Origins and dynamics of oral dysbiosis associated with environmental enteric dysfunction. Preventive intervention in Central African infants – Afribiota2

To date, globally one out of four children is stunted and the current best- of -practice treatments are not able to correct for more than a third of the observed growth delays. The development of complementary, innovative interventions are therefore of utmost importance. In the Afribiota study we showed that stunting was associated with small intestinal bacterial overgrowth dominated by bacteria that normally reside in the oropharyngeal cavity and are associated with small intestinal inflammation and decrease lipid absorption. The oral-hygienic approach emerges as an entirely new preventive approach to tackle stunting. Therefore, our primary objective is to demonstrate by a specifically-designed clinical trial among 720 infants and their families in Bangui (Central-African Republic (CAR), that educating children and their families to implement strict and sustained rules of oral and nasopharyngeal hygiene will significantly prevent or reverse stunting; Our second objective is to investigate the oral cavity as a microbiological hub whose qualitative and quantitative alterations may impact on the future of child’s health. This will encompass fine description and monitoring of the oral microbiome assembly by and dynamics from birth, including key parameters influencing its ecological successions, like maternal and child hygiene, antibiotic use, and nutrition (including breastfeeding); Our third objective is to nucleate the conditions for the development of a global program of education to oral health in the CAR. Beyond the crucial question on how oral microbial communities expand to the gut resulting in the establishment of dysbiosis and stunting, this study will thus have a direct clinical benefit regarding both oral health and the treatment of undernutrition in Africa. The planned intervention on oral health will also allow us to assess the role of oral hygiene on other comorbidities, an area of much interest, as there are no data available on oral health in Africa.