London School of Hygiene & Tropical Medicine

Researchers from the School have been awarded funding from the Bill & Melinda Gates Foundation through the Achieving Healthy Growth programme to study the causes of poor growth among children in Africa.

Achieving Healthy Growth is part of the Grand Challenges in Global Health initiative which aims to overcome persistent bottlenecks preventing the creation of new and better health solutions for the developing world.

David Mabey, Professor of Communicable Diseases, and colleagues will use the $1.7m grant to investigate the causes of environmental enteropathy, a disorder of the small intestine which has been implicated in the poor growth of many children in low-income countries. The team will test the response of Malawian children to the antibiotic azithromycin through a randomised controlled trial to compare growth over a two year period and analyse the response of their intestinal tract to the treatment.

The study follows two decades of research by the School and collaborators at Johns Hopkins University and the University of California at San Francisco (UCSF) into the effects of azithromycin. In 1993, Professor Mabey and Professor Robin Bailey published a paper in The Lancet showing that a single oral dose of the antibiotic was an effective treatment of trachoma, the most common infectious cause of blindness. The research team has also recently been awarded a $10m grant, also from the Bill & Melinda Gates Foundation, to study the impact of the antibiotic on child mortality in Niger, Tanzania and Malawi.

Professor Mabey said: “We have been studying the effects of the broad spectrum antibiotic azithromycin on trachoma and other infectious diseases for many years; and working closely with the International Trachoma Initiative, who have donated more than 250 million doses of the drug to trachoma control and elimination programmes.

“Three years ago a study was published by our collaborators at UCSF which showed that all cause mortality in children aged 1-5 years was reduced by almost 50% in Ethiopian communities in which all children received an annual dose of azithromycin.

“These funds will enable us to study the mechanism underlying this remarkable finding, by looking at the effect of azithromycin on the function of the bowel, the absorption of nutrients and on the growth of babies in Malawi."

In addition, the Medical Research Council’s International Nutrition Group based at the School and at MRC Keneba in The Gambia, West Africa will receive funding of $2m each for two projects in The Gambia.

The first, with George Washington and Cambridge Universities, will select the most malnourished children and compare them with the best-nourished children to explore why the two groups differ despite the same environmental influences.

The second grant, with Leeds University, will follow up previous hints that aflatoxins (toxins produced by moulds growing on staple foods) may modify the DNA of young children in a way that affects a key pathway regulating child growth.

Professor Andrew Prentice, Director of the International Nutrition Group, said: “The failure of children to grow well in very poor populations is a very important measure of poor diet and multiple infections, as well as a signpost to future ill health and mortality.

“Despite decades of research we still do not properly understand why these children fail to thrive. In funding this consortium approach to Achieving Healthy Growth the Bill & Melinda Gates Foundation has encouraged leading international researchers to apply novel methods in discovery science to studying this age-old problem.”

The goal of the Healthy Growth grant programme is to discover the causes of faltering growth during the first 1,000 days of life and to identify effective and affordable interventions to promote healthy growth.