Gut Health and Child Survival

Our Challenge

Even among children who survive diarrhea, multiple episodes of the disease and the underlying enteric infections can lead to chronic malnutrition, increased risk of lower respiratory tract infections, cognitive disabilities, and poor school performance. These consequences hold extreme economic and societal implications.

Our Response

We are a collaboration of clinicians, epidemiologists and microbiologists, based both in Seattle and internationally, who share a common goal of preventing and treating the adverse effects of enteric and diarrheal disease. Our team currently leads multiple clinical trials and observational studies to better understand the unique host, pathogen, and environmental determinants of why some children fail to recover from common infections. Equipped with this information and appropriate interventions, we strive to ensure children survive and reach their developmental potential.

Our Priority Areas

Many children suffer an elevated risk of mortality and chronic malnutrition months after acute infectious illnesses. This prolonged risk may be due to inadequately treated or new bacterial infections, a prolonged state of inflammation as a result of the infection and its associated treatment, or immune-deficiencies that arise after illness.

Within two clinical trials we are testing whether empiric use of a broad spectrum antibiotic improves post-infection survival in Kenyan children.  Through data and samples collected in these studies, we are building a platform to identify mechanisms and, eventually, to test additional interventions for reducing the short and long-term consequences of infectious diseases in children.

Recent estimates suggest that almost half of all childhood deaths are attributed to malnutrition. The relationship between malnutrition and enteric diseases is cyclical; malnutrition is a serious consequence of enteric and diarrheal disease and undernourished children experience a higher risk of death after infection.

Our team is leading a multi-country network of clinical research centers from Sub-Saharan Africa, South East Asia, the UK and USA dedicated to identifying risk factors that increase mortality, hospital readmission, and poor recovery in children who are malnourished and suffering from acute infection.

Specific bacterial and parasitic enteric infections contribute a disproportionate burden to diarrheal disease, malnutrition, and poor academic performance. We conduct an array of evidence-generating activities to inform international prevention and treatment policy of specific enteric infections including literature reviews challenging current management guidelines for Shigella infections, household Cryptosporidium transmission studies, and clinical trials testing the feasibility of integrated approached to eliminating soil-transmitted helminths.

Our Leadership

Gut Health and Child Survival is led by Drs. Patricia Pavlinac and Judd Walson.

Patricia Pavlinac is an epidemiologist and Acting Assistant Professor in the UW Department of Global Health.

Judd Walson is a clinical researcher and Professor in the UW Departments of Global Health, Medicine, Pediatrics, and Epidemiology.

Patricia Pavlinac, PhD, MS

Judd Walson, MD, MPH

Our Research

Pavlinac P, Denno D, John-Stewart G, Onchiri F, Naulikha J, Singa B, Manhart L,
Walson J.

Failure of syndrome-based diarrhea management guidelines to detect Shigella infections in Kenyan children
J Pediatr Infect Dis 2015

Arndt MB, Richardson BA, Ahmed T, Mahfuz M, Haque R, John-Stewart GC, Denno DM, Petri WA Jr, Kosek M, Walson JL; in coordination with the MAL-ED Network Project.
Fecal Markers of Environmental Enteropathy and Subsequent Growth in Bangladeshi Children.
Am J Trop Med Hyg. 2016 Sep 7;95(3):694-701. doi: 10.4269/ajtmh.16-0098.

Means AR, Ásbjörnsdóttir K, Mwandawiro C, Rollinson D, Jacobson J, Littlewood T, Walson JL.
Sustaining Progress towards NTD Elimination: An Opportunity to Leverage Lymphatic Filariasis Elimination Programs to Interrupt Transmission of Soil-Transmitted Helminths.
PLoS Negl Trop Dis. 2016 Jul 14;10(7):e0004737.

ABCD Trial: Antibiotics for Children with Severe Diarrhea
Judd Walson, Patricia Pavlinac (Kenya site), Stephanie Tornberg-Belanger, Hannah Atlas
This trial aims to determine the efficacy of two antibiotics in reducing risk of death in children less than two years of age with diarrhea and dehydration or malnutrition through a double-blind placebo-controlled clinical trial. The study is designed to provide clear evidence in favor or against using antibiotics to treat diarrhea, to inform a revision of current World Health Organization (WHO) diarrhea guidelines.

CHAIN Network: Childhood Acute Illness & Nutrition
Judd Walson, Donna Denno, Kirk Tickell, Dorothy Mangale (Migori Hospital site, Kenya)
The CHAIN Network seeks to build the evidence base for the care of sick, undernourished children in resource-limited settings. At the core of the network is a group of global experts creating a cohort of acutely ill children from Sub-Saharan Africa, South East Asia, the UK and USA, and who are dedicated to reducing childhood mortality caused by co-morbid severe illness and malnutrition. The multi-site, multi-country observational study is expected to close in 2019.

Toto Bora: Preventing Post-discharge Morbidity and Mortality in Kenyan Children
Judd Walson, Patricia Pavlinac, Rebecca Brander, Stephanie Tornberg-Belanger
Toto Bora, an expression meaning “healthy baby” in Kiswahili, is a randomized, double-blind, placebo-controlled trial aimed at reducing childhood morbidity and mortality post-hospitalization. A recent trial found that mass administration of azithromycin reduced mortality by half among children receiving the intervention in Ethiopia. The Toto Bora team will determine the efficacy of azithromycin provided at discharge in reducing mortality and re-hospitalization rates in Kenyan children age 1-59 months. The Toto Bora Trial began enrollment in June of 2016 and is estimated to be complete data collection in June 2019.

Judd Walson, Arianna Rubins Means, Kristjana Asbjornsdottir, Marie-Claire Gwayi-Chore
Over 1.45 billion people are infected with soil-transmitted helminths (STHs), including 845 million children, in some of the world’s poorest communities. The DeWorm3 project tests the feasibility of eliminating STHs or intestinal worms and developing cost-effective methods for scaling up elimination programs. DeWorm3 aims specifically to:

-demonstrate the feasibility of eliminating STHs using existing and intensified mass drug administration (MDA) strategies, specifically by leveraging existing lymphatic filariasis elimination platforms

-inform the guidelines, policies, and operational plans needed to successfully achieve STH elimination

-link qualitative and operational studies of the acceptability and feasibility of different strategies to ongoing field trials, guiding future implementation and scale-up plans.

Scientific Working Groups


Technical Advisors


Rebecca Brander MPH
Emily Deichsel, MPH, PhDc
Claire Gwayi-Chore, MHS
Gillian Levine, MPH
Stephanie Tornberg-Belanger, MS, MPH


Kristjana Asbornsdottir, PhD, MPH
Dorothy Mangale, MPH, BA
Rowena de Saram, BA
Hannah Atlas, BA

External Advisory Board

Coming soon