Child malnutrition& Adult NCDs-Generating Evidence on mechanistic links in Jamaica, Malawi & Ethiopia to inform future policy/practice (CHANGE study)

Lead Research Organisation: London School of Hygiene & Tropical Medicine
Department Name: Epidemiology and Population Health

Abstract

Severe malnutrition in early childhood is a major public health concern globally. This has serious consequences:
- Short term: for children to survive: malnutrition in all its forms underlies some 45% of all under 5 child deaths worldwide.
- Long term: for children to thrive: there is increasing realisation that early life malnutrition contributes to the fast-growing global epidemic of non-communicable diseases (NCDs).

As more children now survive episodes of malnutrition in childhood there is increasing need to understand what causes the long term problems. Evidence on this would lead to: improved early treatment of child malnutrition; improved longer term treatment aiming to reduce long term adverse effects.

In this project we have a unique opportunity to explore three groups of children/adults in:
- Jamaica: children suffering from severe malnutrition in the 1980s have been followed up on several occasions already, with scope for further analysis from already collected data.
- Malawi: We recently followed up a group of children admitted for severe malnutrition in 2005/6. We plan to both analyse existing data in more depth: also to possible collect new data in future.
- Ethiopia: Individuals who were young children at the time of the great Ethiopia famine of 1983-85 are about to be followed up in a pilot study. Learning from the above two projects will inform and improve plans for the Ethiopia work.
We aim to understand what are the long term problems following early child malnutrition and why they occur (the 'mechanisms' by which the two problems are linked)


The work proposed in this applicaiton is background towards the above future project. There are two main activities planned

A) Review of exisiting evidence: we will search the scientific literature to better understand what other have found to date re links between early life malnutrition and adult NCDs. Through this we will identify key knowledge gaps to target in future work.

B) Collaborator meeting - we will bring together the teams working on the above three groups of children to: learn from each other and share experiences. Through this better future work will be possible and there is great potential to enhance the overall learning compared to following each group as a stand-alone.
This meeting will be organised in Ethiopia in Autumn 2019: we will invite a number of key experts to make detailed plans for future work.
The Ethiopia/Malawi/UK teams will also visit Jamaica (the most advanced/experienced group) to learn from their experience and thus help plan better future projects in Malawi and Ethiopia.

Technical Summary

Malnutrition is a major global public health problem underlying some 45% of all deaths among children aged under 5 (child u5) worldwide. Severe Acute Malnutrition (SAM) is particularly serious, affecting some 17 million children u5 and causing over 500,000 deaths/year. As well as affecting chances to survive, data also suggests that children's potential to thrive is affected by early life episodes of malnutrition. This has major implications, especially for efforts to tackle the rapidly growing epidemic of NCDs (non-communicable disease).

While intrauterine undernutrition has been linked to later life NCDs, data on the effects of child malnutrition is sparse. Some of the few long-term post-SAM follow-up studies currently that are available show interesting associations between SAM (and related forms of severe malnutrition) in childhood and processes associated with muscle function and growth, including cardiac development, and overall metabolism (especially glucose metabolism) in adulthood. These observations make it plausible that child SAM increases risk of adult NCD - but mechanisms underlying these association are far from understood.
More data matters because:
a) There are many children alive today who suffer from or have suffered from SAM: better understanding their life-course risks is vital for policy, planning and advocacy
b) Understanding SAM>NCD mechanisms could lead to improved treatments for SAM
c) Understanding SAM>NCD mechanisms could also lead to post-SAM treatments to reduce NCD risk.

This study will ultimately provide more data by learning from three unique cohorts:
- Jamaica:
- Malawi:
- Ethiopia
Working with the 3 cohorts together will enable more lesson to be learnt - to inform policy and practice in many other LMIC countries.

The requested grant is towards background literature reivews and collaborator meetings to shape details of future larger studies.

Planned Impact

The following would benefit from this reasearch

1) Local communities (including vulnerable infants/children and adults with NCD)
--> If any problems (specifically NCDs such as high blood pressure or poor glycaemic control) are identified in study participants at follow-up they will be referred for appropriate medical care, thus directly benefiting their health. We will definitely aim to follow up local communities in Ethiopia. Data is already available from Malawi and Jamaica - depending on outcomes of the investigator meeting further follow-up may be planned.
--> Awareness of NCD and links with early life malnurition will be raised in local communities through our work
--> Vulnerable infants and children would also benefit it (as we anticipate) data from this study ultimately leads to improved treatments for child malnutrition.

