Talk:Environmental enteropathy

Wiki Education Foundation-supported course assignment
This article is or was the subject of a Wiki Education Foundation-supported course assignment. Further details are available on the course page. Student editor(s): Michelleyo. Peer reviewers: Has018.

Above undated message substituted from Template:Dashboard.wikiedu.org assignment by PrimeBOT (talk) 20:46, 17 January 2022 (UTC)

Wiki Education Foundation-supported course assignment
This article was the subject of a Wiki Education Foundation-supported course assignment, between 2 September 2020 and 11 December 2020. Further details are available on the course page. Student editor(s): Bettchlk618. Peer reviewers: K8-25.

Above undated message substituted from Template:Dashboard.wikiedu.org assignment by PrimeBOT (talk) 20:46, 17 January 2022 (UTC)

Description of the condition
I have copied this from the Humphrey paper - how could I paraphrase it or should I put it in inverted commas?: "Environmental enteropathy is characterised by villous atrophy, crypt hyperplasia, increased permeability, inflammatory cell infiltrate, and modest malabsorption."[1] EvM-Susana (talk) 08:20, 13 November 2014 (UTC)
 * Would fit in a section on mechanisms.
 * Could simplify as "Environmental enteropathy results in a number of changes in the intestines including: smaller villi, larger crypts, greater permeability, and inflammatory cell build up within the intestines. These changes result in poor absorption of food, vitamins and minerals."
 * Doc James (talk · contribs · email) 21:36, 13 November 2014 (UTC)


 * what do we mean by greater permeability? Permeability of what? I am asking because I got a message from a bot questioning the hyperlink for permeability as it led to a disambiguation page (I have removed the hyperlink now). EvM-Susana (talk) 12:27, 18 November 2014 (UTC)
 * Vascular_permeability Doc James (talk · contribs · email) 00:52, 25 November 2014 (UTC)

New section: Stunting/Malnutrition?
While the full discussion of stunting/cognitive development deficits etc. as a result of mal-nutrition that is partially caused by EE should probably be linked to a dedicated article (stunted growth already exists), a short sub-section is probably needed.--Krischan Makowka (talk) 19:47, 17 November 2014 (UTC)


 * Yes, that sounds like a good idea to me. EvM-Susana (talk) 20:39, 17 November 2014 (UTC)
 * Ok added, further suggestions welcome.--Krischan Makowka (talk) 21:07, 23 November 2014 (UTC)

Mechanism
Add the CC-by photos from the "Levine" paper linked below to show the differences between normal and EE intestinal mucosa?--Krischan Makowka (talk) 19:47, 17 November 2014 (UTC)


 * I think getting photos would be great. I am not sure if the photos in the Levine article can be directly taken? DocJames? From this article here: http://www.biomedcentral.com/1741-7007/8/129
 * Would we need to contact the author first? I have learnt that we need a statement like this if it's not clear: "I acknowledge that I own the images in question and are willing to release it under a CC BY SA license."
 * The article is released as a whole under the CC-by, so simple attributing the authors should be sufficient from a legal point of view. What makes it a bit complicated is that in the paper a 3rd party is attributed with the copyright of the photos and while strictly speaking the author of the paper should have gotten permission from those to allow redistribution under the CC-by, in reality this is often not the case as people are not aware of the license implications.--Krischan Makowka (talk) 21:12, 17 November 2014 (UTC)
 * is CC-by the same as CC BY SA? Wikipedia needs also the "for commercial use" part... And I have been taught that even when citing, one still has to paraphrase (and simplify) what the author has said. EvM-Susana (talk) 21:33, 17 November 2014 (UTC)
 * CC-BY is even more permissive than the CC-BY-SA, as it isn't copyleft, so yes fully compatible with the Wikipedia requirements even including commercial use. This wouldn't be "citing" as understood in scientific literature but simple reuse under the allowed license terms (you can even cut&paste if you "attribute the source").--Krischan Makowka (talk) 16:37, 20 November 2014 (UTC)
 * You also linked to a good presentation with photos. Presumably the authors of that presentation would have an interest in spreading information about EE and would perhaps make photos available? Jean Humphrey seems to be an important one. This is the list of authors, should we try to contact them?

