Understanding and acting on the developmental origins of health and disease in Africa would improve health across generations

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ABSTRACT

Data from many high- and low- or middle-income countries have linked exposures during key developmental periods (in particular pregnancy and infancy) to later health and disease. Africa faces substantial challenges with persisting infectious disease and now burgeoning non-communicable disease.This paper opens the debate to the value of strengthening the developmental origins of health and disease (DOHaD) research focus in Africa to tackle critical public health challenges across the life-course. We argue that the application of DOHaD science in Africa to advance life-course prevention programmes can aid the achievement of the Sustainable Development Goals, and assist in improving health across generations. To increase DOHaD research and its application in Africa, we need to mobilise multisectoral partners, utilise existing data and expertise on the continent, and foster a new generation of young African scientists engrossed in DOHaD.

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Most cited references 19

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Maternal and child undernutrition and overweight in low-income and middle-income countries

Robert E Black, Cesar G Victora, Susan P. Walker … (2013)

The Lancet, 382(9890), 427-451

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Breastfeeding in the 21st century: epidemiology, mechanisms, and lifelong effect.

Cesar Victora, Rajiv Bahl, Aluísio Barros … (2016)

The importance of breastfeeding in low-income and middle-income countries is well recognised, but less consensus exists about its importance in high-income countries. In low-income and middle-income countries, only 37% of children younger than 6 months of age are exclusively breastfed. With few exceptions, breastfeeding duration is shorter in high-income countries than in those that are resource-poor. Our meta-analyses indicate protection against child infections and malocclusion, increases in intelligence, and probable reductions in overweight and diabetes. We did not find associations with allergic disorders such as asthma or with blood pressure or cholesterol, and we noted an increase in tooth decay with longer periods of breastfeeding. For nursing women, breastfeeding gave protection against breast cancer and it improved birth spacing, and it might also protect against ovarian cancer and type 2 diabetes. The scaling up of breastfeeding to a near universal level could prevent 823,000 annual deaths in children younger than 5 years and 20,000 annual deaths from breast cancer. Recent epidemiological and biological findings from during the past decade expand on the known benefits of breastfeeding for women and children, whether they are rich or poor.

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Associations of linear growth and relative weight gain during early life with adult health and human capital in countries of low and middle income: findings from five birth cohort studies

Linda S Adair, Caroline Fall, Clive Osmond … (2013)

Summary Background Fast weight gain and linear growth in children in low-income and middle-income countries are associated with enhanced survival and improved cognitive development, but might increase risk of obesity and related adult cardiometabolic diseases. We investigated how linear growth and relative weight gain during infancy and childhood are related to health and human capital outcomes in young adults. Methods We used data from five prospective birth cohort studies from Brazil, Guatemala, India, the Philippines, and South Africa. We investigated body-mass index, systolic and diastolic blood pressure, plasma glucose concentration, height, years of attained schooling, and related categorical indicators of adverse outcomes in young adults. With linear and logistic regression models, we assessed how these outcomes relate to birthweight and to statistically independent measures representing linear growth and weight gain independent of linear growth (relative weight gain) in three age periods: 0–2 years, 2 years to mid-childhood, and mid-childhood to adulthood. Findings We obtained data for 8362 participants who had at least one adult outcome of interest. A higher birthweight was consistently associated with an adult body-mass index of greater than 25 kg/m2 (odds ratio 1·28, 95% CI 1·21–1·35) and a reduced likelihood of short adult stature (0·49, 0·44–0·54) and of not completing secondary school (0·82, 0·78–0·87). Faster linear growth was strongly associated with a reduced risk of short adult stature (age 2 years: 0·23, 0·20–0·52; mid-childhood: 0·39, 0·36–0·43) and of not completing secondary school (age 2 years: 0·74, 0·67–0·78; mid-childhood: 0·87, 0·83–0·92), but did raise the likelihood of overweight (age 2 years: 1·24, 1·17–1·31; mid-childhood: 1·12, 1·06–1·18) and elevated blood pressure (age 2 years: 1·12, 1·06–1·19; mid-childhood: 1·07, 1·01–1·13). Faster relative weight gain was associated with an increased risk of adult overweight (age 2 years: 1·51, 1·43–1·60; mid-childhood: 1·76, 1·69–1·91) and elevated blood pressure (age 2 years: 1·07, 1·01–1·13; mid-childhood: 1·22, 1·15–1·30). Linear growth and relative weight gain were not associated with dysglycaemia, but a higher birthweight was associated with decreased risk of the disorder (0·89, 0·81–0·98). Interpretation Interventions in countries of low and middle income to increase birthweight and linear growth during the first 2 years of life are likely to result in substantial gains in height and schooling and give some protection from adult chronic disease risk factors, with few adverse trade-offs. Funding Wellcome Trust and Bill & Melinda Gates Foundation.