2) Policy makers / programme managers
- Highlighting the mechanistic links beween early life severe malnutrition and later life NCD will offer invaluable advocacy materials for policy makers and programme managers working in LMIC/emergency settings.
- Linking the two conditions will provide powerful arguments for greater investment in both preventing and treating early life malnutrition: both an important need in itself, also a way of tackling the growing epidemic of NCDs

3) Scientists & academics
By proving mechanisitc information for researchers to :
- develop better treatments for severe malnutrition.
- develop better post-treatment care packages.
...at-risk individuals and communities will directly benefit.
 
Description The main aim of this award was to develop a detailed proposal to explore "Links between nutrition and non-communicable disease (NCD)" in depth/over a longer time period. Already however, through meetings and networking with colleagues in Ethiopia, Jamaica and Malawi, we have made steps towards our ultimate goal of understanding and tackling the links between nutrition and NCDs:
Through the background literature review done as part of this project we have confirmed that child malnutrition has negative effects on later life / adult health and disease and increases the risk of non-communicable disease such as heart disease and diabetes. This matters because it makes tackling child malnutrition all the more important: it is not just a child health issue with short term risk of death and disease but it is also relevant for the health and wellbeing of survivors. To effectively tackle the current global epidemic of non-communicable disease (NCD), the global health community must also focus on children and child nutrition in particular.
This finding (and sharing it at networking/dissemination activities detailed in the ResearchFish submission) is especially relevant to ODA countries where:
- Child malnutrition (undernutrition) is still common
- NCDs like heart disease and diabetes are rapidly increasing and are both a current problem / will be a significant future problem.
Though our project is focused on Jamaica, Ethiopia and Malawi, the findings of the review take into account all low and middle income countries and are thus widely relevant.
Exploitation Route We have already submitted an application for follow-on work based on the data and discussion arising from this seed award. WE hope the literature review (currently being submitted for publication) will also help others in future.

March 2021 Update:
Following this successful seed award we were successful in our application for a full award to explore this topic in more detail (this will be separately recorded in future RF submissions). This is a:
--> Multi-country (Jamaica, Ethiopia, Malawi) study of 7 different cohorts looking at early life malnutrition and later life cardiometabolic NCD.
We have secured funding for a 32 month project to explore this - though we must successfully acheive year 1 objectives to get the full award amount.

Our manuscript on "Long term NCD outcomes following child malnutrition" has also recently been accepted for publication by BMJ Global Health - this will be reported in next years' submission as proof has just been sent and we don't yet have a DOI.
Sectors Healthcare
 
Description Through sharing findings and issues raised during this seed award at meetings aimed at policy-makers/practitioners (e.g. Action Against Hunger "Research 4 Nutrition Meeting) we are already starting to raise wider awareness of the long term consequences of severe malnutrition. This being a very early stage in the project it is too early to assess wider impact of this but we anticipate that it will be relevant to a large number of LMIC settings, not just our target countries Jamaica, Ethiopia, Malawi. As per reporting guidelines: - To ensure meaningful and equal opportunties for people of different genders we have assembled a mixed team of both male and female scientists to work on the project (also scientists at different career stages. - We have not yet started field activities, but plans involve research participants of all genders and include start-up workshops to help local communities/particpants/other stakeholders engage with the work - We do not anticipate and negative consequences on gender equality - In our plans for the full study we will aim to recruit all survivors of severe malnutrition in childhood irrespective of gender and will report outcomes by gender and age. - We have a very diverse research team representing not only different genders but also different professional/personal backgrounds and nationalities. - This being only a seed grant our impacts to date are small - though we have begun engagement activities raising awareness of our research topic (the link between early child undernutrition and later life / adult NCD). We hope that this is an inital step towards influencing future health / nutrition policy and practice. March 2021 Update We are pleased to report that we have been successful in our application for a larger follow-on award under this scheme. This will allow us to pursue the project overall aims in more detail and depth in future. We hope to begin this project this month and will report in full in next year's RF submission March 2023 update We are pleased to report that we are continuing work on our project and evidence of the need and impact from future outputs is that the topic of post malnutrition weight gain was discussed in a recent WHO Guideline Development Group meeting. THe lack of current evidence was highlighted - our work will help provide this evidence in future.
First Year Of Impact 2022
Sector Healthcare
Impact Types Policy & public services
 
Description MAMI Global Network (co-chair)
Geographic Reach Multiple continents/international 
Policy Influence Type Contribution to new or improved professional practice
Impact Many organizations are now doing MAMI infant nutrition programme: these are inspired, helped and indirectly supported by us at the MAMI Global Network, including via monthly "implementors' meeting" and by many links and coversations that arise via the group. Several of us are also involved in the WHO Guideline Development Group - infants aged <6m are a key population being considered by WHO in this process.
URL https://www.ennonline.net/ourwork/research/mami
 
