|“CHRIS” (Cerebrovascular, Heart Failure, Rheumatic Heart Disease Interventions Strategy)||Cardiology, Training/Education||Zimbabwe||Havranek, E., Maddox, T.|
Ed Havranek and Tom Maddox work on the project “CHRIS” (Cerebrovascular, Heart Failure, Rheumatic Heart Disease Interventions Strategy). CHRIS is an initiative based in Zimbabwe. It is funded by NIH (NHLBI and the Fogarty Center), and is part of the Medical Education Partnership Initiative (MEPI) that pairs medical schools in the United States with medical schools in sub-Saharan Africa for the purpose of enhancing medical school capacity. This cardiovascular disease initiative is linked with a larger partnership known as NECTAR between the University of Colorado School of Medicine and the University of Zimbabwe College of Health Sciences, also funded under the MEPI program. The CHRIS initiative primarily seeks to train UZ post-graduates in cardiovascular disease so that they may become future cardiology faculty members. Activities have included visiting professorships from UC cardiology faculty, an exchange program that has brought UZ trainees to Denver for brief attachments, and development of patient registries for clinical research in peripartum cardiomyopathy, pediatric rheumatic heart disease, stroke, and atrial fibrillation. We have also provided instruction in cardiovascular disease for clinical and pre-clinical medical students, and have worked to transfer responsibility for this activity to our UZ trainees. The project began in late 2010 and is currently funded through 2015.
|A Randomized Control Trial of a Novel Nutritional Product in Children with Acute Diarrhea in Guatemala||Diarrhea and Dehydration||Guatemala||Berman, S., Gaensbauer, J.|
Diarrheal disease remains one of the most significant causes of child mortality and morbidity in the Developing World. In addition to causing dehydration and electrolyte abnormalities, diarrhea causes inflammation in the intestines that contributes to a cycle of malnutrition by not allowing already vulnerable children to appropriately digest calories and nutrients after an acute episode of diarrhea has resolved. In collaboration with PanTheryx, Inc. of Boulder, CO, the Center for Global Health is conducting a clinical trial of a nutritional product designed to both attenuate the acute diarrheal episode but also promote healing and improved weight gain in the weeks following the illness. The trial is a double blinded, randomized control trial in children age 6 months to 3 years in two sites in Guatemala, and is enrolling children with moderate and severe diarrhea in two arms. The primary outcomes are duration of diarrhea and weight gain in the 4 weeks following the episode. All children will be tested by multiplex PCR for the cause of the diarrhea. Enrollment in the trial began in April of 2015 and aims to complete enrollment within 1 year.
You can reach Dr. Gaensbauer at email@example.com
or Dr. Berman at Stephen.Berman@childrenscolorado.org
|Absorption of Zn and Fe from bio fortified pearl millet in young Indian children||Child Health, Nutrition||India||Hambidge, M.|
Michael Hambidge, MD, ScD, Professor Emeritus, Department of Pediatrics, University of Colorado School of Medicine, is the principal investigator of this project. The objective of this project is to determine Zn absorption from bio fortified maize meal at different levels of fortification, the determine the effect of milling on bioavailability, to compare increase in Zn absorption for each group, and to utilize data derived from these studies to develop a trivariate model which will predict the effect of dietary Zn and phyate on the total quantity of Zn absorbed each day. This project is being conducted between May 2009 and April 2011.
|Absorption of Zn form Zn-bio fortified and Zn-fortified maize in young Zambian children||Child Health, Nutrition||Zambia||Hambidge, M.|
Michael Hambidge, MD, ScD, Professor Emeritus, Department of Pediatrics, University of Colorado School of Medicine, is the principal investigator of this project. The objectives of this project is to determine Zn absorption from bio fortified maize meal at different levels of fortification, the determine the effect of milling on bioavailability, to compare increase in Zn absorption for each group, and to utilize data derived from these studies to develop a trivariate model which will predict the effect of dietary Zn and phyate on the total quantity of Zn absorbed each day. This project is being conducted between May 2009 and April 2011.
|Assessing Barriers to Accessing Emergency Medical Services in Ghana||Emergency Medicine||Ghana||Mould-Millman, N.K.|
In this collaborative project, Dr. Nee-Kofi Mould-Millman (Assistant Professor, Department of Emergency Medicine at the University of Colorado) is partnering with Prof. Ahmed Zakariah, MD, MBA, MPhil (CEO, Ghana National Ambulance Service, Government of Ghana), Samuel Kaba, MD, PhD (Head, Institutional Care Division, Ghana Health Service) and Sarah Rominski, MPH (Global REACH, University of Michigan) to conduct a cross-sectional in-hospital and population-based survey to assess citizen-perceived barriers to accessing emergency transportation and timely emergency care. For this purpose, an digitized assessment instrument was created and validated, which will subsequently be employed in other African settings to assess similar barriers of their respective citizens.
