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1.
© Bill &
Melinda Gates Foundation
2.
3.
4.
5.
© Bill &
Melinda Gates Foundation | ▪ Multiple variables may affect each outcome ▪ Relative impact of different variables may vary in different contexts ▪ It’s difficult to know how to intervene most effectively 5 These problems are extremely complex and affected by multiple, interrelated variables
6.
7.
© Bill &
Melinda Gates Foundation | 7 HBGD is seeking the answers to five critical questions Interaction Between Growth & Development Outcomes Growth Outcomes Determinants Pathways 1 Can we quantitatively characterize the relation and interaction between preterm birth, physical growth, and brain development? To what extent is growth faltering explained by pre- vs postnatal insults? What kind of recovery can we expect in infants born small for gestational age (SGA)? Are there disproportionately large contributions on growth faltering from certain pathways, and can we rank-order risk factors? Are there specific pathways directly impacting linear growth faltering that coincide with increased risk of noncommunicable diseases such as cardiovascular disease, obesity, and diabetes? 2 3 4 5
8.
© Bill &
Melinda Gates Foundation | 8 HBGDki is building a knowledge base to help answer the questions Region No. of Studies No. of Subjects No. of Countries United States 66 8,684,868 1 Asia/Pacific 33 590,641 7 Americas (except USA) 13 56,652 5 Africa 12 55,340 10 Europe/Middle East 7 111,952 2 Total 122* 9,499,453 25 *Total < sum of different regions because some studies spanned several regions.
9.
© Bill &
Melinda Gates Foundation | 9 HBGDki moves from data to discovery to decisions KNOWLEDGE BASE CAUSAL POPULATION EMPIRICAL MECHANISTIC NEW INSIGHTS Multiple Modeling Methods Data Build a knowledge base of existing research data Discovery Apply multiple modeling methods to answer questions faster and deeper Decisions Inform comprehensive intervention decisions to prevent preterm birth, growth faltering, and neurocognitive deficits
10.
© Bill &
Melinda Gates Foundation | 10 ▪ Nadir extremes: ▪ Fraction of children below HAZ=-2 at nadir. ▪ Recovery age: ▪ Age (after nadir) at which less than 10% of children are below HAZ=-2. HBGDki analyses are already yielding new insights A 600 gram difference in birth weight can cost ~8 years in growth recovery
11.
© Bill &
Melinda Gates Foundation | 11 HBGDki can help promote precision public health: the right intervention for the right child at the right time WHO WHAT WHEN HOW WHERE Preterm, small for gestational age, growth faltering, and others Nutrition, vaccines, sanitation, vector control, and others Fetal growth and development, birth, and motor milestones Preventive and/or therapeutic Urban vs rural, wet vs dry, and others
12.
© Bill &
Melinda Gates Foundation | 12 Precision public health pinpoints the right dose to get the best response max min Dose Beneficial Childhood Response Adverse Adult Response Physical Growth Diabetes Obesity Cardiovascular too hightoo low optimal min max Neurocognitive Development
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