Description Member of WHO GDG (Guideline Development Group) for update of Severe Malnutrition in Children Guidelines Dec 2020, Jan-Dec 2021 (2021 timelines TBC)
Geographic Reach Multiple continents/international 
Policy Influence Type Membership of a guideline committee
 
Description Member of WHO Guideline Development group for Severe Malnutrition 2021, 2022, 2023
Geographic Reach Multiple continents/international 
Policy Influence Type Participation in a guidance/advisory committee
Impact Though final guidelines are still not out the process is already influencing the work and thinking of the global experts who are, like myself, part of the WHO Guideline Development Group. Our work has been discussed in the guideline meetings: both MAMI infant malnutrition work and CHANGE project work of weight gain post malnutrition.
 
Description RCPCH International Child Health group meeting
Geographic Reach National 
Policy Influence Type Influenced training of practitioners or researchers
Impact This was a guest lecture to the International Child Health group of RCPCH. I talked about malnutrition and included mention of the research work I'm doing with colleagues on severe malnutrition in children.
 
Description Teaching and training future global health leaders and practitioners at LSHTM
Geographic Reach Multiple continents/international 
Policy Influence Type Influenced training of practitioners or researchers
Impact In my teaching role at LSHTM I have multiple opportunties to teach and train (as well as learn from) our Msc and PhD students - many of whom will go on to be future leaders in global health in their own right. For example, I regularly: - Teach on Malnutrition on the Diploma in Tropical Medicine & Diploma in Tropical Nursing at LSHTM - Lead the organization of the "Nutrition in Emergencies" module - where there's a particuarly key opportunity to influence future leaders (as well as sharing details of the reserach I do in collaboration with various partners globally) - Discuss research-related issues with MSc students on the "Nutrition for Global Health MSc" - of which I am programme director - Discuss research-related issues with student and staff in the MARCH (Maternal, Adolescent, Reproductive and Child Health) Centre - of which I am co-lead for the C(Child) theme - this includes regular seminars and other meetings. MARCH newletters and other media also help disseminate key reserach findings and papers. All these are ongoing - I arrived at LSHTM in Sept 2014 and contibue to build and consolidate teaching/training at the university.
URL https://www.lshtm.ac.uk/aboutus/people/kerac.marko
 
Description CHild malnutrition & Adult NCD: Generating Evidence on mechanistic links to inform future policy/practice (CHANGE project)
Amount £2,016,924 (GBP)
Funding ID MR/V000802/1 
Organisation Medical Research Council (MRC) 
Sector Public
Country United Kingdom
Start 03/2021 
End 10/2023
 
Description Child malnutrition& Adult NCDs-Generating Evidence on mechanistic links in Jamaica, Malawi & Ethiopia to inform future policy/practice (CHANGE study)
Amount £49,819 (GBP)
Funding ID MR/T008628/1 
Organisation Medical Research Council (MRC) 
Sector Public
Country United Kingdom
Start 08/2019 
End 01/2020
 
Description GCRF Mechanistic Nutrition Links (LMICs) Jan 2020
Amount £1,994,948 (GBP)
Funding ID MR/V000802/1 
Organisation Medical Research Council (MRC) 
Sector Public
Country United Kingdom
Start 03/2020 
End 09/2023
 
Title CHANGE Cohort 1: Long-term Implications Of Nutrition (LION) dataset 
Description LION is an existing prospective cohort of survivors of severe malnutrition in Jamaica which has been followed-up post-discharge after been identified as severely malnourished and treated with specialised feeds. The cohort consist of malnourished children treated in inpatient care (1965-93). Included in the study are children with severe wasting (weight-for-age < 60%) or oedematous malnutrition (weight-for-age 60-80%, plus oedema). NCHS reference. The data comes from a cross-sectional retrospective survey on non-communicable disease (NCD) risk in adult survivors of severe malnutrition in childhood carried out between 2008-2012 at the Tropical Metabolism Research Unit (TMRU), the University of the West Indies (UWI), Jamaica. Adult data include blood pressure, anthropometric measures, body composition data, laboratory test results, and self-reported data relating to medical history, drug history and socioeconomic status. Childhood data include birth weight, and weight, length (height) and mid upper arm circumference (MUAC) measurements taken on admission, during hospitalization and up to 2 years post discharge from hospital. 
Type Of Material Database/Collection of data 
Year Produced 2022 
Provided To Others? Yes  
Impact This has recently been posted and forms the background to one of our CHANGE project analyses 
URL https://datacompass.lshtm.ac.uk/id/eprint/2656
 
