EID pathogens.
 
To leverage the combined power of MAL-ED and EO, we will partner with the MAL-ED investigator community to develop a database of relevant climate, hydrology, ecology, and human activity at each study site. This database will be used to develop statistical models of high impact EID, with the goal of informing understanding, monitoring, and prediction. We will use the global coverage available from EO to perform objective regionalization of global tropical land areas on the bases of seasonality and environmental associations of specific EID. MAL-ED and complementary studies will be used to train and evaluate the regionalization. This yields a map of environment-EID risk profiles that will form the basis for a GEO Monitor of Enteric Diseases (GEO-MED) that provides maps of EID potential, near real-time monitoring of elevated risk, and projections of future EID potential. This information will inform interventions and investments to reduce childhood EID.