SHINE Investigators: MoHCW Goldberg Mangwadu – Director of Environmental Health, MoHCW (Co-PI) Cynthia Chasokela – Director of Nursing Zvitambo Jean Humphrey (Co-PI) Mduduzi Mbuya, Naume Tavengwa, Kuda Mutasa, Robert Ntozini Johns Hopkins Bloomberg School of Public Health Larry Moulton, Jim Tielsch (J Humphrey) Cornell Rebecca Stoltzfus University of London Andrew Prendergast University of British Columbia Amee Manges Funding Gates, DFID, CIDA, NIH, Wellcome Trust, UNICEF

EvM-Susana (talk) 20:47, 17 November 2014 (UTC)
 * Yes we can use images in CC BY or CC BY SA publications. Doc James  (talk · contribs · email) 22:27, 20 November 2014 (UTC)


 * If I understood Kris right, he wasn't just referring to the images but also to some of the text? EvM-Susana (talk) 10:05, 21 November 2014 (UTC)
 * We can use the text aswell. Doc James  (talk · contribs · email) 00:52, 25 November 2014 (UTC)

Chronic immune response
Should this article go into chronic immune response and the likely impacts on oral vaccination efficiency? This seems to be a closely related effect of EE (or rather something that is cased by similar reasons?), but maybe it is worth a seperate article? Many research articles mention it together with EE. --Krischan Makowka (talk) 13:39, 13 November 2014 (UTC)


 * Yes, I think so. Make sure you write it in simple easy to understand language (not copy & paste) and cite high quality sources (not just an odd individual journal paper if you know what I mean. So glad to see your note on Wikipedia here!! :-) EvM-Susana (talk) 13:48, 13 November 2014 (UTC)

Other interesting literature
Water, sanitation, and hygiene (WASH), environmental enteropathy, nutrition, and early child development: making the links gives a broader overview on the interlinkages and also mentions the interesting parrallel research into "growth enhancers" from veteriany medical research, which seems to combat the same as EE in lifestock.--Krischan Makowka (talk) 13:55, 13 November 2014 (UTC)

EE: Going Beyond Nutrition to Understand Child Growth and Development (Presentation) includes a very short summary of EE and interlinkages etc. Might be usefull for formulating a short text.--Krischan Makowka (talk) 13:55, 13 November 2014 (UTC)

Environmental enteropathy and malnutrition: do we know enough to intervene? Very recent commentary article. --Krischan Makowka (talk) 14:25, 13 November 2014 (UTC)
 * This one is actually under a license (CC-by/CC-0) compatible with Wikipedia, so much of the text and tables could be used.--Krischan Makowka (talk) 21:38, 13 November 2014 (UTC)

Enteropathies in the Developing World: Neglected Effects on Global Health Also a good review from 2012. --Krischan Makowka (talk) 21:38, 13 November 2014 (UTC)

Immunogenicity and efficacy of oral vaccines in developing countries: lessons from a live cholera vaccine Includes also pictures of normal intestinal mucosa Vs. that found in EE cases, all seemingly under the CC-by license that would allow reuse here.--Krischan Makowka (talk) 22:39, 13 November 2014 (UTC)

Cluster-randomised controlled trials of individual and combined water, sanitation, hygiene and nutritional interventions in rural Bangladesh and Kenya: the WASH Benefits study design and rationale Has an interesting section on EE.--Krischan Makowka (talk) 19:47, 17 November 2014 (UTC)


 * Thanks for all these links. I hope I will find the time (or someone else will) to make use of these sources for this article! Here is also some advice I got form DocJames:

"Secondary sources are key for getting your content to stick.

This is a primary source http://tropej.oxfordjournals.org/content/30/4/204

This gives you review articles on the topic from the last 5 years http://www.ncbi.nlm.nih.gov/pubmed?term=%28+%22Environmental+enteropathy%22+%29+AND+Review%5Bptyp%5D+AND+%22last+5+years%22%5BPDat%5D"

EvM-Susana (talk) 21:51, 16 March 2015 (UTC)

Here is another article that we could draw on (I wish I had the time or expertise right now): https://sanitationupdates.wordpress.com/2017/01/24/unsafe-child-feces-disposal-is-associated-with-environmental-enteropathy-and-impaired-growth/ Unsafe Child Feces Disposal is Associated with Environmental Enteropathy and Impaired Growth. EvMsmile (talk) 13:33, 26 January 2017 (UTC)

EE Vs. Tropical Sprue
This article (from 1972!) argues that it is not the same or "tip of the iceberg": Tropical enteropathy and tropical sprue It also mentiones another term for Environmental/Tropical Enteropathy: "Tropical Jejunopathy" --Krischan Makowka (talk) 14:21, 13 November 2014 (UTC)
 * A little old. We try to stick with refs from the last 10 years. We do need to look into it further... Doc James  (talk · contribs · email) 21:31, 13 November 2014 (UTC)