Title CHANGE Cohort 2: Chronic disease outcomes after Severe Acute Malnutrition (ChroSAM). Malawi 
Description A dataset containing information collected from a prospective cohort of children originally admitted for treatment of severe acute malnutrition (SAM) in Blantyre, Malawi during 2006 and 2007. It includes health and anthropometric data from admission to care, during treatment, at discharge, at 1 year post-discharge, and at 7-years post-discharge. During original admission to care, data was collected as part of a randomised controlled trial into the effects of pre- and probiotics on treatment recovery - findings were null (trial registry number ISRCTN19364765). At the most recent follow-up in 2013/14, data pertaining to NCD risk were also collected, and data on 1 sibling control and 1 community control (age and sex matched) was also added. 
Type Of Material Database/Collection of data 
Year Produced 2022 
Provided To Others? Yes  
Impact This has just recently been posted and will form the basis of our CHANGE project analysis 
URL https://datacompass.lshtm.ac.uk/id/eprint/2657
 
Title CHANGE Cohort 3: Assessment of Long-Term Health Consequences of Acute Malnutrition (ACAM). Ethiopia 
Description ACAM is an existing prospective cohort of wasting treatment survivors in Ethiopia which has been followed-up post-discharge after been identified as severely malnourished and treated with therapeutic food. Population cohort includes malnourished children treated in outpatient care in 2014-15. Included in the study are children with WLZ 
Type Of Material Database/Collection of data 
Year Produced 2022 
Provided To Others? Yes  
Impact This has just recently been posted and will form the basis of our CHANGE project analysis 
URL https://datacompass.lshtm.ac.uk/id/eprint/2658
 
Title CHANGE Project (CHild malnutrition & Adult NCD: Generating Evidence on mechanistic links to inform future policy/practice) - main project page 
Description This is the main page for our CHANGE project describing overall aims and objectives. As papers come out they will be linked to this. 
Type Of Material Database/Collection of data 
Year Produced 2022 
Provided To Others? Yes  
Impact We are still in process of gathering data but outputs will emerge over the coming years. Already the topic of weight gain after severe malnutrition has been discussed at a WHO Guideline meeting since evidence in this area is lacking: we anticipate that our project will help contribute important evidence to future disucssions/international/national guidelines. 
URL https://datacompass.lshtm.ac.uk/id/eprint/2655/
 
Title ChroSAM database 
Description This is data from a follow-up study of an existing cohort of ex-malnourished children aiming to describe long term outcomes following SAM (Severe Acute malnutrition) Data collection is about to be complete so that we will have linked data from: a) Original episode of malnutrition b) A 1- year follow-up study http://www.ncbi.nlm.nih.gov/pubmed/24892281 c) The current follow-up (which is the most detailed to date) The latest variables in the database include: 1) Main outcomes • Alive or dead at 7 years post-SAM • Detailed anthropometric measures, including: o Weight o Height (including standing and sitting height, lower leg length); o Circumferences of head, chest, waist, hip, upper leg and mid-upper arm; From these, measures, appropriate indices will be calculated (height-for-age; weight-for-height; BMI z-scores) 2. Early markers of chronic disease: • Cardiovascular o Blood pressure o Haemoglobin • Respiratory o Oxygen saturation o Lung function assessed by spirometry (Forced vital capacity; Forced expiratory volume in first second; forced expiratory flow 25%-75%) • Physical capacity assessed by shuttle run test (aerobic fitness); hand grip strength • Body composition assessed by bioelectrical impedance and skinfold thickness • Cognitive function o school achievement; o brain MRI (subset of patients only); • Metabolic function assessed by salivary cortisol; and venous blood for HbA1c; fasting blood glucose/glucose tolerance test (subset only); 3. Predictors of favourable or adverse long term outcomes: • Family characteristics (including parental education, employment and family size - again repeated at follow-up to assess changes from original baseline) • Socioeconomic status and household characteristics (repeated at follow-up to assess any changes from original baseline assessment) • Maternal/carer mental health (SRQ questionnaire) • Social support and wellbeing (MPSS - Multidimensional Scale of Perceived Social Support; SWBS - spiritual wellbeing scale; WHO-QoL Bref) • Disability (12 questions screen) 
Type Of Material Database/Collection of data 
Year Produced 2016 
Provided To Others? No  
Impact We are just about to finish data recruitment. The bulk of data will be reported in a PhD which I am supervising. However, we already anticipate that there will be significant "other" data left over for future students and investigators to use to look at related questions about long term outcomes following malnutrition. 2017 update The main paper has now been published. Funding allowing, we hope to continue with further outputs from this database. 2018 update We have published a further paper on lung function following severe malnutrition; have one more paper on cognitive function submitted; are planning further publications over the coming year. 2020 update As well as a MSC summer project based on this database it is one of a number of cohorts which we hope to explore in teh MRC CHANGE study looking at long term outcomes following severe malnutrition. 
 
