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Management of small, nutritionally vulnerable infants aged 6 months or less - NU/LSHTM project

Supervisory team

LSHTM

Lead: Dr Marko Kerac (marko.kerac@lshtm.ac.uk), Faculty of Epidemiology & Public Health)

Nagasaki University

Prof Michiko Toizumi (toizumi@nagasaki-u.ac.jp) 

NB. Prof Toizumi is tentatively the second supervisor from NU. Prof Toizumi will propose another potential supervisor from NU if necessary and depending on the applicant’s specific area of interest) 
 

Project

In this PhD, applicants would have the flexibility to choose from a variety of projects and project methods under the overall theme of improving the management of infant nutrition/malnutrition. 

The PhD would contribute to the work of the MAMI Global Network (Management of small, nutritionally at-risk Mothers and Infants), which LSHTM co-founded. The MAMI vision is that “every small and nutritionally at-risk infant under six months and their mother is supported to survive and thrive.” 

The PhD is particularly topical since new (July 2023) WHO guidelines on child malnutrition highlight the importance of the <6m age group, but also note the paucity of evidence currently available. Having contributed to the guidelines as part of the WHO Guideline Development Group, MAMI supervisors and collaborators will be able to give the PhD student clear direction on how to best fill those evidence gaps.

The MAMI project overall addresses three core problems:

  1. Globally, millions of infants are small and undernourished. Some 21% of infants worldwide in low/middle income country (LMIC) settings are wasted (too thin), 18% are stunted (too short for their age), 20% are underweight. The problem is not just confined to LMIC: even in high income settings like UK and Japan, infants are born premature and low birth weight and are vulnerable and would benefit from improved management approaches. 
     
  2. These infants are at increased risk of:
  • Death and illness in the short-term
  • Poor development and in turn poorer educational achievement 
  • Non-communicable disease in adulthood / later life
     
  1. Existing care is limited and often fragmented: even if the infants are properly identified, they often do not get the treatment they need. 

 

Over the years, work by LSHTM and others in the MAMI network has increased the profile of this vulnerable group of infants. For example, we have developed a suite of support tools (a clinical care pathway) to help healthcare workers better identify and support at-risk infants. We are currently testing this in a large RCT in Ethiopia and will have lots of secondary data to analyse (https://www.isrctn.com/ISRCTN47300347) 

We are also working on a closely-related project looking at long-term outcomes post-malnutrition which will have secondary data from Ethiopia, Malawi and Jamaica (https://datacompass.lshtm.ac.uk/id/eprint/2655/ )

Some other relevant past projects are listed below:  

This PhD will be tailored according to the applicant’s professional background and personal areas of interest. Options include:

  • Development of clinical teaching and training tools - e.g. for those with medical, nursing, dietetics or other healthcare background
  • Policy analysis and development - e.g. for those with public health, health promotion background
  • Secondary analyses of existing data - e.g. for those with an epidemiology / stats background 
  • Qualitative work (either desk-based or including travel to our main partner countries Ethiopia, Malawi, +/- others) – to understand community and healthcare worker perceptions of MAMI
  • Health-economics – to explore the scalability of the intervention (e.g. for health economists)
  • Pilot testing of our MAMI clinical care pathway - this could even be done in high-income settings focusing on preterm and LBW and other infants who have feeding difficulties (e.g. for clinicians)
  • Infant and child health; nutrition; mental health; maternal health (since there are many possible causes underlying infant malnutrition)  (e.g. maternal health, child health, mental health specialists) 
     

References

  1. https://www.ennonline.net/ourwork/research/mami
  2. WHO Guidelines on the Management of Infant and Child Wasting, July 2023. https://app.magicapp.org/#/guideline/7330 
  3. Research Priorities to Improve the Management of Acute Malnutrition in Infants Aged Less Than Six Months (MAMI), PLoS Medicine, 2015. https://doi.org/10.1371/journal.pmed.1001812  
     

The role of LSHTM and NU in this collaborative project

LSHTM will be the overall lead since we have long-term field experience in MAMI and an extensive network of contacts including WHO / UNICEF. We also hold the data from both MAMI RCT and CHANGE studies. NU would provide experience to support the individual student’s specific area of subtopic or method interest

Particular prior educational requirements for a student undertaking this project

This depends on the exact project and proposed methodology – an appropriate undergraduate and MSc qualification would be expected as a basic educational requirement. 

Applicants with prior experience of publications are particularly encouraged to apply. 

Please contact marko.kerac@lshtm.ac.uk to discuss. 

Skills we expect a student to develop/acquire whilst pursuing this project

As well as solid technical and scientific skills, we would also expect a student to develop skills and experience in the wider public health environment. 

The project team is particularly focused on real-world policy/practice impact and hence students would be exposed to wide global networks of colleagues and collaborators working on many different aspects of the research > policy > practice pathway. We expect that the results of our work would feed into future WHO Guidelines on child malnutrition.