Cohort Profile: The Kiang West Longitudinal Population Study (KWLPS)—a platform for integrated research and health care provision in rural Gambia

Hennig, Branwen J.; Unger, Stefan; Dondeh, Bai Lamin; Hassan, J.; Hawkesworth, Sophie; Jarjou, Landing; Jones, Kerry S.; Moore, Sophie E.; Nabwera, Helen M; Ngum, Mohammed; Prentice, Ann; Sonko, Bakary; Prentice, Andrew M.; Fulford, Anthony J. C.

doi:10.1093/ije/dyv206

Cited by 85 publications

(141 citation statements)

References 27 publications

(50 reference statements)

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“…This study was conducted within the Kiang West Longitudinal Population Study (KWLPS) cohort in The Gambia, [24] which captures >14000 residents across 36 villages within the rural Kiang West District, served by the Medical Research Council (MRC) Keneba field station. Relevant data for these analyses primarily originated from the Keneba Biobank (http://ing.mrc.ac.uk/home/research-areas/the-keneba-biobank/), with BP, anthropometric and hematological measures, and questionnaire data collected between May 2012 and October 2014.…”

Section: Methodsmentioning

confidence: 99%

High blood pressure and associated risk factors as indicator of preclinical hypertension in rural West Africa

Jobe

Agbla²,

Prentice

et al. 2017

Medicine

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Section: Methodsmentioning

confidence: 99%

High blood pressure and associated risk factors as indicator of preclinical hypertension in rural West Africa

Jobe

Agbla²,

Prentice

et al. 2017

Medicine

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“…Given the prevalence of AS (15.9%) (Cox et al, 2008) and anemia (75%) (Hennig et al, 2015), we thus calculated the population level impact of malaria growth reduction to be 3.5% from sickle-cell trait and 15.9% from anemia in these Gambian children. Note that this underestimates the protection by anemia because it simply compares anemic (defined as Hgb < 11 g/dl, 2 SD below the mean) versus non-anemic children.…”

Section: Resultsmentioning

confidence: 99%

“…The RG values for sickle-cell trait and hemoglobin were based on the standardized β coefficients from our multivariate modelling results. In this population of Gambian children, the pp for anemia is 0.75 (derived from 688 children < 3y in the Kiang West Longitudinal Population Study) (Hennig et al, 2015) and the pp of AS is 0.159, (Cox et al, 2008). This calculation does not give an epidemiological measure of disease risk, it is a simple calculation designed to illustrate the relative magnitudes of the impacts of sickle-cell trait and anemia in our study population.…”

Section: Methodsmentioning

confidence: 99%

Anemia Offers Stronger Protection Than Sickle Cell Trait Against the Erythrocytic Stage of Falciparum Malaria and This Protection Is Reversed by Iron Supplementation

et al. 2016

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BackgroundIron deficiency causes long-term adverse consequences for children and is the most common nutritional deficiency worldwide. Observational studies suggest that iron deficiency anemia protects against Plasmodium falciparum malaria and several intervention trials have indicated that iron supplementation increases malaria risk through unknown mechanism(s). This poses a major challenge for health policy. We investigated how anemia inhibits blood stage malaria infection and how iron supplementation abrogates this protection.MethodsThis observational cohort study occurred in a malaria-endemic region where sickle-cell trait is also common. We studied fresh RBCs from anemic children (135 children; age 6–24 months; hemoglobin < 11 g/dl) participating in an iron supplementation trial (ISRCTN registry, number ISRCTN07210906) in which they received iron (12 mg/day) as part of a micronutrient powder for 84 days. Children donated RBCs at baseline, Day 49, and Day 84 for use in flow cytometry-based in vitro growth and invasion assays with P. falciparum laboratory and field strains. In vitro parasite growth in subject RBCs was the primary endpoint.FindingsAnemia substantially reduced the invasion and growth of both laboratory and field strains of P. falciparum in vitro (~ 10% growth reduction per standard deviation shift in hemoglobin). The population level impact against erythrocytic stage malaria was 15.9% from anemia compared to 3.5% for sickle-cell trait. Parasite growth was 2.4 fold higher after 49 days of iron supplementation relative to baseline (p < 0.001), paralleling increases in erythropoiesis.InterpretationThese results confirm and quantify a plausible mechanism by which anemia protects African children against falciparum malaria, an effect that is substantially greater than the protection offered by sickle-cell trait. Iron supplementation completely reversed the observed protection and hence should be accompanied by malaria prophylaxis. Lower hemoglobin levels typically seen in populations of African descent may reflect past genetic selection by malaria.FundingNational Institute of Child Health and Development, Bill and Melinda Gates Foundation, UK Medical Research Council (MRC) and Department for International Development (DFID) under the MRC/DFID Concordat.

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“…Here, I summarise the work completed to date. Since the late 1940s, the UK Medical Research Council (MRC) has been conducting a health and nutrition research programme among the rural West Kiang population of The Gambia [4] . As part of this programme, demographic records have been collected on the residents of three villages (Keneba, Kantong Kunda and Manduar), providing the longest documented continuous surveillance of a rural African population.…”

Section: Introductionmentioning

confidence: 99%

Early-Life Nutritional Programming of Health and Disease in The Gambia

Moore¹

2017

Ann Nutr Metab

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Background: Exposures during early life are increasingly being recognised as factors that play an important role in the aetiology of chronic non-communicable diseases (NCDs). The “Developmental Origins of Health and Disease” (DOHaD) hypothesis asserts that adverse early-life exposures - most notably unbalanced nutrition - leads to an increased risk for a range of NCDs and that disease risk is highest when there is a “mismatch” between the early- and later-life environments. Thus, the DOHaD hypothesis would predict highest risk in settings undergoing a rapid nutrition transition. Summary: We investigated the link between early-life nutritional exposures and long-term health in rural Gambia, West Africa. Using demographic data dating back to the 1940s, the follow-up of randomised controlled trials of nutritional supplementation in pregnancy, and the “experiment of nature” that seasonality in this region provides, we investigated the DOHaD hypothesis in a population with high rates of maternal and infant under-nutrition, a high burden from infectious disease, and an emerging risk of NCDs. Key Messages: Our work in rural Gambia suggests that in populations with high rates of under-nutrition in early life, the immune system may be sensitive to nutritional deficiencies early in life, resulting in a greater susceptibility to infection-related morbidity and mortality.

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Cohort Profile: The Kiang West Longitudinal Population Study (KWLPS)—a platform for integrated research and health care provision in rural Gambia

Cited by 85 publications

References 27 publications

High blood pressure and associated risk factors as indicator of preclinical hypertension in rural West Africa

High blood pressure and associated risk factors as indicator of preclinical hypertension in rural West Africa

Anemia Offers Stronger Protection Than Sickle Cell Trait Against the Erythrocytic Stage of Falciparum Malaria and This Protection Is Reversed by Iron Supplementation

Early-Life Nutritional Programming of Health and Disease in The Gambia

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