Research is being conducted from May 1, 2013 – June 30, 2015.
|Birth Attendant Training and Rural Obstetric Care Health Provison Access||Child Health, Maternal Health, Training/Education||Guatemala||Heinrichs, G., Niermeyer, S.|
Gretchen Heinrichs, MD, DTMH, Assistant Professor of Obstetrics and Gynecology at the University of Colorado School of Medicine and Denver Health, as Director of Maternal Health Initiatives for the Center for Global Health has formulated the maternal health objectives for the ongoing Guatemala Trifinio project being conducted by Center for Global Health.
Susan Niermeyer, MD, MPH, FAAP, Professor of Pediatrics, Section of Neonatology at the University of Colorado School of Medicine and Professor of Epidemiology at the Colorado School of Public Health is Co-Director of the Center for Global Heatlh's Maternal and Child Health Initiative along with Eric Simoes, MB, BS, DCH, MD, Professor of Pediatrics, Section of Pediatric Infectious Disease at the University of Colorado School of Medicine and Professor of Epidemiology at the Colorado School of Public Health.
Together they will work on current projects beginning in Guatemala in birth attendant training and rural obstetric care health provision access. The Guatemala Trinifio Project started in 2011 and is planned to conclude in 2017.
|Breastfeeding support in postpartum care||Child Health, Training/Education||Guatemala||Bunik,M.|
Dr. Maya Bunik, MD, MSPH, Associate Professor of Pediatrics, Section of General Academic Pediatrics at the University of Colorado School of Medicine has extensive expertise in breastfeeding management and research in Latinas. She started teaching in Guatemala in July, after the breastfeeding initiative was launched by Amy Nacht CNM and Ana Williams CNM, with training of the comodronas and tecnicas. The emphasis was on exclusive breastfeeding and avoiding unnecessary water or formula supplementation especially in the context of water contamination and diarrhea prevalence in the community. Additionally, home visitors were advised to observe a breastfeeding session towards the end of their visits to assess latch and breast problems. Dr. Bunik’s book Breastfeeding Telephone Triage and Advice, translated into Spanish (thanks to Dr. Berman) has many practical topics for breastfeeding management and support and is now used as an ongoing resource for medical providers there at Trifinio. In addition, Dr. Bunik held hour-long trainings with the outpatient, postpartum and neonatal intensive care nurses at the hospital in Coatepeque and gifted them a Medela Symphony hospital grade pump and kits. They are planning on working towards Baby Friendly status and nutrition leadership is championing this project. Training in all aspects of above breastfeeding support will be ongoing as new staff are hired.
|Capacity building and education of health Promoters in the Loreto Region, Peru||Child Health, Training/Education||Peru||Bellows, J.|
Jennifer Whitfield Bellows, MD, MPH, Assistant Professor, Department of Emergency Medicine at the University of Colorado School of Medicine and Denver Health serves as a faculty mentor to a CU student-run non-profit organization called Comunidades Unidas Peru ("CU Peru"), whose goal is to provide trainings to lay health promoters in rural areas of the Loreto region of Peru. The trainings are based on the WHO's Integrated Management of Childhood Illness (IMCI) curriculum and include ongoing focus group, interview, and survey-based evaluation to determine reception and impact among populations served. Trainings occur over several weeks every summer.
|Case Control Study of Suicide Attempts Among Farmers in Jilin Province, China||Mental Health, Occupational Health||China||Stallones, L.|
This project is being conducted by Lorann Stallones, MPH, PhD, Professor of Psychology, Director of the Graduate Degree program in Public Health at Colorado State University. The project investigates the relationship between organophosphate pesticide (OP) exposures, agression, impulsivity, and attempted suicides. Although previous studies have suggested an association between suicide and OP exposure, no studies have assessed the relationship between suicide attempts and OP exposures.
