The NIHR Southampton 1000 DaysPlus Global Nutrition Research Group: leveraging improved nutrition preconception, during pregnancy and postpartum in Sub-Saharan Africa through novel intervention models, at the University of Southampton

Sub-Saharan Africa (SSA) has persistently high rates of pre-term birth, low birthweight, underweight and child stunting, but also rapidly increasing rates of overweight and obesity. Further, communities across SSA now have a 'double burden' of malnutrition, where undernutrition in infancy is followed by over-nutrition in terms of macronutrients, but with enduring deficiencies in micronutrients (iron, folic acid and other vitamins). Developmental Origins of Health and Disease (DOHaD) research has identified that early life under-nutrition coupled with excessive weight gain in later life significantly increases risk for adult obesity, diabetes and hypertension. Given that non-communicable diseases (NCD) are major causes of death and disability globally and are now increasing most rapidly in low- and middle-income countries (LMICs), optimising the nutritional status of future parents, and thus tackling the double burden of malnutrition may in the short-term improve growth and neurodevelopment of their offspring, and in the longer-term could set up healthier trajectories that reduces the risk for NCDs in later life. To address the double burden of malnutrition we will establish a group of researchers to develop a framework focussing on our 1000 DaysPlus concept (optimise nutrition before, during and after pregnancy). We envisage that implementing supportive double-duty nutrition interventions to tackle both aspects of the double burden of malnutrition will require engagement of critical multisectoral stakeholder groups, including target population groups along with policy-makers and health care professionals (HCPs), to co-create opportunities and services to allow vulnerable populations to adopt healthy diets. HCPs have an important role in motivating men and women to change eating behaviours; in LMICs the case for such policy action has not yet been made, and HCPs lack knowledge and skills to assist motivation. Over 3 years, our objectives are to: 1. Establish a multidisciplinary group of researchers across SSA, with UK Southampton 2. Undertake in-depth review of nutrition policy and engagement of health policy-makers and healthcare leaders with the issue, in three different SSA countries, to establish the barriers and the opportunities to instituting a clear 1000 DaysPlus double duty healthy nutrition policy 3. Formulate the economic case for investment in nutrition in the 1000 DaysPlus for optimal health of people and their future offspring 4. Leverage our on-going work in different contexts and with a range of stakeholders to identify the best 1000 DaysPlus nutrition interventions that could be embedded in ongoing reproductive health services, community health worker programmes, community antenatal care clinics, or fiscal measures (for example, sugar sweetened beverage tax) 5. Develop protocols and pilot novel approaches to improve the nutritional status in the 1000 DaysPlus period. The INPreP work started in 2018 and will be completed in 2021. We are working in 3 sites Nanoro, Burkina Faso; Navrongo, Ghana and Soweto, South Africa. To date, we have held group and one-to-one discussions with a wide range of stakeholders including national and local government officials, health professionals, academics working in maternal and child health research, NGO representatives (e.g. Red Cross) and members of international agencies such as the UN World Food Programme. The aim of these discussions is to understand the maternal and child health needs and priorities from the perspective of policy makers and those who develop and implement programmes to improve health. We have also conducted focus group discussions with community members in each of the sites. Ultimately these are the people who will benefit from the interventions we develop so we have asked them what their priorities are and what needs they perceive. We will use this information as well as a review of published literature, calculation of the economic case for intervening and analysis of local nutrition data to inform which interventions we develop and test for feasibility. In the longer term we aim to implement successful interventions to improve maternal and child health across sub-Saharan Africa.