Description 2012-2014 Malawi-Liverpool-Wellcome ChroSAM project (+support for MAMI project) + new MLW PhD 2020-2023 
Organisation Wellcome Trust
Department Malawi-Liverpool Wellcome Trust Clinical Research Programme
Country Malawi 
Sector Academic/University 
PI Contribution The ChoSAM project is based on a cohort of children recruited for my PhD study in Malawi from 2006 to March 2007. I drafted the initial concept paper underlying this proposal and am overall lead researcher on this project, supervising UCL PhD student Natasha Lelijveld, who is working on the project as her PhD (I am one of 3 supervisors and the main supervisor in the field)
Collaborator Contribution MLW hosts the ChroSAM project in Malawi. The project is funded as an £197000 extension award to MLW core grant from the Wellcome trust. This pays all project and staff costs (my salary is covered separately by my ACL funding) MLW also supported my ACL Starter Grant looking at infant malnutrition: the communications team were key partners enabling and co-authoring the qualitative parts of this project, providing both ideas and intellectual inputs as well as the critical links to community groups who were interviewed.
Impact ChroSAM project started recruiting patients in Aug 2013 - mainly internal progress reports presented so far. One abstract accepted at IAEA meeting, May 2014 (please see publications) Will be further publications/outputs late 2014. MAMI has also resulted in several poster and oral presentations to date - a paper is being planned. This project is highly multidisciplinary, involving me as project leader/PI (Public Health/Clinical background); MSc students (hence also playing a role in training future researchers); social scientists from the MLW communications team. Project has now finished - but collaboration continues. We have just sumbitted the main paper arising from this study and it is in peer review. 2017 update: The main paper from the ChroSAM study has now been published and the first (of what we hope will be numerous) secondary papers accepted. For now, this project will be closed - though I hope there will be future papers arising from the dataset and future grant applications based on the same cohort as they get older. 2020 update: As well as some further MSc project and papers arising from the ChroSAM cohort we have recently established a link with a MLW PhD researcher who will undertake further follow-up of the cohort. This is due to start in Sept 2020 and is in planning phase now. The follow-up is also linked to the CHANGE study and would be a study site for the big project if awarded.
Start Year 2012
 
Description 2012-2014 Malawi-Liverpool-Wellcome ChroSAM project (+support for MAMI project) + new MLW PhD 2020-2023 
Organisation Wellcome Trust
Department Malawi-Liverpool Wellcome Trust Clinical Research Programme
Country Malawi 
Sector Academic/University 
PI Contribution The ChoSAM project is based on a cohort of children recruited for my PhD study in Malawi from 2006 to March 2007. I drafted the initial concept paper underlying this proposal and am overall lead researcher on this project, supervising UCL PhD student Natasha Lelijveld, who is working on the project as her PhD (I am one of 3 supervisors and the main supervisor in the field)
Collaborator Contribution MLW hosts the ChroSAM project in Malawi. The project is funded as an £197000 extension award to MLW core grant from the Wellcome trust. This pays all project and staff costs (my salary is covered separately by my ACL funding) MLW also supported my ACL Starter Grant looking at infant malnutrition: the communications team were key partners enabling and co-authoring the qualitative parts of this project, providing both ideas and intellectual inputs as well as the critical links to community groups who were interviewed.
Impact ChroSAM project started recruiting patients in Aug 2013 - mainly internal progress reports presented so far. One abstract accepted at IAEA meeting, May 2014 (please see publications) Will be further publications/outputs late 2014. MAMI has also resulted in several poster and oral presentations to date - a paper is being planned. This project is highly multidisciplinary, involving me as project leader/PI (Public Health/Clinical background); MSc students (hence also playing a role in training future researchers); social scientists from the MLW communications team. Project has now finished - but collaboration continues. We have just sumbitted the main paper arising from this study and it is in peer review. 2017 update: The main paper from the ChroSAM study has now been published and the first (of what we hope will be numerous) secondary papers accepted. For now, this project will be closed - though I hope there will be future papers arising from the dataset and future grant applications based on the same cohort as they get older. 2020 update: As well as some further MSc project and papers arising from the ChroSAM cohort we have recently established a link with a MLW PhD researcher who will undertake further follow-up of the cohort. This is due to start in Sept 2020 and is in planning phase now. The follow-up is also linked to the CHANGE study and would be a study site for the big project if awarded.
Start Year 2012
 
