The document discusses the Healthy Birth, Growth and Development knowledge initiative (HBGDki) which aims to answer critical questions about the relationships between preterm birth, physical growth, and brain development. HBGDki is building a knowledge base from over 9 million subjects across 25 countries to quantitatively characterize these relationships and the effects of different risk factors. The initiative will apply multiple modeling methods to gain new insights from the data to inform comprehensive intervention decisions that can prevent preterm birth, growth faltering, and neurocognitive deficits. A key finding so far is that a 600 gram difference in birth weight can result in about 8 years delay in achieving normal growth patterns.

1. © Bill & Melinda Gates Foundation

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

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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

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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.

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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

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▪ 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

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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

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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