Upon pursuing the current time’s need for a good understanding of the direct or indirect factors that independently or collectively determine children’s health conditions, we have collected data from about 1,200 families of 3,400 participants in two study sites in Lumbini and Gandaki provinces. We plan to continue the process of data collection until December 2023.
Although the primary focus of this study is the lung health of children aged 6-9 years, this study also measures the factors related to i) Climate Change, Environmental and Occupational Exposures, ii) Cardiometabolic, iii) Infections, iv) Mental Health, v) Neurodevelopment, vi) Nutrition and Endocrine, vii) Physical Activities, viii) Sleeping disorder, ix) Communicable and Non-communicable diseases, x) Women’s health, among others.
Why this study
In 2012, this author published an article in the European Respiratory Journal. The main finding was that those young Nepali adults aged 16-25 years old who were exposed to biomass smoke from domestic cooking had abnormal lung growth than those using liquefied petroleum gas (LPG). This was the first paper to report such a finding. Still, the more important questions were: At what age did young adult exposure to biomass contribute to their compromised lung growth and what other factors could have contributed to it? This is important as other studies from the developed world indicate that impaired lung growth is related to many diseases in adulthood that lead to premature mortality. We know that lungs mature when one turns 20-25 years old and continue to remain constant until age 35 and then start to decline.
This pointed to the need to carry out a long-term follow-up study in Nepal on young children to identify the factors associated with impaired lung development and intervene at a young age so that the lungs can attain their full growth potential. This led to the setting of the first family cohort of low-and middle-income countries called “The Nepal Family Cohort Study (NeFCoS).” We started training field research staff at our first site, Lumbini Cultural Municipality, in June 2022 after receiving ethical approval from Nepal Health Research Council, Kathmandu, Nepal and Hamilton Integrated Research Ethical Board in Hamilton, Canada.
NeFCoS is a multidisciplinary study designed to be of its kind, informative research to be expanded in various geographical areas of Nepal where the families will be followed for a long time. Our primary focus is understanding the multiple risk factors of health conditions, particularly lung health in children. We recruit 6-9-year-old children and their parents who have provided written consent to take part in this study and their willingness to be contacted at a later date for subsequent follow-up.
The parents offer information on socio-demographics, lifestyle factors, dietary habits, occupational history, educational history, environmental conditions at home and outside and any diseases they or their children have had since birth. They also undergo a series of measurements such as lung function, oxygen saturation, blood pressure, hand-grip strength, anthropometry, body fat percentage, muscle mass, body water content and skin-fold thickness as an indirect measure for malnutrition. We are also measuring eleven different parameters in spot urine samples semi-quantitatively.
The current ongoing study is a first step for the comprehensive assessment of risk factors, prevention of diseases, and management of health outcomes by various interventions. But a lot more needs to be done.
Dr Nagendra Chaudhary, an Associate Professor and a practicing pediatrician, examines each child for any current lung abnormalities. Dr Chaudhary is the country’s principal investigator of the study. The study is supported by many researchers from partner institutions in Nepal, the United Kingdom and the United States (listed in the https://nepalstudy.org/team/ ).
In Nepal, Nexus Institute of Research and Innovation (nirinepal.org ) is the lead partner that helps with the day-to-day functioning of the cohort research study in collaboration with the principal investigator (Dr Kurmi). We will continuously monitor the participants’ health subjects using questionnaires, objective measurement of health conditions, and collecting healthcare-based data. NeFCoS researchers will follow the children prospectively as they develop from childhood to adolescence and adulthood to correctly identify the effects of exposure to early life factors such as environment, lifestyles or socio-demographics on health and disease.
Our findings will likely influence medical practice, parenting choices, consumer product regulation, and policy development—from building codes and household purchasing behaviors to decisions about childbirth and delivery, diet, breastfeeding, cleaning products used in homes, owning a family pet, environmental conditions and dealing with stress. We mainly focus on understanding the burden of various lung diseases in young children, including lung growth.
One of the specific aims we are focusing on right now is to understand the determinants of lung health in Nepali children aged 6-9 years old so that at a later stage, we can design an intervention that will help in the prevention of impaired lung growth, particularly in the risk group. This is likely to help prevent or reduce the development of heart and lung diseases in early or middle-aged individuals, thus increasing longevity, particularly in marginalized communities.
Long term goals
In general, we have five long-term goals for this study. First, to conduct large-scale prospective observational and experimental studies to understand major determinants and biological understanding of diseases through rigorous and innovative methods using digital technologies.
Second, to enhance the understanding and promote a systematic collection of complex data from healthcare providers, such as electronic medical records and behavioral data from communities, through a mixed-method approach.
Third, to create an intergenerational cohort to understand the complexities of diseases and find solutions for the prevention and management of various diseases, particularly lung conditions and other diseases associated with lung conditions in adults.
Fourth, to partner with academic and research institutions worldwide based on equity, engagement, excellence, and global impact to facilitate innovative, interdisciplinary, collaborative, and policy-driven research on maternal and child health, non-communicable diseases, multimorbidity and environmental health, and finally to train, prepare and provide a platform to young researchers, including post-graduate students and postdoctoral fellows, in a life-course epidemiology approach to understanding complexities of health, including diseases and management of adverse health outcome events.
Current status and future follow-up
This study is being conducted in two municipalities: Lumbini and Waling. So far, we have collected data from over 1075 families of 3100 participants (about 50 percent are children, and the rest are parents) in Lumbini Cultural Municipality. In about 45 percent of the family, the children’s fathers participated in the study and provided data, whereas most of those who did not participate in the data acquisition were working abroad.
Recently, we started collecting data from a hilly site (Waling Municipality) in December 2022, and so far, we have collected data from about 125 families of 300 participants (parents and children). The majority of the study at Waling site is funded by America Nepal Medical Foundation (ANMF). We plan to continue the data acquisition for the baseline study until December 2023.
The current ongoing study is a first step for the comprehensive assessment of risk factors, prevention of diseases, and management of health outcomes by various interventions. However, a lot more needs to be done. We plan to extend this cohort to all seven provinces of Nepal, subject to securing additional funding. Following the completion of the baseline study, we plan to apply for further funding from different funding agencies to expand this study to other provinces and the study’s follow-up cost.
In the first round of follow-up, we plan to have some enhancement to collect additional data such as fractional exhaled nitric oxide, carotid-intima media thickness measurement, electrocardiogram, and bone mineral density. We also plan to collect blood and saliva samples for storage and to conduct genetic-related studies, which will help in personalized medicine, measurement of various biomarkers and chemical analysis of air pollution data. We are also applying for PhD studentship to work on multiple health outcomes in this study.
Dr Om Kurmi is Associate Professor (Cardio-Respiratory Epidemiology and Environmental Health) at Coventry University, UK.