they can be both environmental and nutritional. preexisting conditions such as micronutrient deficiencies, diarrheal diseases, and various chronic infections all serve as risk factors for ee. environmental conditions such as poor sanitation and unimproved water sources also contribute to the prevalence of ee. exposure to environmental microbial agents such as these is thought to be the most important factor in the development of ee. research initiatives there are multiple large-field, multi-country research initiatives focusing on strategies to prevent and treat ee. the mal-ed project the bangladesh environmental enteric dysfunction (beed) study (clinicaltrials.gov identifier: nct02812615) the study of environmental enteropathy and malnutrition (seem) in pakistan (clinicaltrials.gov identifier: nct03588013) the alive and thrive nutrition project the sanitation, hygiene and infant nutrition efficacy (shine) trial (clinicaltrials.gov identifier: nct01824940) the wash benefits study