Healthy Lives - Malawi : Intergenerational Cohort of Chronic Conditions (360G-Wellcome-217073_Z_19_Z)

We aim to create an intergenerational longitudinal population study of chronic conditions in rural and urban Malawi, leveraging substantial existing research infrastructure, to address the lack of high-quality longitudinal-data on chronic conditions in low income sub-Saharan Africa (LI-SSA). Our prospective cohort data will provide age-specific incidence and survival estimates for multiple chronic conditions, and improve understanding of determinants (socioeconomic, psychological, nutritional, microbial and inflammatory) of health-related trajectories over the life-course, from poor pregnancy outcomes to multimorbidity in adulthood. Understanding how early-life exposures interact with later-life factors to mediate disease risk will indicate when and how to intervene effectively. Within rural and urban populations (110,000 individuals) we hold detailed non-communicable disease risk factor and HIV- test data in adults, plus an extensive biorepository. Procedures for longitudinal tracking, community surveillance and birth capture are well- established in rural Karonga and have been piloted in urban Lilongwe. Wellcome LPS support will enable; 1_Longitudinal tracking of 110,000 urban/ rural individuals. 2_Repeat biomarker and clinical assessments of chronic conditions. 3_Establish novel, effective migrancy tracking within/between rural/urban settings. 4_Recruit/follow 7,500 nested families (grandparents- parents-siblings-pregnancy-birth-cohort); pregnancy, early-life and intergenerational effects. 5_Health facility linkage; low-cost longitudinal health-care/outcomes data. This resource will be shared with the global research community to best-practice guidelines.