Poor growth performance during infancy and early childhood is a frequent fa
ct of life in most developing countries. Work in The Gambia has demonstrate
d that more than 43 % of observed growth faltering during the first 15 mont
hs of life can be explained by the presence of a mucosal enteropathy in the
small intestine. Within communities the illness is very common: in the are
a investigated more than 95 % of infants above 8 months of age were affecte
d, and on average they suffered a growth-limiting enteropathy for more than
75 % of their first year of life. Two mechanisms of weight loss have been
defined. First, partial villus atrophy reduces absorption and digestion of
lactose and probably other nutrients. Second, and more importantly, damage
to the mucosal barrier allows translocation of macromolecules into the muco
sa and blood, triggering both local and systemic immune and inflammatory me
chanisms. Given the severity of the enteropathy it is not surprising that i
nfants fail to grow at a normal rate. Recent findings suggest that these le
sions continue throughout childhood and into adulthood. Thus, a persistence
of chronic, local and systemic inflammation throughout childhood may be re
sponsible for continued poor growth during this period. Although the nature
of the enteropathy and the mechanisms of growth failure have been defined,
the factors involved in the initiation and persistence of the intestinal l
esion remain uncertain, making clinical management difficult. More work is
clearly required to elucidate these factors and to define interventions to
prevent or treat the enteropathy.