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Project to optimise nutrition during the crucial first 1000 days of a child’s life in Sub Saharan Africa

Published: 17 August 2018
Mothers in Ghana
Ghana will benefit from the work of the Southampton 1000 DaysPlus Global Nutrition Research Group.

A new project led by researchers at the University of Southampton will focus on optimising nutrition in mothers in Sub-Saharan Africa before, during and after pregnancy.

Funding worth £1.8M from the National Institute for Health Research (NIHR) Global Health Research Programme will lead the Southampton 1000 DaysPlus Global Nutrition Research Group to deliver interventions to tackle malnutrition, linking experts in the UK with colleagues in Burkina Faso, Ghana and South Africa.

The Southampton group is one of 20 in the UK to be awarded a total of £40M in funding through the NIHR’s Global Health Research Programme aimed at delivering measurable benefits to patients and the public in low- and middle-income countries. This round of funding covers a broad range of research themes, from improving asthma outcomes in African children to health system responses to violence against women.

The Southampton group will focus its efforts on Sub-Saharan Africa which has persistently high rates of intrauterine growth restriction, pre-term birth, low birthweight, underweight and child stunting, but also rapidly increasing rates of children being overweight and obese. Communities in this region now have a ‘double burden’ of malnutrition, where under-nutrition in infancy is followed by over-nutrition in terms of macronutrients (fats, proteins, carbohydrates), but with enduring deficiencies in micronutrients (iron, folic acid and other vitamins).

The Group has selected three specific sites – Nanoro in Burkina Faso, Navrongo in Ghana and Soweto in South Africa - to capture diversity in terms of rural and urban contexts, stages within the nutrition transition, and extent of the double burden of nutrition. These three sites also have substantial research experience and access to communities, and an interest in improving the health of children from an early age.

“The 1000 days from the start of a woman's pregnancy through to her child's second birthday is crucial in establishing the foundation for all that follows in the child’s life, particularly where good nutrition is concerned,” says project lead Marie-Louise Newell, Professor in Global Health and Infectious diseases Epidemiologist in the Institute of Developmental Sciences at the University of Southampton. “Of particular concern to us is that from Developmental Origins of Health and Disease (DOHaD) research, early life under-nutrition coupled with excessive weight gain in later life significantly increases risk for adult obesity, diabetes and raised blood pressure.”

“Given that these non-communicable diseases are major causes of death and disability globally and are now increasing most rapidly in low- and middle-income countries, optimising the nutritional status of future parents, and thus tackling the double burden of malnutrition may in the short-term improve growth and neurodevelopment of their offspring, and in the longer-term could set up healthier trajectories that reduces the risk for non-communicable diseases in later life,” Professor Newell continues.

To address the double burden of malnutrition, the Southampton group will establish a network of researchers in Africa to identify where best in the health care system to locate supportive interventions to optimise nutrition before, during and after pregnancy.

Professor Keith Godfrey, Co-Director of the new NIHR group, add “We envisage that implementing supportive “double-duty” nutritional interventions to tackle both aspects of the double burden of malnutrition will require engagement of critical multi-sectoral stakeholder groups, including target population groups along with policy-makers and health care professionals, to co-create opportunities and services to allow vulnerable populations to adopt healthy diets.”.  

Much is known already, some from research by members of this group, about which nutritional interventions may work, but little is known how best to deliver such interventions, in particular where in the system to provide the necessary support in the community.  For example, “Health care professionals have an important role in motivating men and women to change eating behaviours,” says Professor Shane Norris, lead investigator at the University of Witwatersrand, South Africa. “In low- and middle-income countries in particular, the case for such policy action has not yet been made, and health care professionals often lack knowledge and skills to assist motivation.

“Through our project, we need to formulate the economic case for investment in nutrition in the 1000 DaysPlus for optimal health of people and their future offspring,” Prof Newell concludes. “We need to ensure that we leverage our on-going work in different contexts and with a range of stakeholders to identify the best 1000 DaysPlus nutrition interventions that could be imbedded in ongoing reproductive health services, community health worker programmes, community antenatal care clinics and fiscal measures, for example taxes on sugar-sweetened beverages.”

 

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