The Global Health Network The Global Health Network WHO Collaborating Centre

www.tghn.org

Not a member?

Find out what The Global Health Network can do for you. Register now.

Less

Member Sites A network of members around the world. Join now.

Research Tools Resources designed to help you.

India

Early Interventions to Support Trajectories for healthy lifE in India: The EINSTEIN Study

The health and economic burden of non-communicable diseases is increasing rapidly globally and falls disproportionally on low- and middle-income countries (LMICs).

Key Facts

Diabetes: In India, 65 million people have diabetes and 77 million are pre-diabetic. Unchecked, the population with diabetes is expected to reach 109 million by 2035.
Cardiometabolic and Mental Health: 13% of young people aged 1–16 years in India experience mental health disorders.
Undernutrition in Children (under 5): The prevalence of stunting is 48%; wasting 20%; underweight 43%; and anaemia 69%.
Undernutrition in Women (15–49 years): 33% are underweight while 55% are anaemic.
Low Birth Weight: Approximately 25% of babies born in India each year have low birth weight.
Obesity: Rates are increasing with 19% of children and adolescents and 15% of women of reproductive age being overweight or obese.

HeLTI India - The EINSTEIN Study

The HeLTI research hypothesis is that integrated interventions administered pre-conceptionally and at appropriate points across the life-course (pregnancy, infancy and childhood) will reduce childhood adiposity, improve cardiovascular and metabolic health, and improve child neurodevelopmental outcomes. The EINSTEIN study is a community-based, cluster randomized intervention with three arms (pre-conception, pregnancy and control) set in rural Mysore, South India, with individual villages forming the basis for the cluster. Women of reproductive age receive a longitudinal multi-faceted intervention delivered by community health workers comprising of:

a) multiple micronutrients;

b) a group parenting program to address maternal depression and improve child development;

c) hygiene and infection prevention measures;

d) reduction of environmental pollution exposure. Interventions are underpinned by a lifestyle behaviour change strategy.

The primary outcome is adiposity in children at 5 years of age measured by fat mass index. Other key outcomes at 5 years include: overweight and obesity, glucose metabolism, blood pressure, and infant/child neurodevelopmental outcomes. In addition, the study tracks a host of intermediate and process outcomes, as well as the efficacy, cost-effectiveness, and acceptability of the intervention package, compared with standard care. The study reports on the relative costs and benefits of commencing the intervention in early pregnancy compared with the preconception period.

The study benefits from outstanding intellectual and infrastructure resources in India and Canada, built over years of research and community engagement. The Indian and Canadian teams bring together researchers from 18 institutions with complimentary expertise in DOHaD research, intervention cohorts, longitudinal studies, data management and knowledge translation/policy development. These strengths combined with strong collaborations with knowledge users and health policy experts will ultimately allow implementation and scale-up of the most effective interventions.