The Entebbe Mother and Baby Study at 21 years (EMaBS@21) is not just a continuation of a long-term cohort study, it is a crucial opportunity to answer pressing global and regional questions about how early-life infections and environmental exposures shape long-term health. With 500 out of 900 participants enrolled within five months, recruitment has been promising.

Globally, longitudinal cohort studies have provided vital evidence on the lasting effects of early-life physical and social exposures, guiding policy on disease prevention, and chronic illness management. However, Africa has a limited number of such long-term studies, making EMaBS one of the few cohorts to provide regional data tailored to local health challenges. The findings from EMaBS@21 will contribute to global knowledge while offering targeted recommendations for Uganda and the wider region, where the burden of infectious and non-communicable diseases remains high.

Navigating the challenge of retention

A key factor in the success of EMaBS@21 is the strong foundation of participant engagement built over the years with the EMaBS cohort. The ability to bring back 900 participants at this stage is not about new retention efforts within EMaBS@21, but rather a reflection of the long-term relationships, trust, and strategic engagement that have been in place throughout EMaBS.

Young adults aged 18-21 are navigating major life transitions, such as higher education, employment, and family responsibilities, making their continued participation in research a significant achievement. Over the years, the study team has addressed challenges like participant mobility, scheduling conflicts, and skepticism about clinical research. Personalized follow-ups, flexible scheduling, and continuous community engagement have helped sustain interest and involvement.

Additionally, peer networks, ambassador programs, and incentives have reinforced the importance of participation. The commitment to building trust within local communities has been central to success ensuring that participants feel valued and understand the impact of their contribution to scientific research.

By maintaining these strong relationships, the study has successfully reached this milestone, with over half of the target group of 900 participants, already returning for follow-up at age 21.

Expanding research through the cohort

The Entebbe Mother and Baby Study (EMaBS) has grown into a vital research platform, providing long-term insights intoinfection, immunity, and overall health outcomes. Over the years, it has supported novel studies in maternal and child health, allergy, and infectious disease epidemiology, while also serving as a foundation for interdisciplinary collaborations within the MRC/UVRI & LSHTM Uganda Research Unit.

Through its long-term cohort, EMaBS has provided valuable insights into immune system development, vaccine responses, and the epidemiology of infectious diseases such as tuberculosis, malaria, and HIV. Additionally, it has also played a key role in understanding how early-life infections and environmental exposures influence long-term health, including the risk of non-communicable diseases (NCDs) like diabetes, hypertension, and asthma.

As non-communicable diseases (NCDs), particularly cardiovascular diseases (CVDs), continue to rise in sub-Saharan Africa, understanding their origins and risk factors remains crucial. Addressing this gap, the MRC/UVRI and LSHTM Uganda Research Unit in collaboration with London School of Hygiene & Tropical Medicine, Kenya Medical Research Institute – Wellcome Trust and the University of Manchester is conducting a study titled, “Entebbe Mothers and Babies at 21 (EMaBS@21)."

​Funded through a research grant from the Medical Research Council (MRC) UK, this study builds upon the unique Entebbe Mother and Baby Study (EMaBS) birth cohort, which has tracked the health and development of participants from pre-natal stages through childhood and adolescence for over two decades. By linking newly collected data to the vast archive of socio-demographic, genetic, immunization and nutrition information, the study will shed light on how early life exposures such as infections and undernutrition shape the cardiovascular health trajectory in adulthood.

Filling critical gaps in cardiovascular research

The EMaBS at 21 study aims to understand how early life factors, like infections and malnutrition affect the development of CVD risk factors such as blood pressure, lipid levels, glucose metabolism and body mass index. The study focuses on understanding how these factors play out in the sub-Saharan context, where early-life exposures differ from those in high-income countries. 

Professor Emily Webb, Principal Investigator, emphasizes that there are very few birth cohorts in tropical Africa, limiting our understanding of how early-life exposures impact long-term health outcomes. The EMaBS cohort offers a unique opportunity to identify critical moments in the life-course where targeted interventions could reduce future risk of CVD.  

A comprehensive approach

This ambitious study uses a mixed-methods approach, combining quantitative and qualitative research. Researchers will collect physical measurements, including anthropometry and blood pressure, along with biological samples such as blood, stool, and urine, for measurement of blood glucose and lipid profiles, infections and metabolomics. Behavioral data, including diet, physical activity, alcohol, and tobacco use will be captured through questionnaires. Cutting edge laboratory analyses will explore pathways through which early life infections influence later CVD risk, while qualitative data from in-depth interviews and focus group discussions will offer insights into participants’ perceptions of CVD risk.

Advanced statistical techniques, including regression and latent class analyses, will be used to identify the links between early-life exposures and adult CVD risk.

Evidence-based interventions

The findings from EMaBS@21 are expected to inform health policy and intervention strategies aimed at reducing the growing burden of cardiovascular diseases in sub-Saharan Africa. By addressing the specific early-life exposures affecting populations in the region, the study aims to develop targeted interventions for populations with unique health trajectories.

About the key scientists:

Professor Emily Webb (study Principal Investigator) is the Director of the MRC International Statistics and Epidemiology Group (ISEG), and co-theme leader for ISEG's work on emerging and neglected diseases. Her current research focuses on the design and analysis of intervention and observational studies in the fields of helminths, vaccines and child health. She leads capacity strengthening programmes in epidemiology and medical statistics for scientists from sub-Saharan Africa.

Bridgious Walusimbi (study Lead Investigator) is a Doctoral researcher at Makerere University, a Research Fellow at London School of Hygiene and Tropical Medicine, as well as Honorary Research Fellow at University of Manchester. He is a bioinformatician with a strong desire to become a top-level researcher committed to improving health of communities in Sub-Saharan Africa through cutting-edge research founded on statistical modelling in infection and immunity, underpinned by a strong base in genetics, epigenetics, metabolomics and microbiome science. He is also involved in Africa Bioinformatics capacity building initiatives such as H3A Africa as faculty.

About the collaborating institutions:

The Medical Research Council/Uganda Virus Institute/ London School of Hygiene & Tropical Medicine Uganda Research Unit (MRC/UVRI & LSHTM) is an internationally recognized center of excellence for research and training. Its mission is to conduct high-quality research that adds knowledge and leads to improved control of infectious and non-communicable diseases in Uganda, Africa and globally, through translation of scientific findings into policy and practice, and rigorous research capacity building.

University of Manchester is a prestigious member of the Russell Group, renowned for its world-class research, exceptional teaching, and commitment to social responsibility. Established in 1824, it has a rich history of groundbreaking achievements, including hosting 26 Nobel Prize winners and pioneering innovations such as the first nuclear reaction, the modern computer, and the isolation of graphene. With a focus on interdisciplinary collaboration and global impact, it continues to address major global challenges, provide transformative education, and shape future leaders.

Kenya Medical Research Institute (KEMRI) is a State Corporation established in Kenya in 1979 through the Science and Technology (Repealed) Act, Cap 250 of the Laws of Kenya operated under the Science Technology and Innovation Act, 2013 as the national body responsible for carrying out research in human health in Kenya. Currently, KEMRI operates under Legal Notice No. 35 of March 2021. KEMRI has grown from its humble beginning over 40 years ago to become a regional leader in human health research. The Institute currently ranks as one of the leading Centres of excellence in health research both in Africa as well as globally.

Learn more about vaccine research at the Unit.