Categories added
I have added some categories to this article, but are these the right ones? Is it important to add categories of lower levels, i.e. is the category "health" perhaps too high level"? I looked at the ones that were at the bottom of the helminthiasis page and at the bottom of the NTDs page. EvM-Susana (talk) 15:20, 15 November 2014 (UTC)
 * These look fine. We do not need health. Agree it is too high level. Doc James  (talk · contribs · email) 00:50, 25 November 2014 (UTC)

WikiProject Medicine 2017: Article Update Workplan
Hi all! I am a 4th year medical student in UCSF's WikiProject Medicine Course. I will be working on expansing an updating this article over the next few weeks. I chose this article because it is rated as a starter, but with ''high importance. ''

My focus for these updates will be in the following areas:

Article Organization & Formatting I will be expanding and updating the article's format in accordance with the Wikipedia Medicine-Related Article style of formatting -- specifically, in the format for diseases/disorders/syndromes. The article will from here have the following outline (note that I have added some very minor edits/notes on what is to be included in each of these headings):


 * Classification
 * Signs and symptoms or Characteristics
 * Causes
 * Mechanism
 * Diagnosis
 * Prevention or Screening
 * Treatment (in plausible order in which they might be tried, or discussing the most common treatments first)
 * Outcomes or Prognosis (for the individual)
 * Epidemiology (incidence, prevalence, age distribution, and sex ratio) --Include a subheading about Outcomes or Prognosis for society/from a public health standpoint.
 * History
 * Society and culture
 * Research directions -- Lots of research in this topic as it is not a very well-studied condition. Highlight the "big picture" of questions that are being addressed in this topic, without citing any specific studies individually.
 * Special populations, such as Geriatrics or Pregnancy or Children -- The majority of research/literature on this condition addresses children

Lead Paragraph I plan to update this to make it stronger. As of now, the language is somewhat nonspecific. For example -- the sentence "There are often minimal acute symptoms"' can be updated to include these minimal acute symptoms (such as diarrheal illness).

Adding Images This article could benefit from images. Specifically, I plan to add links depicting:
 * Histology/pathology of this condition (small intestine microvilli blunting, inflammation)
 * Diagram from an open-source resource describing the interaction between the environment, developing microbiome, nutritional deficiencies, growth & development
 * Map depicting areas of the world where this disorder is (or is suspected to be) most prevalent

Update Sources/References

Current references:
 * 1: Keep
 * 2: Remove. Strong resource in reputable journal, but is >8 years old. Will try to find equivalent review article with more updated information.
 * 3: Keep
 * 4: Remove (however will consider keeping for use of these images, if acceptable).
 * 5 & 6: - Remove (these are primary scientific research articles)

Potential References to add:
 * Ali, A., N.T. Iqbal, and K. Sadiq, Environmental enteropathy. Curr Opin Gastroenterol, 2016. 32(1): p. 12-7.
 * Prendergast, A. and P. Kelly, Enteropathies in the developing world: neglected effects on global health. Am J Trop Med Hyg, 2012. 86(5): p. 756-63.
 * Oria, R.B., et al., Early-life enteric infections: relation between chronic systemic inflammation and poor cognition in children. Nutr Rev, 2016. 74(6): p. 374-86.
 * Mbuya, M.N. and J.H. Humphrey, Preventing environmental enteric dysfunction through improved water, sanitation and hygiene: an opportunity for stunting reduction in developing countries. Matern Child Nutr, 2016. 12 Suppl 1: p. 106-20.
 * Rogawski, E.T. and R.L. Guerrant, The Burden of Enteropathy and "Subclinical" Infections. Pediatr Clin North Am, 2017. 64(4): p. 815-836.
 * Ahmed, T., et al., An evolving perspective about the origins of childhood undernutrition and nutritional interventions that includes the gut microbiome. Ann N Y Acad Sci, 2014. 1332: p. 22-38.
 * Lindenmayer, G.W., R.J. Stoltzfus, and A.J. Prendergast, Interactions between zinc deficiency and environmental enteropathy in developing countries. Adv Nutr, 2014. 5(1): p. 1-6.
 * Gilmartin, A.A. and W.A. Petri, Jr., Exploring the role of environmental enteropathy in malnutrition, infant development and oral vaccine response. Philos Trans R Soc Lond B Biol Sci, 2015. 370(1671).

