Children that survive and thrive

What is the C theme about?

During the Millenium Development Goal (MDG) era, deaths for children under five have been halved. Our focus is on ending preventable child deaths, and improving child development and nutrition.

Despite significant progress in reducing childhood mortality there are still more than 6.7 million deaths of children under five each year (1 child every 5 seconds), almost half occurring in the first month of life.

In 2013 preterm birth complications became the leading cause of child deaths at 1 million per year, followed by pneumonia. The causes with the largest reductions since 2000 were pneumonia, diarrhea and measles, together accounting for almost half of the overall reduction. Those with the slowest progress (<3% per year) included preterm birth, congenital conditions, neonatal sepsis, injury.

Many of these deaths could be prevented if we reached every woman and every child with evidence based interventions, particularly care of the newborn and prevention, diagnosis and treatment of infections. Evaluating how best to implement, overcoming systems barriers and promoting behaviour change, is critical. The School excels at this research as well as more upstream discovery and delivery research.

Worldwide, as more children survive, increasing attention is focused on healthy childhood: nutrition, growth, development and the prevention and management of injury and disability, maximizing health in later life.

What does the C theme do?

MARCH is uniquely positioned to address the priority challenges in child and newborn health. As one of the world’s largest schools of public health, London School of Hygiene & Tropical Medicine researchers work across a range of disciplines: from molecular biologists discovering vaccine targets and biomarkers of infections, and immunologists unpacking the relationship between host immunity and infection, through to social scientists, epidemiologists, mathematical modellers and health economists, using qualitative and quantitative approaches to describing and understanding newborn and child health, and to design and evaluate interventions to address key challenges.

School researchers also lead multidisciplinary research in collaboration with other sectors, for example research on injury and violence prevention in schools, collaborative research on nutrition and agriculture, innovative work on water, sanitation and hygiene (WASH), and research on the prevalence and impact of disability in childhood.

C theme research

 Examples of research:

SPRING (Sustainable Program Incorporating Nutrition and Games)

SPRING is a five year programme in Haryana, India and Rawalpindi, Pakistan funded by the Wellcome Trust to develop and evaluate an innovative, integrated strategy to reduce child deaths and improve child growth and development. The intervention consists of a community worker home visit package from pregnancy through the first 2 years of life to promote optimum child care practices, including infant and young child feeding, mother-child interaction an play. The evaluation is through a cluster randomized controlled trials in each site.

SuperAmma handwashing promotion

The Super-Amma programme in rural India represents leadership in behavior change research that also engages the private sector. Through the use of a fictional character (SuperAmma) and emotional motivators the intervention was shown to increase handwashing with soap at key times by 31%.

TRAC II (Tracking Resistance to Artemisinin Collaboration)

Resistance to artemisinins, the first-line treatment for falciparum malaria, is a major threat to children. TRAC is conducting research to track and limit the spread of resistance, including assessments of treatment.

CHAMPS (Child Health and Mortality Prevention Surveillance)

CHAMPS seeks to provide better data about how, where and why young children are getting sick and dying. There goal is to establish a network of high-quality sites to collect robust, standardized data that can be shared across a range of partners and stakeholders to analyze and track the preventable causes of child mortality. The resulting data will be used to develop evidence-based policy, set priorities for research and inform the provision of much-needed vaccines and medicines. In order to collect this data, CHAMPS will systematically identify the causes of under-five mortality at sites across South Asia and Sub-Saharan Africa. CHAMPS aim to capture both perinatal and childhood causes of death from infectious and noninfectious etiologies. A special emphasis will be placed on identifying and classifying stillbirths and neonatal deaths, which will require special attention towards prioritizing and ensuring health services for pregnant women.

Personalised Risk assessment in Febrile illness to Optimise Real-life Management across the European Union (PERFORM)

PERFORM aims to improve diagnosis and management of febrile patients, by application of sophisticated phenotypic, transcriptomic  (genomic, proteomic) and bioinformatic approaches to well characterised large-scale, multi-national patient cohorts. LSHTM are leading on comparative health systems analysis and health technology assessment, describing current care pathways for acute febrile illness in children and evaluate the potential of changing diagnosis and management.

Integrated eDiagnosis Assessment for children under 5 years old (IeDA)

Improving the assessement of chilhood illness at the primary health care level.

Saving Brains, Grand Challenges Canada

Complex impact and process evaluation of portfolio of early child development interventions in various low-resource settings.

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Examples of outputs:

ChroSam

Management of Acute Malnutrition in Infants aged <6 months. Other objectives include: to improve catch-up growth/nutritional status; to improve maternal mental health/caring practices; to improve infant feeding practices.

Associated research groups: 

MRC International Nutrition Group

Researchers from the School led by Branwen Hennig and Andrew Prentice have produced the first evidence in humans that a mother’s diet before conception can lead to epigenetic modifications in her child’s DNA, with the potential to permanently affect lifelong health. By utilising a unique ‘experiment of nature’ in rural Gambia, where there is marked seasonal variation in people’s dietary patterns, they found that infants from dry season conceptions had lower rates of DNA methylation than those conceived during the wet season, altering how the genes will be interpreted with potentially lifelong impact.

Artemsinisn Combination Therapy (ACT) consortium (ACTc)

Operation research on access, targeting, quality and safety of Artemsinin Combination Therapy including a lot of work on malarial rapid diagnostic tests.