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

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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.