Description College of Medicine Malawi - Nutrition Projects 
Organisation University of Malawi
Department Department of Paediatrics & Child Health
Country United Kingdom 
Sector Academic/University 
PI Contribution I have a long standing relationship with CoM Malawi, since originally working there as a volunteer paediatric registrar/lecturer in 2003-4. The link has both inspired and directly enabled my research career, hosting my PhD in 2005-8 and hosting subsequent links and projects ever since. Since the start of ACF/ACL posts I have maintained close links and have had several UCL MSc students visit Malawi to work on their projects there - all themed around my overall area of research into severe acute malnutrition / infant nutrition. We are currently collaborating on my AMS Clinical Lecturer Starter Grant - COM colleagues are co-authors on work presented at meetings to date and will be co-authors on the future papers arising.
Collaborator Contribution The CoM (Department of Paediatrics in particular) have hosted my UCL MSc students and facilitated access to patients / staff for the the project. Without this the projects would not have been possible. They have also helped with room hire for the community dissemination event which I organized as a key output of my AMS starter grant.
Impact Please see publications list: - Lelijveld et al - Ahmad et al. Other papers are in-progress (two are directly arising from the AMS starter grant: 1) Carers' and health workers' perspectives on Community Management of Acute Malnutrition (CMAM) in infants of less then 6 months: qualitative founding of a formative study from Malawi. (awaiting comments from co-authors; to be submitted to BMC Nutrition Journal) 2) Management of Acute Malnutrition in Infants aged <6 months (MAMI) in Malawi: prevalence and risk factors in an observational study (accepted for presentation at Royal College of Paediatrics Annual Meeting, April 2015. Will be submitted to peer review journal immediately after that) All the above pieces of work are already informing future research discussion / policy-discussions (e.g. in the ENN collaboration to develop assessment / patient management 'tools' for infants <6m). Hence there are already early impacts on policy/health services. 2016 update: This collaboration continues. CoM I hope will be involved in the adolescent study for which I have just been awarded a grant. We also continue collaborating on student projects. 2017 update I remain in contact with colleages at CoM. We are joint investigators on an application to look at body composition in our cohort of ex-malnourished children in Blantyre, Malawi - this is hoped to start later in 2017 (funding allowing) 2019 update - This past year I have not been out to Malawi but did have a MSc student visit over summer 2018 to work on a project looking at nutritional status of surgical patients. 2020 update - another MSc student did her MSc project on Malawi data which we hope to publish together. COM colleagues were also co-applicants on a MRC application (the full version of the CHANGE study). This is a good example of long term outcomes arising from a long established contact.
 
Description Jimma University MAMI Project (funded) & Post-malnutrition follow-up project (seeking funding) 
Organisation University of Jimma
Country Ethiopia 
Sector Academic/University 
PI Contribution I am PI on the $2.5m Eleanor-Crook Foundation funded project on infant malnutrition. It is the culmination and major step forward for the infant nutriton work I've been doing for many years now. Related to but separate from the above project, Jimma are also partners on the MRC CHANGE study. We submitted the main application in Jan 2020 and are awaiting outcomes from a MARCH 2020 panel meeting.
Collaborator Contribution Colleagues at Jimma are leading the research locally in Ethiopia where our study is set.
Impact We have just started the project in Aug 2019 so are in year 1 developing formative work to inform our main RCT planned to start Oct 2020. March 2021 update: - We have completed MAMI project formative work though our main RCT plans have been delayed for a year due to COVID. - We were awared the follow-on larger grant and look forward to continued collaboration on the CHANGE project in 2021/22 (though an overall 3 year project we only have year 1 funding to begin with and need to meet project milestones in order to progress to full 32 month project) March2023 - collaboration still active. Publications and other outputs still in progress
Start Year 2019
 
