Multi-center, prospective cohort study in Ghana on early-life exposure to malaria and nutrition-related non-communicable diseases in adult life

Keywords

Climate change impacts, malaria, dietary habits, cardio-metabolic health, young adults

Countries

Ghana

Summary

The main goal of this project is to establish robust understanding of the distributions, the risk factors, and the potential prevention strategies of cardio-metabolic diseases among young adults living in Ghana, with a focus on the role of early-life exposure to malaria. Cardio-metabolic conditions have risen tremendously in Ghana, but data on the cardio-metabolic state of adolescents and young adults are scarce. This lack of basic epidemiological information among adolescents and young adults has also been acknowledged for the behavioral risk factors, such as dietary practices, smoking habits, alcohol consumption, and sedentary behavior. Previous evidence pin-points towards an interlinkage between early-life exposure to malaria and the development of cardio-metabolic conditions in later life. The proposed mechanisms comprise malaria-specific inflammatory processes that alter brain structures and epigenetic profiles, restrictions in growth and function of major cardio-metabolic organs, as well as altered gut microbiota. Up to now, only fragmented research has been conducted to determine the contributions of early-life malaria exposure to the development of risk factors as well as cardio-metabolic conditions in sub-Saharan Africa. Therefore, the specific objectives of this project are i) characterizing the cardio-metabolic profiles and associated behavioral risk factors of young adults in three sites in Ghana; ii) determining the causal impact of early-life exposure to malaria on the cardio-metabolic profiles and associated dietary risk factors among these young adults; and iii) establishing the population’s readiness for an integrated program for the prevention of cardio-metabolic conditions, focusing on malaria prevention and dietary modifications during the first 1000 days of life.

Methodology

Methodologically, this project relies on three large randomized, controlled trials that were conducted 20 years ago to prevent clinical malaria during infancy. These former infants are re-invited to participate in the present study. We anticipate to retrieve 60% of them. They will be invited to the examination centers at nearby hospitals and health facilities. Trained personnel will conduct questionnaire-based interviews focusing on dietary practices, physical examinations incl. anthropometric measurements, venous blood sample collection, and laboratory analysis, incl. HbA1c, fasting glucose, hemoglobin concentration (Hb), malaria rapid test and microscopy, as well as blood lipids. To achieve objective i), we will apply descriptive statistics and appropriate graphical representations of cardio-metabolic conditions, by age group, sex, and early-life malaria status. For objective ii), we will employ instrumental variable analysis using the assignment to the former intervention group as the proxy to malaria protection, and various dietary and cardio-metabolic parameters as the outcomes. For objective iii), we will use an established readiness framework to determine the level of intervention readiness from in-depth interview data.

Main Cooperation Partners

• Dr. Yaw Ampem Amoako and Dr. Samuel Adjei, Kwame Nkrumah University of Science and Technology (KNUST), Kumasi, Ghana
• Prof. Jürgen May, Bernhard-Nocht-Institute of Tropical Medicine (BNITM), Hamburg, Germany
• Prof. Frank Mockenhaupt, Institute for Tropical Medicine and International Health (ITMIH), Charité – Universitaetsmedizin Berlin, Berlin, Germany
• Prof. Abdulai Abubakari, University for Development Studies (UDS), Tamale, Ghana
• Dr. Faith Agbozo, University of Health and Allied Sciences (UHAS), Ho, Ghana
• Prof. Abraham Oduro, Research and Development, Ghana Health Service (GHS), Accra, Ghana
• Prof. Daniel Chandramohan, London School of Hygiene and Tropical Medicine (LSHTM), London, United Kingdom

Main Funding Partners

University of Bonn, Transdisciplinary Research Area “Technology and Innovation for Sustainable Futures” (TRA6)

Publications

• Utomo DAM, Andriolo V, Bärnighausen T, Danquah I. Linking malaria in pregnancy with dietary behavior of the next generation. Brain Behav Immun. 2019 Aug;80:1-3.
• Bedu-Addo G, Alicke M, Boakye-Appiah JK, Abdul-Jalil I, van der Giet M, Schulze MB, Mockenhaupt FP, Danquah I. In utero exposure to malaria is associated with metabolic traits in adolescence: The Agogo 2000 birth cohort study. J Infect. 2017 Nov;75(5):455-463.
• Buchholz U, Kobbe R, Danquah I, Zanger P, Reither K, Abruquah HH, Grobusch MP, Ziniel P, May J, Mockenhaupt FP. Multiplicity of Plasmodium falciparum infection following intermittent preventive treatment in infants. Malar J. 2010 Aug 26;9:244.
• Danquah I, Dietz E, Zanger P, Reither K, Ziniel P, Bienzle U, Mockenhaupt FP. Reduced efficacy of intermittent preventive treatment of malaria in malnourished children. Antimicrob Agents Chemother. 2009 May;53(5):1753-9.
• Aponte JJ, Schellenberg D, Egan A, Breckenridge A, Carneiro I, Critchley J, Danquah I, Dodoo A, Kobbe R, Lell B, May J, Premji Z, Sanz S, Sevene E, Soulaymani-Becheikh R, Winstanley P, Adjei S, Anemana S, Chandramohan D, Issifou S, Mockenhaupt F, Owusu-Agyei S, Greenwood B, Grobusch MP, Kremsner PG, Macete E, Mshinda H, Newman RD, Slutsker L, Tanner M, Alonso P, Menendez C. Efficacy and safety of intermittent preventive treatment with sulfadoxine-pyrimethamine for malaria in African infants: a pooled analysis of six randomised, placebo-controlled trials. Lancet. 2009 Oct 31;374(9700):1533-42.
• Mockenhaupt FP, Reither K, Zanger P, Roepcke F, Danquah I, Saad E, Ziniel P, Dzisi SY, Frempong M, Agana-Nsiire P, Amoo-Sakyi F, Otchwemah R, Cramer JP, Anemana SD, Dietz E, Bienzle U. Intermittent preventive treatment in infants as a means of malaria control: a randomized, double-blind, placebo-controlled trial in northern Ghana. Antimicrob Agents Chemother. 2007 Sep;51(9):3273-81.

Duration of the Project

Start in October 2023

Team

• Prof. Dr. Ina Danquah
• Marian Abrafi Osei (candidate PhD)