All Children Thriving
Recent World Health Organization (WHO) estimates show that there were 5.9 million deaths among children below five years of age in 20152. Approximately 45% of all child deaths under the age of five years take place during the neonatal period (first 28 days of life), which is the most vulnerable stage in a child’s life. India’s children remain among the most affected by poor maternal and child health, with 1.2 million children dying before their fifth birthday each year.
The most obvious consequence of poor mother and child health is mother deaths during child birth and neonatal and infant deaths. However, for those mothers and children that do survive birth, there remain several challenges that could impact their future survival and development. Children’s health is inextricably linked to the mother’s, a relationship that we have only begun to study and understand. A malnourished mother is more likely to have trouble during pregnancy and childbirth which is likely to impact the growth and development of the fetus and could result in a pre-term birth or a host of complications that will have a long-term impact on the child’s health and development. For instance, emerging research on developmental origins of health and diseases has suggested that an individual’s lifelong health and capacity is characterized by fetal nutrition at different stages of gestation and infancy. Likewise, research has also suggested that intrauterine growth restriction is linked to future non-communicable diseases that further exacerbate the magnitude of problems in the child.
It was to address some of these issues that the ‘All Children Thriving’ call was launched under Grand Challenges India (GCI) program, under the larger Grand Challenges in Global Health. The initiative intends to investigate novel cost-effective measurement tools and mechanisms to combat unhealthy birth, growth and development. By creating and measuring integrated solutions for healthy birth and development, the call is aimed at ensuring not only the survival of children but aims at ensuring that they lead a healthy and productive life.
Seven proposals are funded under this program and each project explores a unique aspect of the issue with special emphasis on innovative, impactful research on maternal and child health and development. Three projects are aimed at developing simple low-cost biomarkers that can be applied early in life to detect and predict adverse outcomes in mothers and children. Three projects intend to validate or develop interventions or packages of interventions to improve maternal and child health. One of the projects is aimed at development of bio-banks for long-term storage of bio-specimens to reduce time and cost for future research in this area.
This is a full grant supported under the call. The project intends to identify challenges to accelerate linear growth among infants/ children in low-income settings and strategies to overcome them. The study proposes delivery of an integrated package of interventions (nutritional, environmental, WASH and care) during pregnancy and early childhood in a community based model. Using stratified randomization, the proposal has been designed in a manner that permits us to assess the impact of these intervention packages when delivered synergistically or independently on growth and development of young child.
The study plans to enrol a cohort of pregnant women from the Gurugram Civil Hospital, Gurugram.
The project is aimed at building better bio-banks for long-term storage of bio-specimens. It has been planned to enroll a cohort of pregnant women, who are less than 20 weeks of gestation and follow them until delivery to study their vulnerability to environmental, clinical and biological factors. The study will contribute to our understanding of the association of these various factors with preterm birth (PTB). Biospecimes such as blood, saliva, high vaginal swab, urine and cord blood (at the time of delivery) will be collected from pregnant women. The study also intends to have transvaginal scans of pregnant women at different time points to contribute to imaging databanks and developing a simple standardized ultrasound imaging based tool for PTB. This study is building on huge research investments /archives of data that will not only accelerate the generation of knowledge-driven interventions, but will also reduce the time and cost of future research in this area. Most importantly, access to large number of standardized, accurately and consistently collected samples will aid in exploring prospective diagnostic or predictive biomarkers for adverse pregnancy outcomes.
The proposal is attempting to address the lack of a simple, low-cost, prospective biomarker for future short stature or stunting This study aims to validate the use of absolute neutrophil count as a predictor/biomarker for stunting in infants. It has been hypothesized that infants in settings with poor sanitation conditions and associated abnormal inflammation of the gut from infections subsequently have poor absorptions of nutrients and loss of supplements which eventually leads to stunting. Neutrophils are drawn to these sites of microbial colonization or are exhausted during the clearing of microbes from circulation. The study is trying to establish the low absolute neutrophil count as a measure of mucosal inflammation and as predictor of linear growth in Indian infants.
The study aims to assess the effect of depression on pregnancy and develop biomarkers for adverse pregnancy outcomes. The study plans to analyze stress outcomes on pregnancy, fetal growth and birth weight.This study has been proposed as a part of ongoing bio-repository cohort and proposes to estimate stress by cross-culture validated and standardized psychological instruments. The overall aim of the study is to determine stress biomarkers for early detection mothers at risk of preterm birth and intrauterine growth restriction (IUGR)and to develop3 interventions to reduce stress and reduce adverse birth outcomes.
The study is aimed at developing novel, low-cost test for pre-term birth (PTB). The proposal is intended to test and validate the low-cost salivary progesterone as a point-of-care (POC) test for detecting risk of PTBs in rural community settings of India. Offering non-invasive sampling of biological fluid that is easy to collect, the study allows validation of saliva from a large cohort of pregnant women residing in low-resource community settings. It has been planned to obtain single saliva sample from each participant and determine its predictive characteristics against gestation at delivery and other obstetrics and neonatal outcomes.
The study intends to develop an inter-generational intervention to ameliorate neonatal gut microbiota. Based on the hypothesis that consuming prebiotic starches such as high amylose maize starch (HAMS) by mothers during the third trimester of pregnancy will modify their fecal microbiota and will subsequently lead to a beneficial variation in the fecal microbiota of the newborn infant. This will consequently guide favorable intestinal activity, thus enhancing growth, and intellectual competence of the infant in the intermediate and long term.
A mother feeding the HAMS to her child, as a part of the study.
The project study proposes the development of nutrient rich genotypes in rice possessing the key nutraceuticals and therapeutic clues through which required nutrients such as iron and zinc for pregnant women and infants of rural households will be supplemented sustainably. Improved line of rice will be compared with the traditional parents and other popularly eaten white rice varieties for its nutritional content and therapeutic values. The improved lines of rice having nutritive, anti-diabetic and therapeutic characters may be registered.