Birth Cohort in Coast Province, Kenya
Condition: Mortality; Morbidity; Child Development; Child Behaviour
Study type: Observational

Summary: 
      In 2010, 7.6 million children under the age of five died worldwide and yet the causes of only
      2.7% (0.205 million) of these deaths were medically certified. A thorough understanding of
      the causes of child mortality is necessary to guide research efforts aimed at tackling this
      important global health problem. Prospective birth cohort studies present an opportunity to
      examine the relationships between early-life exposures and multiple health and non-health
      related outcomes including death, illness, and socioeconomic factors. In this study, the
      investigators will provide insight into the underlying causes of child mortality by
      collecting data on early-life exposures and health and non-health related outcomes in the
      first year of life.
    

Detailed description: 
      In 2010, 7.6 million children under the age of five died worldwide, mainly from preventable
      and treatable conditions (Liu et al., 2012). Notably, the burden of under-five mortality
      varies dramatically by country. The majority of child deaths are seen in Africa (3.6 million)
      and southeast Asia (2.1 million deaths), compared to 0.16 million and 0.28 million under-five
      deaths in Europe and the Americas, respectively (Liu et al., 2012). In Kenya, over 120,000
      under-5 deaths were estimated in 2010 and approximately 35% of these deaths occurred in the
      neonatal period.

      A thorough understanding of the etiology of child mortality is necessary to guide research
      efforts aimed at tackling this important global health problem. Importantly, in 2010, the
      causes of only 2.7% (0.205 million) of all deaths in children under the age of five were
      medically certified (Liu et al., 2012), highlighting the need to gather data on the causes of
      mortality.

      Prospective longitudinal birth cohort studies present an opportunity to examine temporal
      relationships between early-life exposures (i.e. prenatal, pregnancy, and early postnatal
      exposures) and multiple health and non-health related outcomes including mortality,
      morbidity, and socioeconomic circumstances. It is well documented that exposures that occur
      early in life, including genetic, environmental, socioeconomic, and lifestyle factors, may
      have long-lasting effects on growth, development, and health outcomes throughout an
      individual's entire life course (Lynch & Smith, 2005). Thus, data on exposures during
      pregnancy and early childhood are valuable and may provide clues to the etiology of long-term
      outcomes.

      Additional value can be gained through cross-cohort collaborations and comparisons (Larsen et
      al., 2013)(Paternoster et al., 2012)(Brion et al., 2011). Notably, by pooling data from
      multiple cohort studies, causal inferences can be made with greater confidence. For example,
      if a similar relationship is observed across multiple populations, each with their own
      distinct set of confounding variables, it is less likely that the observed association is
      being driven by confounders. Similarly, cross-cohort comparisons enable researchers to
      investigate patterns associated with health, social, and economic outcomes in distinct
      regions of the world. These types of analyses may provide valuable insight into the
      underlying causes of global health inequalities.

      The objective of this study is to implement a longitudinal prospective birth cohort study in
      Kenya to obtain extensive information on early-life exposures and health and non-health
      related outcomes in the first year of life.
    

Observational model: Cohort
Time perspective: Prospective
Sampling method: Probability Sample
Study population: 
        All pregnant women (and their unborn newborns) who consent to participate in the control
        arm of the previously approved trial "An integrated toolkit to save newborn lives and
        brains in Kenya" (NCT02208960) will be eligible for enrollment in this study. At the time
        of consent, participants will be informed that they are free to consent to the neonatal kit
        trial without consenting to the birth cohort study.
      
Keywords: Kenya; Cohort