"Translate-ability" Once I have made these changes, I will review the article for "translatability" to other languages (in collaboration with Translators Without Borders).

Overall, I do not plan to remove much, since this article is already short/a starter. My overall plan is to add more headings and subsequently filling in these expanded section with more details. Michelleyo (talk) 02:14, 27 November 2017 (UTC)


 * That sounds really great, User:Michelleyo - good luck with this assignment! I have two points: 1) when you do the research, keep an eye open for the links between open defecation (lack of sanitation) and EE. Feces in the environment is apparently a big factor (see also discussion earlier on this talk page). 2) don't wait until the end before you tackle "translatability". A better term is probably "readability". We have written some stuff about that here (in the section on "improve readability". That mentioned Hemmingway App (for free) is really very helpful! Readability is a big issue for Wikipedia articles, particularly those from the medical field. EMsmile (talk) 11:19, 27 November 2017 (UTC)


 * Thanks User:EMsmile! I will absolutely incorporate your points and advice into account. -Michelleyo (talk) 15:57, 28 November 2017 (UTC)

Peer Feedback:

Great work so far! Here are a few comments: Has018 (talk) 01:43, 11 December 2017 (UTC)
 * The lead paragraph is great. I think it gives a good, quick overview of EE and I was able to get a pretty good handle of what EE is just from that. I agree with your suggestion that “minimal acute symptoms” should be updated to include a sentence about what these symptoms could be
 * It wasn’t totally clear to me from your workplan whether you were thinking of filling out some of the various sections besides the lead paragraph. If not, then the outline you propose provides a pretty thorough framework for the article, although some of the topics you plan to introduce may require reshuffling of the older ones (e.g. the current classification section includes some of the history).
 * It’d be great to get more pictures!


 * Thank for the feedback Has018! Some thoughts/notes in response to your peer review:
 * Filling in headings - I do plan on filling in the sections I've added to the article outline. I have not gotten to all of these sections yet.
 * Shuffling of sections - I agree that some shuffling was needed. Compared to the original work plan above, I have combined/integrated a few sections. For example; (1) history has been absorbed into the classification and terminology section; (2) causes and mechanisms have been combined into one section; (3) prevention and screening and treatment have been combined, as the current thinking emphasizes a "prevention as treatment" approach. The disorder is thought to be self-resolving once the environmental insults are removed (or alternatively, the individual leaves the unsanitary environment).
 * I have added a few more images Michelleyo (talk) 05:35, 12 December 2017 (UTC)


 * Your work, Michelleyo, looks really great. I am so happy that you found additional images to add! How much longer is this course assignment running for? Most student editors seem to disappear after the course is completed so it would be good to know how much time we have left with you. :-) For the new article content, could you change it a bit so that it conforms more with Wikipedia style? I think you might have used too many bullet point lists now (could you change some of it to prose?). Also I don't think we should have bold inside of the main text; also I am not sure if all those external links are allowed in the research section. Shouldn't external links only go in a separate section below the references? Maybe User: Doc James has further feedback here? EMsmile (talk) 00:07, 28 December 2017 (UTC)
 * Made a few small changes. Doc James  (talk · contribs · email) 03:02, 28 December 2017 (UTC)
 * Thanks for the suggestions! The course is over but I hope to continue contributing. I agree that prose > bullets and I will get to this soon. Thanks! Michelleyo (talk) 18:17, 2 January 2018 (UTC)

First sentence
Thanks for your recent work, User:Ozzie10aaaa! I think we should put the two synonyms back into the first sentence though. It is too easy to overlook them in that info box on the right. If they are important synonyms then they should be in the first sentence, I think. EMsmile (talk) 00:00, 4 July 2019 (UTC)
 * if you insist, however the infobox gives quick information to our readers...IMO--Ozzie10aaaa (talk) 02:27, 4 July 2019 (UTC)
 * @ User:Ozzie10aaaa if I understand the concept of infoboxes correctly, it serves to summarise the content of the article but not to be the exclusive place where information can be found. Therefore, I am putting the synonyms back into the first sentence if that's OK by everyone. EMsmile (talk) 04:49, 23 July 2019 (UTC)

Epidemiology section
Hello! I am working on drafting an epidemiology section for this article. I've recently finished a draft of the section, and I'd love any and all feedback! I will link to my sandbox where the article can be accessed: Bettchlk618/sandbox

Thanks much!

Bettchlk618 (talk) 03:40, 12 November 2020 (UTC)