BUilding Knowledge and a foundation for HeALthy lIfe trajectories: The BUKHALI Study

The health, societal and economic burden of NCDs is significant, increasing, and propagated by early life environments and later life adiposity, decreasing physical activity, increasing sedentary behaviour, poor dietary diversity, and intergenerational factors. The NCD burden falls heavily on low- and middle-income countries and this pattern is predicted to intensify dramatically in the near future. South Africa’s (SA) evolving burden of disease is complex due to: (i) persisting malnutrition (infant stunting of 20%); (ii) high prevalence of overweight and obesity (OWO) particularly among women; and (iii) rising rates of NCDs such as of type 2 diabetes (T2D). Global initiatives to mitigate adversity during the first 2000 days have resulted in significant improvements in maternal and child survival. However, the longer-term impact of interventions delivered from preconception to early childhood on child growth and social/cognitive development has been less clear. Therefore, there is a need to begin laying the foundation for healthy trajectories by optimising women’s health prior to and during pregnancy and reinforcing optimal health in the infant to offset obesity and cardiometabolic risk and improve cognitive development.

To address this need, a multidisciplinary team of experts from South Africa and Canada is implementing a longitudinal analysis of how early-life exposures in the preconception period and during pregnancy, infancy and childhood impact life-long trajectories of health and development of children in South Africa. The study population is drawn from Soweto, a historically disadvantaged urban area of the City of Johannesburg. The study hypothesizes that an integrated intervention starting pre-conceptionally in women and at appropriate points across the lifecourse (pregnancy, infancy and childhood) will improve cardiovascular and metabolic health, reduce childhood adiposity and improve child development outcomes; ultimately reducing the risk of NCDs. Using an individual randomized design the project tests the efficacy of interventions that address behaviour change to improve diet and physical activity during preconception, and health during pregnancy; reduce perinatal depression, increase exclusive breastfeeding and improve parental nurturing care.

The primary outcome at age 5 years in the children is adiposity as measured by the Fat Mass Index. Other key outcomes at 5 years in the children include: OWO rate as assessed by BMI; other indicators of body composition and distribution; glucose metabolism; blood pressure; and neurodevelopment. A comprehensive series of measures to track maternal and child growth and development is included along with the collection of biospecimens that support studies into the science of the developmental origins of health and disease.

The team has the expertise to establish and maintain the cohort, to ensure integrity of data and biospecimens, measure the impact of interventions on the holistic development of children, define interactions between environments and genetics that underlie developmental trajectories, develop and apply innovative analytic methodologies, ensure open, global access to the HeLTI datasets and engage with community and policy makers to ensure that the information generated by the study can be applied to policies and practice change within communities to enhance the life-long health and wellbeing of South African children.