This project ran from 2010-2011.
|CHA/PA Program||Health Systems Capacity Building, Training/Education||South Africa||Glicken, A.|
Anita Duhl Glicken, MSW, Associate Dean, Physician Assistant studies, University of Colorado School of Medicine, and Director, Child Health Associate/Physician Assistant (CHA/PA) program has been working on an ongoing partnership with the Walter Sisulu University (WSU), located in Eastern Cape, South Africa. As one of the first physician assistant programs in the United States, the CHA/PA program at the University of Colorado School of Medicine was recently selected by the American International Health Alliance (AIHA) to partner with WSU. The 3-year Clinical Assistant (CA) program is needed to produce qualified practitioners who can assess patients, make diagnoses, prescribe treatments and undertake minor surgical procedures. Additionally, WSU leaders would like to develop a student exchange program so their students can come to Colorado and learn what it means to be a physician assistant. The program recruits 20 students a year from the local population. Recruiting locally guarantees students can speak Xhosa, the local language. Often the region’s doctors are not from the local community so they find it hard to communicate directly with patients. CAs also have limited opportunities to work outside of their geographic area or country, which means they are more likely to be retained in the local health system. This project has no defined end date.
|Cleft Lip and Palate Surgery ||Surgery||Guatemala||Winkler, A.|
Dr. Andrew Winkler, MD, Assistant Professor of Otolaryngology-Head & Neck Surgery leads a team to Antigua, Guatemala each year to perform cleft lip and palate repair surgery. These trips are coordinated with Faith In Practice (FIP), a non-profit, ecumenical Christian organization that works solely in Guatemala. This group organizes many short-term surgical and medical mission trips to Guatemala each year and has a permanent headquarters there. Each year, surgeries are performed at Obras Sociales del Santo Hermano Pedro, a church that has been converted into a hospital and treatment center for the mentally and chronically ill. With the support of a grant from the FIP leadership, Dr. Winkler has initiated a cleft patient database to aid in continuity of care. His team is also devising a plan for short-, medium- and long-term expansion cleft services within the capabilities of the Obras. The most pressing need is to develop a speech therapy program to improve speech and language development in cleft children.
|Collaborative Studies in Epidemiology and Molecular Virology: the Human Animal Interface||Infectious Disease, Training/Education||Indonesia||Simoes, E.|
Dr. Eric Simoes, MB, BS, DCH, MD, Professor of Pediatrics, Section of Pediatric Infectious Disease at the University of Colorado School of Medicine is conducting a 3-year study to investigate the role of the animal human interface in human and avian influenza virus infections in Bandung, Indonesia. The project will also build capacity in Indonesia to conduct molecular virologic and epidemiologic investigations using advanced techniques used in basic virology and epidemiology. This USAID-funded project is possible with the cooperation of the University of Padjajaran, the West Java Department of Animal Husbandry, and the Genome Institute of Singapore. This project will run from January 2013 to December 2016.
|Complementary Feeding and Micronutrient Supplements||Child Health, Maternal Health, Nutrition, Training/Education||China, Democratic Republic Congo, Guatemala, India, Kenya, Pakistan, Zambia||Krebs, N.|
Nancy Krebs, MD, FAAP, Professor, Department of Pediatrics, University of Colorado School of Medicine is working as Co‐PI on the NICHD/NIH supported Global Network for Women’s and Children’s Health Research. She works at the lead site for a multi‐country efficacy trial on complementary feeding. She is also working on projects related to interventions of micronutrient supplements, biofortification and plant breeding, and dietary diversification in Guatemala, China, India, Pakistan, Kenya, Zambia and Democratic Republic of Congo. An investigation of iron interventions in a malaria‐endemic area of Kenya and the impact on the gut microbiome is also underway.
|Complementary Feeding: A Global Network Cluster RCT||Child Health, Nutrition||Guatemala||Hambidge, M.|
Michael Hambidge, MD, ScD, Professor Emeritus, Department of Pediatrics, University of Colorado School of Medicine, is the principal investigator of this project. The broad objective of this proposal is to improve growth and health of infants and young children less than two years of age by improving the quality of complementary feeding. The proposed interventions will compare the potential benefits of incorporating meat into routine infant and toddler feeding versus optimized traditional plant based complementary feeding regimens. This is a multi-country study, of which our site [Colorado-Guatemala] is the lead site in the current Complementary Feeding Project, the CBA Survey and the pending Preconception intervention. This project began in September, 2001 and will continue through April 2012.