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Journal

Journal ID (nlm-ta): Glob Health Action

Journal ID (iso-abbrev): Glob Health Action

Journal ID (archive): ZGHA

Journal ID (publisher-id): zgha20

Title: Global Health Action

Publisher: Taylor & Francis

ISSN (Print): 1654-9716

ISSN (Electronic): 1654-9880

Publication date Collection: 2017

Publication date (Electronic): 18 July 2017

Volume: 10

Issue: 1

Electronic Location Identifier: 1334985

Affiliations

[ ^a ] Stellenbosch Institute for Advanced Study (STIAS), Wallenberg Research Centre at Stellenbosch University , Stellenbosch, South Africa

[ ^b ] MRC/Wits Developmental Pathways for Health Research Unit, Department of Paediatrics, Faculty of Health Sciences, University of the Witwatersrand , Johannesburg, South Africa

[ ^c ] Dalla Lana School of Public Health and Department of Surgery, University of Toronto , Toronto, Canada

[ ^d ] L V Prasad Eye Institute , Hyderabad, India

[ ^e ] Department of Public Health and Clinical Medicine, Umeå University , Umea, Sweden

[ ^f ] African Population and Health Research Center , Kenya

[ ^g ] Department of Pediatrics, University of British Columbia , Vancouver, Canada

[ ^h ] Institute of Child Health, University College London , London, UK

[ ⁱ ] King Edward Memorial Hospital Research Centre , Pune, India

[ ^j ] INDEPTH Network , Ghana

[ ^k ] Department of Diabetic Medicine and Endocrinology, University of Cape Town , Cape Town, South Africa

[ ^l ] Department of Epidemiology, Hospital Farhat Hached, Sousse , Tunisia

[ ^m ] Department of Anthropology, University of the Witwatersrand , Johannesburg, South Africa

[ ⁿ ] Division of Women’s Health, King’s College London , London, UK

[ ^o ] College of Medicine, University of Malawi , Zomba, Malawi

[ ^p ] DST-NRF Centre of Excellence in Epidemiological Modelling and Analysis (SACEMA), University of Stellenbosch , Stellenbosch, South Africa

[ ^q ] Human and Social Development Research Programme, Human Sciences Research Council , Durban, South Africa

[ ^r ] Department of Psychiatry, Stellenbosch University , Stellenbosch, South Africa

[ ^s ] Department of Applied Epidemiology, University of Yaoundé , Yaounde, Cameroon

[ ^t ] Department of Psychology, Stellenbosch University , Stellenbosch, South Africa

[ ^u ] Department of Social Policy and Intervention, University of Oxford , Oxford, UK

Author notes

CONTACT Shane A. Norris shane.norris@ 123456wits.ac.za MRC/Wits Developmental Pathways for Health Research Unit, Department of Paediatrics, Faculty of Health Sciences, University of the Witwatersrand , 7 York Road, Parktown, 2198 Johannesburg, South Africa

Author information

Shane A. Norris http://orcid.org/0000-0001-7124-3788

Moffat Nyirenda http://orcid.org/0000-0003-2120-4806

Juliet R. C. Pulliam http://orcid.org/0000-0003-3314-8223

Eugene Sobngwi http://orcid.org/0000-0001-5457-6572

Mark Tomlinson http://orcid.org/0000-0001-5846-3444

Cari van Schalkwyk http://orcid.org/0000-0001-5154-1390

Article

Publisher ID: 1334985

DOI: 10.1080/16549716.2017.1334985

PMC ID: 5533158

PubMed ID: 28715931

SO-VID: 887d7722-3a02-429b-8d7f-ea9cc4d81747

License:

This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

History

Date received : 10 October 2016

Date accepted : 10 March 2017

Page count

Figures: 1, References: 18, Pages: 5

Funding

Funded by: Knut and Alice Wallenberg Foundation 10.13039/501100004063

The consultation meeting was funded through a STIAS grant from the Knut and Alice Wallenberg Foundation.

Understanding and acting on the developmental origins of health and disease in Africa would improve health across generations

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UCL: UN SDG 03 Good Health and Well-Being

Most cited references 19

Maternal and child undernutrition and overweight in low-income and middle-income countries

Breastfeeding in the 21st century: epidemiology, mechanisms, and lifelong effect.

Associations of linear growth and relative weight gain during early life with adult health and human capital in countries of low and middle income: findings from five birth cohort studies

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