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The University of Southampton
Population HealthEducation

Postgraduate - PhD

PhD students researching Population health are supported by faculties across the University of Southampton

Multimorbidity is a trend linked to the ageing population and the burden of non-communicable disease
Ageing in Sri Lanka

Sara Afshar (Faculties of Medicine and Social, Human and Mathematical Sciences)

Prior to her PhD Sara trained in Biomedical Sciences and gained a Masters in Global Health & Development from University College London; following which time she worked as Project Manager for a donor funded project at a Cancer Hospital in Sri Lanka. Her current interests lie in global health research, including epidemiological methods for public health and addressing the global burden of non-communicable disease.
Sara's project is about Multimorbidity which has been described as a ‘significant health-care problem’ for high-income countries; a trend linked to a rise in both an ageing population and burden of non-communicable disease. Evidence on multimorbidity prevalence in low- and middle-income countries (LMICs) remains sparse, however. Defined as the co-occurrence of more than two chronic conditions, multimorbidity has a complex impact on health outcomes: including functional status, disability and quality of life. Despite its increasing prevalence, the contextual factors that give rise to multimorbidity, including the biological and social determinants, are relatively understudied globally. Research Study The study examines the evidence from several data sources, including the World Health Survey, the Study of Global AGEing and Adult Health (SAGE) and the Women’s Health Survey Accra, Ghana (WHSA). Through a multicountry comparison – of low, middle, and high-income countries - the study aims to measure the global prevalence and impact of multimorbidity. A further cross-national study will be conducted, focusing on vascular multimorbidity in Ghana and using both the longitudinal surveys, WHSA and the SAGE. Specific measures include the association of multimorbidity with known aetiological risk factors and socioeconomic deprivation. Possible implications of the study include better health planning; evidence for policy; and community interventions, particularly for LMICs facing a rising multimorbidity burden.

Christina Black, NIHR Doctoral Student

This research focuses on mothers from disadvantaged backgrounds and the results could identify ways to assist poorer families to eat more healthy foods. Christina's research is on the relative influence of the local food environment and psychosocial factors on dietary inequalities among women in Hampshire.
There is little known in the UK about how the food stores where people shop, and near where they live, influence their diet. Christina's research is exploring the relationship between the quality of diet of mothers and their local food environment. She has mapped all retail food stores in six council areas of Hampshire to measure how the location of different types of food stores, and the 'healthfulness' of the mothers' main supermarket are associated with their quality of diet. She is also looking at how psychosocial factors such as sense of control and social support, interact in the relationship between environmental factors and diet quality.

Sarah Kehoe (MRC Lifecourse Epidemiology Unit)

The Pune Maternal Nutrition Study
Sarah's project is recruiting women, in Mumbai, who plan to become pregnant in the next 1-2 years, with the aim of starting supplementation before conception. Supplementation will becontinued throughout pregnancy, until the baby is delivered. In order to collect data for 1,600 pregnancies the study will recruit 4000-5000 women.
This is because the study so far has shown that mothers with higher intakes of green leafy vegetables (GLVs), fruit and milk had larger babies. Such foods are rich in vitamins and minerals and one explanation for the results, consistent with other data, is that micronutrients are limiting for fetal growth. Another is that the results simply reflect confounding by unmeasured maternal factors linked to eating more of these foods. The strength of the associations (a mean difference in birthweight between the highest and lowest categories of GLV intake of 170g) merited further investigation, and led to the Mumbai Maternal Nutrition Project (MMNP), launched in 2006.
MMNP is a randomised controlled trial of a food-based micronutrient-rich supplement, designed to improve the micronutrient status of women preparing for pregnancy. Green leafy vegetables, fruit and milk are combined into savoury snacks, like samosas, which are cooked fresh each day and distributed to centres throughout the study area (Bandra, Khar, Santa Cruz and Andheri). These supplements were developed during 2 years of pilot work and there are over 20 different recipes designed to maximise nutrient content and minimise monotony for the women participants. Control supplements are also made entirely from locally sourced vegetables, and prepared to be similar in outward appearance to the intervention supplements.
The immediate study outcomes include maternal micronutrient status, fetal growth (measured by ultrasound), newborn size and body composition and infant survival. Later outcomes will include growth and cognitive performance, and markers of cardiovascular risk, in the children.
The project is funded by the Wellcome Trust, the Parthenon Trust and ICICI Bank Ltd

Sara Afshar is passionate about her interdisciplinary research
Sara Afshar is passionate about her interdisciplinary research

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Christina's work is NIHR funded
Christina's work is NIHR funded
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