Description Partnership with Cambridge University on CHANGE Project Child malnutrition & Adult NCDs: Generating new Evidence on mechanistic links to inform future policy and practice (CHANGE project) 
Organisation University of Cambridge
Department Institute of Metabolic Science (IMS)
Country United Kingdom 
Sector Academic/University 
PI Contribution Following a seed award in Sept 2019 - Jan 2020 we successfully applied for a 32 month MRC project to explore long term outcomes post severe malnutrition in more detail. We have to deliver on year 1 milestones for the project to proceed - these focus on profiling the cohorts and ensuring detailed plans for follow-up work. I am PI on the project and led both the writing of the seed award and also the main award.
Collaborator Contribution Cambridge (Dr Albert Koulman - Wellcome-MRC Institute of Metabolic Science) are our key lab partner in the CHANGE project and will lead on lipidomic work
Impact The main project is due to start this month, March 2021. Overall aims and objective are as below: THE AIM: To optimise severe malnutrition treatment programmes by better understanding the mechanisms linking infant/child undernutrition to longer-term (adult) NCD OBJECTIVES: 1. To understand how post-malnutrition weight gain (PMWG) affects risks of cardiometabolic NCD a. How does the timing of an episode of malnutrition influence this risk? b. How does severity of malnutrition influence this risk? c. How do different patient management approaches influence this risk? 2. To develop biomarkers for predicting NCD risk in survivors of child malnutrition by: a. Describing the biochemical characteristics of malnutrition survivors, differentiating those with/without NCD. b. Describing the biochemical profiles of different patterns of PMWG c. Identifying biomarkers common to different patterns of PMWG and NCD risk in survivors March2023 - collaboration still active. Publications and other outputs still in progress
Start Year 2020
 
Description Partnership with MEIRU (Malawi Epidemiology & Intervention Research Unit) - CHANGE Project Child malnutrition & Adult NCDs: Generating new Evidence on mechanistic links to inform future policy and practice (CHANGE project) 
Organisation Malawi Epidemiology & Intervention Research Unit
Country United Kingdom 
Sector Learned Society 
PI Contribution Following a seed award in Sept 2019 - Jan 2020 we successfully applied for a 32 month MRC project to explore long term outcomes post severe malnutrition in more detail. We have to deliver on year 1 milestones for the project to proceed - these focus on profiling the cohorts and ensuring detailed plans for follow-up work. I am PI on the project and led both the writing of the seed award and also the main award.
Collaborator Contribution MEIRU are one of our 3 key partners and will collect data from two cohorts: - A cohort of children from 2003-4 (the "MEIRU 1000" cohort) who were small/undernourished then and who we will follow-up now in their teens to look for early signs of NCD - A birth cohort
Impact The main project is due to start this month, March 2021. Overall aims and objective are as below: THE AIM: To optimise severe malnutrition treatment programmes by better understanding the mechanisms linking infant/child undernutrition to longer-term (adult) NCD OBJECTIVES: 1. To understand how post-malnutrition weight gain (PMWG) affects risks of cardiometabolic NCD a. How does the timing of an episode of malnutrition influence this risk? b. How does severity of malnutrition influence this risk? c. How do different patient management approaches influence this risk? 2. To develop biomarkers for predicting NCD risk in survivors of child malnutrition by: a. Describing the biochemical characteristics of malnutrition survivors, differentiating those with/without NCD. b. Describing the biochemical profiles of different patterns of PMWG c. Identifying biomarkers common to different patterns of PMWG and NCD risk in survivors March2023 - collaboration still active. Publications and other outputs still in progress
Start Year 2020
 
Description Partnership with Southampton University - CHANGE Project Child malnutrition & Adult NCDs: Generating new Evidence on mechanistic links to inform future policy and practice (CHANGE project) 
Organisation University of Southampton
Department Human development and health
Country United Kingdom 
Sector Academic/University 
PI Contribution Following a seed award in Sept 2019 - Jan 2020 we successfully applied for a 32 month MRC project to explore long term outcomes post severe malnutrition in more detail. We have to deliver on year 1 milestones for the project to proceed - these focus on profiling the cohorts and ensuring detailed plans for follow-up work. I am PI on the project and led both the writing of the seed award and also the main award.
Collaborator Contribution Southampton (Prof Jon Swan) are our key lab partner and will lead on metabolomic aspects of this work
Impact The main project is due to start this month, March 2021. Overall aims and objective are as below: THE AIM: To optimise severe malnutrition treatment programmes by better understanding the mechanisms linking infant/child undernutrition to longer-term (adult) NCD OBJECTIVES: 1. To understand how post-malnutrition weight gain (PMWG) affects risks of cardiometabolic NCD a. How does the timing of an episode of malnutrition influence this risk? b. How does severity of malnutrition influence this risk? c. How do different patient management approaches influence this risk? 2. To develop biomarkers for predicting NCD risk in survivors of child malnutrition by: a. Describing the biochemical characteristics of malnutrition survivors, differentiating those with/without NCD. b. Describing the biochemical profiles of different patterns of PMWG c. Identifying biomarkers common to different patterns of PMWG and NCD risk in survivors March2023 - collaboration still active. Publications and other outputs still in progress
Start Year 2020
 
