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

幼儿期严重营养不良是全球关注的一个重大公共卫生问题。这产生了严重的后果：-短期：对儿童的生存：一切形式的营养不良是全世界五岁以下儿童死亡总数的45%左右的原因。-长期：促进儿童茁壮成长：人们日益认识到，生命早期营养不良导致全球非传染性疾病迅速流行。随着越来越多的儿童在童年时期营养不良的情况下幸存下来，越来越需要了解导致长期问题的原因。这方面的证据将导致：改善儿童营养不良的早期治疗；改善长期治疗，减少长期不良反应。在这个项目中，我们有一个独特的机会来探索以下三组儿童/成人：-牙买加：在20世纪80年代遭受严重营养不良的儿童已经进行了几次跟踪调查，并根据已经收集的数据进行了进一步分析。-马拉维：我们最近跟踪了一组2005/6年度因严重营养不良入院的儿童。我们计划更深入地分析现有数据，也可能在未来收集新的数据。-埃塞俄比亚：在1983-85年埃塞俄比亚大饥荒时还是儿童的个人将在一项试验性研究中进行跟踪调查。从上述两个项目中学习将为埃塞俄比亚的工作提供信息和改进计划。我们的目标是了解早期儿童营养不良后的长期问题是什么，以及为什么会出现这些问题（这两个问题联系在一起的“机制”）。本申请中提出的工作是上述未来项目的背景。计划开展两项主要活动A)审查现有证据：我们将检索科学文献，以更好地了解迄今为止其他研究发现的关于生命早期营养不良与成人非传染性疾病之间的联系。通过这种方式，我们将确定在未来工作中要针对的关键知识差距。B)合作会议-我们将把以上三组儿童的团队聚集在一起：相互学习，分享经验。通过这种更好的未来工作将是可能的，与单独跟踪每个组相比，有很大的潜力来提高整体学习。本次会议将于2019年秋季在埃塞俄比亚举行：我们将邀请一些重要专家为未来的工作制定详细的计划。埃塞俄比亚/马拉维/英国团队还将访问牙买加（最先进/经验最丰富的团队），以学习他们的经验，从而帮助规划马拉维和埃塞俄比亚更好的未来项目。

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.