MAL-ED Consortium 5th Annual Meeting

The MAL-ED Consortium held its 5th Annual Meeting on May 8-10, 2013 at the Bill & Melinda Gates Foundation Conference Center in Seattle, Washington. Over 130 investigators from around the world were invited to participate in the workshop-like sessions. The meeting’s oral and poster presentations, breakout sessions and panel discussions focused on scientific progress, data analyses, and future plans for the MAL-ED Project – formally titled the Etiology, Risk Factors, and Interactions of Enteric Infections and Malnutrition and the Consequences for Child Health Project. Participants included members of the MAL-ED Network (international and national collaborators on the MAL-ED project), investigators representing MAL-ED companion projects, program officials from the Bill & Melinda Gates Foundation (BMGF; the Consortium’s financial supporter) and other invited guests with close ties to the MAL-ED Project, including members of the project’s Scientific Advisory Committee.

The five-year MAL-ED clinical research project is designed to investigate birth cohorts in resource-constrained geographic areas within eight countries where there is a high prevalence of malnutrition (specifically, undernutrition), enteric infections and associated diseases, and shortfalls in physical growth and cognitive development. Staggered enrollment for the birth cohorts began at the end of 2009; follow-up of the children in the study to 24 months of age will conclude at the end of February 2014. The overarching goals of the project are to measure nutritional status and enteric infections; and, to determine their relationship with gut function and inflammation, and their effects on physical and cognitive development as well as on immune responsiveness to scheduled oral and parenteral vaccinations. Individual sessions at the 2013 annual meeting presented results from preliminary analyses of longitudinally collected measures of diarrheal burden, enteric infections (number of different pathogens and duration of fecal shedding), nutrition, and gut function biomarkers; and, their relationship to outcome measures such as physical growth (length, weight and head circumference), cognitive development and responses to vaccinations.

MAL-ED network-wide data analyses may reveal potential intervention approaches that are generalizable across the multiple geographies and cultures involved in the study to improve the health of well-being of all young children living in under resourced areas. However, given the extensive differences across the sites with respect to environmental and cultural factors, individual study site analyses are likely to identify potential site-specific interventions. Preliminary analyses, network-wide and site-specific, examining the effects of nutrition (breastfeeding practices, micronutrients), pathogen exposure, child caregiver interactions, diarrhea, maternal depression, and water, sanitation and child cleanliness on project outcomes (cognitive development, growth, gut function, and vaccine response) were presented during at the three-day annual meeting. Many ideas and strategies on data modeling, for examining associations between measurements and outcomes, and for identifying appropriate statistical methodologies were discussed during the meeting.

Although the annual meeting was primarily focused on MAL-ED project data, there was time devoted to updates from the MAL-ED companion projects – projects funded separately by BMGF that are related to the goals of MAL-ED and that leverage MAL-ED project data, samples and resources. Companion project reporting on their progress included the Quantitative Molecular Diagnostics for Enteropathogens; Breast Milk, Gut Microbiome and Immunity (BMMI); Mycotoxins and Growth Impairment; Performance of Rotavirus and Oral polio Vaccines in Developing Countries (PROVIDE); and a potential new project on genomic sequencing of human Norovirus strains.

At the conclusion of the meeting, the MAL-ED Scientific Advisory Committee acknowledged strengths of the Network, which include the development and implementation of harmonized research protocols, and the interactive nature of the network investigators, while acknowledging that because of the length (in time) of the project and its complexity, scientific papers are only just starting to emerge. In addition, a conversation was started among the MAL-ED Network members to identify ways in which the MAL-ED data and research infrastructure can be used to identify new research hypotheses, to design and implement studies that will utilize the knowledge gained, to test potential intervention strategies, and to develop new funding strategies to accomplish these goals.

Many thanks to everyone who contributed to the success of this meeting – from behind the scenes, the speaker’s podium, and the poster sessions – and especially to those dedicated to finding solutions for improving the health of children worldwide.