Description Partnership with UWI Tropical Metabolism Research Unit (TMRU) on application to study links between child malnutrition and adult NCD 
Organisation University of West Indies
Department Tropical Metabolism Research Institute
Country Jamaica 
Sector Academic/University 
PI Contribution Together with TMRU, Jimma University and MEIRU Malawi we applied to and obtained seed funding to develop a project to explore links between early child malnutrition and later life NCD. I am PI on the project and had a research assistant lead on a background systematic review / contribute to grant-writing.
Collaborator Contribution TMRU colleauges made key scientific contributions to multiple aspects of this project: - The original concept - Co-authors on the systematic review - Co-authors of the full grant application - Hosted a research planning meeting in Jamaica in November
Impact We submitted a full application to MRC in Jan 2020 and are awaiting results. Irrespective of what happens with that we hope that the collaboration can continue. March 2021 update: - We were awared the follow-on larger grant and look forward to continued collaboration on the CHANGE project in 2021/22 (though an overall 3 year project we only have year 1 funding to begin with and need to meet project milestones in order to progress to full 32 month project) March2023 - collaboration still active. Publications and other outputs still in progress
Start Year 2019
 
Description Action Against Hunger "Research for Nutrition" conference, Nov 2019 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Professional Practitioners
Results and Impact This was a meeting linking researchers with practitioners / funders and others working in nutrition. The aim was to encouage dialogue and sharing of evidence. As well as chairing a session on infant malnutrition I also enabled a number of ex-MSc students to attend and present their summer project research. This included a systematic review on long term outcomes following malnutrition which is directly related to the CHANGE project
Year(s) Of Engagement Activity 2019
 
Description LSHTM Open day 
Form Of Engagement Activity Participation in an open day or visit at my research institution
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Postgraduate students
Results and Impact This was LSHTM wide open day. Students mainly came to learn about our MSc courses (including the Nutrition MSc I'm programme Director of). But in process they also learn about LSHTM research and our nutrition research.
Year(s) Of Engagement Activity 2020
 
Description MARCH summer projects launch event 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach Local
Primary Audience Postgraduate students
Results and Impact As part of LSHTM MARCH centre activites we held a Christmas party / summer project launch event. This involved linking current MSc students with potential projects /supervisors. This is a win/win:
- Researchers get linked to a student who can support their research
- Students get a policy/practice relevant project to work on.
I also included work on my projects in the project list: both MAMI projects and long term follow-up projects.
Year(s) Of Engagement Activity 2019
 
Description Rank Prize meeting on Severe Undernutrition 
Form Of Engagement Activity A formal working group, expert panel or dialogue
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Professional Practitioners
Results and Impact I was invited as a guest speaker to a RANK PRIZE symposium organized by Imperial College London.
This was a meeting of about ~20 professionals and policy makers working in severe malnutrition.
THe meetings are usually reported on the RANK website.
DIscussions were had about possible future links and collaborations after sharing of ideas at the meeting.
Year(s) Of Engagement Activity 2023
URL https://www.rankprize.org/symposia/
 
Description STRONGER foundation talk 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Supporters
Results and Impact I was invited speaker to a STRONGER Foundations talk, speaking to core team and other funders who are part of coalition about my research and it's impact / what it might mean for future funding efforts.
Though too early to say I planned this talk to influence future funding efforts and approach to work by funders (including reflection on why longer term investments are so important)
Year(s) Of Engagement Activity 2022
URL https://stronger-foundations.org/
 
Description Teaching on LSHTM courses: Diploma in Tropical Medicine; Diploma in Tropical Nursing; Nutrition in Emergencies Module 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Postgraduate students
Results and Impact I regularly teach on severe malnutrition on the above three courses at LSHTM. All talks are informed by / include descriptions of research I'm also engaged with and a key aim (from my perspective) is to broaden awareness of the research - and in turn to imporve policy/practice in the field of severe malnutrition. THis happen because:
- Some students go directly to research in this area (e.g. via summer project with myself; via projects with others)
- Many of our students will go onto be leading policy-makers/practitioners in their own right.
All the above begins with change in views/knowledge - as evidenced by positive feedback I get.
Year(s) Of Engagement Activity 2019,2020,2021,2022,2023
 
Description Wageningen University Study visit - Feb 2020 
Form Of Engagement Activity Participation in an open day or visit at my research institution
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Undergraduate students
Results and Impact As part of a study tour of a number of UK Universities, a group of undergrad / postgrad students from Wageningen University, Netherlands visited LSHTM for an afternoon. I was among a number of staff who shared short summaries of the research we're doing. No direct impact in short term but was helpful to broaden awareness of the research we're doing.
Year(s) Of Engagement Activity 2020