Evaluating the causal effects of anti-malarial chemoprevention in pregnancy and childhood on growth outcomes - PROJECT SUMMARY Malaria and growth faltering continue to be major causes of child morbidity and mortality in sub- Saharan Africa where over 400,000 children under the age of 5 die from malaria1 and 57 million children are stunted2 each year. Given the high co-prevalence of these conditions in the region, interventions that synergistically address both malaria and growth failure may have a larger impact on child health than individual efforts to prevent either condition.3 There is increasing evidence that malaria infections in pregnancy and childhood may contribute to poor growth outcomes through increased risks of low birthweights4–9, systemic inflammation10–15, and gut microbiome dysbiosis16–19. Maternal and neonatal factors are the most influential for child growth20–22, so there is a critical need to identify interventions that prevent these malaria-associated risks in pregnancy and early childhood to reduce long-term growth faltering. Intermittent preventative treatments in pregnancy (IPTp) and childhood (IPTc), where pregnant women and young children are regularly given anti- malarial drugs, have emerged as key strategies to control malaria in high-transmission settings. These treatments have been shown to effectively lower malaria infections and could subsequently improve child growth outcomes, but no prior studies have systematically assessed the impact of IPTp and IPTc on growth faltering. Here, we propose a study that aims to (1) evaluate the effect of IPTp and IPTc on child growth and (2) investigate the causal pathways through which IPTp and IPTc affect child growth. We will leverage rich, longitudinal data from two ongoing randomized trials of IPTp and IPTc in Uganda, allowing us to measure child height and weight, inflammatory biomarkers, and gut microbiome composition over several years. Our findings will improve our understanding of how malaria chemoprevention impacts child growth and may guide the implementation of future interventions that target both malaria and growth faltering. This award will also support the career development of Anna Nguyen, a doctoral student in the Department of Epidemiology and Population Health at the Stanford School of Medicine. Through completing the proposed research, the applicant will pursue training in (1) the epidemiology of maternal and child malaria, (2) causal inference methods for longitudinal data, (3) gut microbiome data analysis for population health research, and (4) responsible conduct of global health research. The applicant will be supported by a mentorship team comprising of experts in casual inference methods, malaria intervention trials, gut microbiome analyses, and global health research. Through this fellowship, the applicant will develop strong methodological skills, gain subject expertise, and become a more independent epidemiologic researcher. The proposed study will provide a strong foundation for the applicant’s future academic research career and position her to become a leader in casual inference, infectious disease epidemiology, and global health.