|Contributions of National Health Policies that Included Community Participation, Switzerland and Selected African and Asian Countries||Health Systems Capacity Building||Switzerland||Rifkin, S.|
Susan B Rifkin, PhD, adjunct faculty at the Colorado School of Public Health and a Senior Research Fellow, Institute of Social Psychology, at the London School of Economics, has been building on the results of a symposium held in Washington, DC in April 2010 with the Department of Preventive Medicine, University of Geneva, and analyzing experiences from countries that have evidence of improved health outcomes from including policies of community participation. This partnership has no end date.
|Creation of an Evaluation Tool to Assess the Impact of Global Health Track on Participating Medical Students||Health Systems Capacity Building, Training/Education||United States||Bellows, J.|
Jennifer Whitfield Bellows, MD, MPH, Staff Physician, Denver Health Medical Center Department of Emergency Medicine Assistant Professor, University of Colorado, School of Medicine is conducting this project in the 2014 calendar year. This project aims to summarize, from the perspective of educators and directors of global health programs, what the aims, structure, desired student outcomes, and assessment methods should be of an effective global health program. We plan to then use this information to review and refine University of Colorado School of Medicine's global health track, including the development of an evaluative survey to measure program impact on students.
|Demonstrating the effectiveness and outcomes of an Emergency First Aid Responder (EFAR) System in a low-resource, violent sub-Saharan community||Emergency Medicine||South Africa||Mould-Millman, N.K.|
This is a collaborative project between Nee-Kofi Mould-Millman, MD (Assistant Professor, Department of Emergency Medicine at the University of Colorado), Prof. Lee Wallis, MBChB MD, FCEM (Head of Emergency Medicine, University of Cape Town, South Africa) and Dr. Shaheem de Vries, MBChB (Head, Western Cape Government, Emergency Medical Services). The collaborators are studying the effectiveness of a novel, sustainable community-based emergency first aid responder (EFAR) system in a violent, high acuity, low-resourced township outside of Cape Town, South Africa. Specifically, the investigators will assess whether EFAR activity and patient care augment the local emergency care system and improve patient-centered outcomes. Funding is provided by two grants from the Emergency Medicine Foundation and the Carnegie Corporation of New York. Study is being conducted between July 1, 2014 - June 30, 2016.
|Developing a Collaborative Health Geographic Information Systems (GIS) with the Catholic University of Health and Allied Sciences (CUHAS)||HIV/AIDS, Maternal Health||Tanzania||Thomas, D.|
Deborah Thomas, PhD, Associate Professor, Department of Geography and Environmental Sciences, University of Colorado Denver, is collaborating with Tanzanian colleagues to develop this relationship across research and educational activities. The University of Colorado Denver and the School of Public Health at CUHAS in Tanzania have formed a collaborative partnership to build an area of concentration around health GIS and evidence-based decision making. In addition to delivering training modules and involving both US and Tanzanian student, the collaboration has applied GIS as a research tool around a variety of projects, including HIV mapping in Misungwi District, artisanal gold mining, and disease mapping in the Ngorongoro Conservation Area (NCA) focusing on malaria. This project is ongoing.
|Developing Dental Capacities in Guatemala's Trifinio Region||Dental, Training/Education||Guatemala||Shick, E.|
Elizabeth Shick, DDS, MPH, Assistant Professor, Department of Pediatric Dentistry, University of Colorado, School of Dental Medicine, is working on the Trifinio project to provide dental services to patients of the future clinic. She plans to provide comprehensive care to patients by travelling multiple times per year to the Trifinio Clinic, and creating an elective rotation for 3rd and 4th year dental students. Students will travel to the clinic to provide dental care with an attending faculty member from the University of Colorado School of Dental Medicine. Shick is investigating possible funding opportunities to cover costs of dental chairs, instruments and materials. Another goal of this project is to collaborate with the local dental school at University of Francisco Marroqin to encourage their involvement in providing dental care at the Trifinio clinic to provide long-term sustainability and increased scope of services offered. The final objective is collaboration with the faculty of the dental school at University of Francisco Marroqin to provide education and training in the area of pediatric dentistry and encourage an exchange program between their school and University of Colorado School of Dental Medicine. This project has no end date.
|Developing Models for Resident Subspecialty Training in Resource Challenged Environments||Medical Education||Bhutan, Cambodia, Laos, Vietnam||Duster, M.|
Mark Duster is a Clinical Professor of Pediatrics in the Section of Cardiology at the University of Colorado School of Medicine. His special interest is improving models for subspecialty education in pediatric congenital heart disease diagnosis and management in resource challenged environments. In these areas primary care physicians are often the only source of care and hence there is an imperative for effective education. Subspecialist volunteers are usually available for a limited period of time and there is a need to maximize this brief educational exposure.
