Evaluating multicomponent interventions to optimize health and development for children and adolescents living in poverty - PROJECT SUMMARY Over 250 million children under age 5 (43%) in low- and middle-income countries (LMIC) experience delays in development which have lasting effects on academic attainment, literacy, and economic opportunities, contributing to adverse health. Early interventions focused on responsive caregiving, early learning, and nutrition in this context have improved short-term health and development outcomes, however, whether these effects persist beyond 6 years of age is largely unknown. Further, few interventions have simultaneously targeted infectious disease prevention, another known risk factor for poor childhood development that disproportionately impacts children in LMICs. The objective of this K99/R00 proposal is to identify mechanisms through which early WASH and nutrition interventions impact health and development, assess whether these effects persist into adolescence, and estimate the potential impact of novel multicomponent interventions that target multiple prevalent risk factors in early life simultaneously. The work proposes to (1) leverage data from a large cluster randomized controlled trial in rural Bangladesh to uncover the mechanism of impact of an effective early water, sanitation, hygiene (WASH), and nutrition intervention on middle-childhood development, (2) use population intervention effects to identify early intervention targets that take into account baseline prevalence of risk and the confluence of risk factors that children experience in early life, and (3) follow up children who received the early WASH and nutrition intervention to evaluate impacts on health and development in adolescence. This work fills critical gaps in the literature regarding how early WASH and nutrition interventions work to improve outcomes, which combinations of interventions could lead to the largest improvements in child development outcomes, and the impact of early WASH and nutrition interventions on later adolescent health and development outcomes. Conducted at the University of California Berkeley, the proposed research will be guided by an exceptional mentor team with expertise spanning epidemiologic and biostatistical methods and adolescent health. The proposed plan builds on the applicant’s background in the design and evaluation of interventions in early childhood by providing subject matter training in (1) late childhood and adolescent health and development; as well as methodological training in (2) causal mediation analysis; (3) population intervention effects and target trial emulation with observational data; and (4) best practices in reproducible and transparent research. Combined, the training and research plan prepare the applicant to pursue their long-term goal of conducting research to improve health and development over the life course in low-resource global settings. Aligned with NICHD’s strategic direction to improve child and adolescent health and the transition to adulthood, this work will inform the design of future interventions that optimize the health and development through childhood and adolescence in the context of global poverty.