Since 2006 he has been involved in teaching in Vietnam, Lao, Bhutan and Cambodia. He has a continued relationship with teaching institutions in these countries. Subspecialists interested in participating in this self-funded project are welcome. This project is scheduled to continue in 2016.
|Development and health of rural Chinese children fed meat as a daily complementary food from 6-18 months of age||Child Health, Nutrition||China||Hambidge, M.|
Michael Hambidge, MD, ScD, Professor Emeritus, Department of Pediatrics, University of Colorado School of Medicine, is the principal investigator of this project. The goal of this project is to determine the efficacy of a daily intake of locally available, low cost meat/liver as a complementary food from 6-18 months of age for young children of this age who are otherwise dependent only on continued breast feeding and locally available non-fortified plant foods. Efficacy will be determined by public health outcomes, including infectious disease morbidity and both physical and cognitive development, with linear growth as the primary outcome measure. Other outcome measures required for interpretation of these results are biomarkers of key micronutrient status, including zinc absorption. This project is being conducted between October 2008 and September 2011.
|Development of a Maternity Center by Global Health Connections at CAMEJO Hospital in Leogane, Haiti||Child Health, Maternal Health, Training/Education||Haiti||Gifford, B.|
Blair Gifford, PhD, Professor, International Health Management, Business School, University of Colorado Denver, is currently working on this project. Leogane is a city of about 220,000 people and is about 25 miles SW of Port au Prince, the capital of Haiti. Leogane was the epicenter for the 2010 earthquake in which 220,000 people died. After the quake, Medicins Sans Frontiers (Physicians W/O Borders) set up a crisis hospital in Leogane. The hospital has been handling between 700 and 1000 births per month at no cost. However, MSF’s hospital will be closing in 2015 since the quake crisis is now considered over. As a result, there is a tremendous need for maternity care capabilities in the Leogane area. CAMEJO is the only Haitian-owned hospital in this part of Haiti. Being Haitian-owned means that the hospital is well received by Haitians, but has little or no financial support from external entities such as the Episcopal Church of America. CAMEJO is also the center for the Childrens’ Nutrition Program. CNP has done a household survey throughout the mountainous areas of Leogane. Health workers have been trained to go to houses in the area to find out health and nutrition conditions. There is tremendous opportunity for public health research and clinical care assistance at the CAMEJO hospital, the GHC maternity center and the CNP program. This program has no end date.
|Effect of SprinklesTM with and without Fe on Zn Absorption from local foods in Kenyan toddlers||Child Health, Nutrition||Kenya||Hambidge, M.|
Michael Hambidge, MD, ScD, Professor Emeritus, Department of Pediatrics, University of Colorado School of Medicine, is the cooperating investigator of this project. The study will examine effects of Fe fortification on Zn absorption in malaria endemic area where Fe deficiency is common. This project will run from December 2009 until January 2013.
|Emergency Medical Service (EMS) Agencies and Systems in Africa – a Multinational Assessment||Emergency Medicine||South Africa||Mould-Millman, N.K.|
Nee-Kofi Mould-Millman, MD (Assistant Professor, Department of Emergency Medicine at the University of Colorado) is collaborating with leading African researchers from the African Federation for Emergency Medicine (AFEM) to launch a 3-phase novel survey of prehospital care systems in Africa. Information from this study will help inform further advocacy, research, development, and capacity building to foster development of basic, effective, and sustainable prehospital care system in low-resource African settings. Funding for this research is being provided by the African Federation for Emergency Medicine.
Study is being conducted from November 1, 2013 to December 31, 2015.
|Evaluation of Indian Government Community Health Worker Scheme (ASHA)||Health Systems Capacity Building||India||Rifkin, S.|
Susan B Rifkin, PhD, adjunct faculty at the Colorado School of Public Health and a Senior Research Fellow, Institute of Social Psychology, at the London School of Economics has been working in collaboration of the National Health Systems Resource Center (Government of India) to implement a systematic review of community health workers using the ASHA scheme to assess the contribution of community participation and empowerment to the community health workers (women) and community people for improved health outcomes. This partnership is ongoing.
|Expanding Adherence in HIV and TB Patients||Infectious Disease, Health Systems Capacity Building||Haiti||Coffee, M.|
Dr. Coffee's work focuses on the treatment of critically ill HIV and TB patients in the public health system, caring for over 1000 patients per year. Long term successful treatment requires adherence to 6-8 months of medications for TB, and lifelong for HIV. Patients often face considerable challenges - moving frequently, living in temporary housing, with limited or no incomes, with limited formal education. We are working on technology that allows peers to support drug adherence. Patients call other patients to remind them to take their medications, using phone lists that even those with limited literacy can utilize. Past patients and counsellors are working to create directions and maps for informal housing with limited formal maps to allow for following patients throughout the course of care. This project began in January 2010, and is ongoing.
|Feasibility Study: Tracking Community Mortality Due to Respiratory Syncytial Virus ||Child Health, Infectious Disease||India||Simoes, E.|
Eric A F Simoes, MB, BS, DCH, MD, Professor of Pediatrics, Section of Pediatric Infectious Disease at the University of Colorado School of Medicine and Professor of Epidemiology at the Colorado School of Public Health is conducting this study between 2016-2019. The primary goal of this study is to identify accurately RSV related mortality in infants/children under 2 years of age, on a population basis, in a rural high-risk community. The study aims first to identify all infants and children under 2 years of age in 100 villages near Melghat, Maharashtra, India, as well as to keep track of all births in the villages for the next 2 years after start of the study, to use as the denominator. Second, nasopharyngeal samples will be obtained from all childhood deaths under 2 years of age, and these samples will be assayed for RSV. Finally, verbal autopsy within 2 weeks of the death for each child death will be obtained. From these figures, we will compute the RSV mortality rate in infants/children under 2 years of age. This will be a feasibility study that could serve as a model for future studies in the community.
|Global Burden of Disease (GBD) - Cochrane Project||Disease Surveillance||Multiple||Dellavalle, R.|
Dr. Robert Dellavalle, MD, PhD, MSPH, Associate Professor of Dermatology and Public Health at the University of Colorado School of Medicine and the Colorado School of Public Health is guiding ongoing projects mapping cause-specific disease burdens determined by the Global Burden of Disease Study to corresponding systematic reviews and protocols of clinical interventions targeting the same diseases in Cochrane Database of Systematic Reviews (CDSR) to determine whether or not more disabling diseases have greater representation in CDSR (https://capsmg.cochrane.org/global-burden-disease-gbd-cochrane-project
). This project is ongoing with no determined end date. Dr. Dellavalle can be contacted at firstname.lastname@example.org.
|Guatemala Trifinio Project||Child Health, Health Systems Capacity Building, Maternal Health||Guatemala||Asturias, E.|
Edwin Asturias, MD, Associate Professor, Department of Pediatrics, Section of Pediatric Infectious Disease at the University of Colorado School of Medicine, began this project in southwestern Guatemala in 2011 with a team of faculty and students from University of Colorado. Banasa Company, the Bolaños Foundation, and the Center for Global Health are currently funding this long-term project. Using data collected in a rapid needs assessment conducted in October of 2011, the team is creating a strategy to address multi-systemic health and infrastructure needs in this region. This developing initiative will cross academic disciplines and bring attention to areas of maternal and child health in the prenatal and neonatal contexts, as well as food security, vaccination coverage, oral health, and education. The development of the site and project are ongoing, however, the Center for Global health expects to provide high-quality educational experiences for University of Colorado students in the near future by working with communities in the Trifinio area of Guatemala. This project is planned to conclude in 2017.
|Identification of nutritionally modifiable hormonal and epigenetic drivers of positive and negative growth deviance in rural African fetuses and infants. ||Nutrition||Gambia||Bernstein, R.|
Robin Bernstein, PhD, Department of Anthropology, University of Colorado Boulder, is the principal investigator of this project. The objective of this project is to undertake one of the most detailed longitudinal studies to date to examine the effects of epigenetic and hormonal factors on growth during the first 1000 days of life. Assessment of a variety of parameters, including infectious exposures and hormone levels, as well as epigenome and transcriptome analyses will be collected from gestation through infancy and early childhood from a cohort of 200 Gambian children. These extensive data sets will reveal the mechanisms contributing to growth faltering, and will aid in the development of targeted interventions to promote healthy growth and infant development. This project started in late 2012 and is planned to conclude in 2018.