• Global Scale of Early Childhood Development (GSED)

While the importance of early development has been well recognized globally, universal measures designed to quantify early child development (ECD) are lacking, particularly for the youngest children. Measurement tools are necessary not only for tracking progress toward meeting global policy goals, but also for informing resource allocation and programming to provide the necessary support to enable children to reach their developmental potential. Current measures of child development range from proxy measures to detailed measures of individual performance that can be expensive, culturally inappropriate, or time-intensive to administer. Neither these proxy measures nor the individual measures are adequate for program evaluation. As yet, there are no widely accepted universal measures of ECD that can be applied at the population level for children under 3 years of age.
The overarching aim of the Global Scale for Early Development (GSED) Project is to develop a robust, universal and psychometrically sound scale to measure development of children aged 0-3 years through two measurement instruments. This study aims at the validation of the GSED instruments (short and long form).

Project Location: Pemba, Zanzibar, TZ
Project Started: June 2020
Funded By: World Health Organization (WHO)

  • MOMI Biorepository Platform: AMANHI Tanzania

To identify new insights and biomarkers for preterm birth and other pregnancy complications to inform prediction and treatment and improve maternal and neonatal health.

Project Location: Pemba, Zanzibar, TZ
Project Started: October 2020
Funded By: The Bill and Melinda Gates Foundation (BMGF)

  • COVID-19: Harnessing AMANHI Infrastructure to Assess Direct Impact on MNCH
    Ongoing AMANHI pregnancy biorepository cohorts, in which children are being followed up for growth and development until 2-3 years of age, offer a unique opportunity to address crucial gaps in knowledge about how COVID-19 impacts women and children.

The objectives of the study are to

1. Determine the age-specific cumulative incidence of COVID-19 infection, as determined by seroconversion, among 1 to 4 years old children and mothers (women of reproductive age) enrolled in the AMANHI-ACT study.
2. Determine proportion of infections causing moderate or severe COVID-19 disease among women of reproductive age and children under-5 years of age.
3. Investigate epidemiological, biological, serological, socio-economic and nutritional status as possible risk factors for infection, and severity of disease given infection.
4. Evaluate the impact of asymptomatic or symptomatic SARS-CoV-2 infection on the risk of subsequent infection and severity of disease.
5. For pregnant women identified in the cohort:
a) Evaluate the clinical presentation, utilization of preventive care, complications, treatment and clinical course of disease for pregnant women or women who have delivered in the last eight weeks who are infected with COVID-19
b) Evaluate the pregnancy, delivery and newborn outcomes among those born to women who have had COVID-19 and identify subgroups that are at a higher for adverse outcomes.
c) To collect data in a harmonized manner and contribute to pooled analysis with other ongoing pregnancy in COVID-cohorts such as those conducted by WHO/SRH and PRIORITY network.
6. Document the non-COVID-19 related health care utilization for preventive and curative health services for pregnant and non-pregnant women and children and how these are affected by the COVID-19 epidemic.

Project Location: Pemba, Zanzibar, TZ
Project Started: Oct 2020
Funded By: World Health Organization (WHO)


  • The Growth Trial – Nutritional management of growth faltering in LBW/SGA/PTB infants

Optimal early nutrition improves the immediate survival prospects of the most at-risk newborns as well as the trajectory of their physical and cognitive development. Despite the importance of nutrition, there is a weak evidence base on how to effectively support the nutritional demands of newborns born too early or born too small, young infants who fail to grow adequately and experience growth faltering, and infants less than 6 months of age with acute malnutrition, particularly in resource constrained settings.

Globally, approximately 15% of babies are born LBW, with a significantly higher burden in South Asia where one in four babies are LBW. This early vulnerability increases their risk of subsequent growth failure and early incidence of acute malnutrition within the first 6 months of life. Data from 18 LMIC longitudinal cohorts (supported by the foundation’s KI “wasting rally”), demonstrates that early growth faltering and subsequent wasting begins by 2-3 months of age, much earlier than initially thought, at a time when children are expected to be exclusively breasted. By 6 months of age, 18% of infants had experienced at least one wasting episode since birth, with increased risk among LBW/SGA/PTB babies.

This Project will focus on early infant nutrition and provide evidence for the following priorities:

  1. How to improve screening and identification of infants less than 6 months of age with growth failure;
  2. How to improve management of infants less than 6 months of age with growth failure;
  3. How to prevent growth failure among infants less than 6 months of age in low resource settings.

Project Location: Pemba, Zanzibar, TZ

Project Duration: 3 Years

Funded By: World Health Organization (WHO)


  • MOMI – Multi Omics for Mothers and Infants (Pemba Tanzania)
    The goals included lowering both infant and maternal morbidity/mortality in low resource settings through innovation and implementation. This project was meant to directly address the critical issues by identifying new predictive biomarkers for preterm birth, preeclampsia, stillbirth and IUGR (intrauterine growth restriction) to enable treatment and triage to decrease the disease burden. In addition it was to identify new biological mechanisms underpinning the causes of preterm birth, preeclampsia, stillbirth and IUGR to create a platform to generate new approaches to treatment and prevention.

The Alliance for Maternal and Newborn Health Improvement (AMANHI) study in Pemba has been established to best characterize population based longitudinal cohort of pregnant women and their babies in sub–Saharan Africa. Our goal was to establish and maintain a bio-bank in resource limited setting in East Africa; develop local capacity around bio-banking and the use of biological samples to explore future hypotheses as new methods and technologies become available to advance knowledge on key adverse pregnancy outcomes including preterm births, miscarriages, still births, IUGR and SGA. Population-based bio-banks will help translate -omics discoveries into promising diagnostic, treatment and prevention strategies that can be further tested in intervention trials. The integration of genome-based knowledge into epidemiological and public health research, policies and health services seems to be the most important public health challenge. Having a characterized cohort of pregnancy with all the metadata presents a unique opportunity to investigate clinical, biochemical markers and add these data to the database having metadata, omics data and outcomes of pregnancy both as associations and etiological path analysis.

Project Location: Pemba, Zanzibar, TZ
Project Duration: Nov 2018 – Oct 2020
Funded By: The Bill and Melinda Gates Foundation (BMGF)

  • All Children Thrive (ACT) Study: Epigenetic and biological markers of preterm births, fetal growth, early childhood growth and neurodevelopment expanding the scope of AMANHI pregnancy Bio-repository cohort.
    Following a pregnancy cohort to determine the burden, timing and causes of maternal deaths and stillbirths. Additional information was collected on the same women as in to determine the burden of major maternal morbidity, care received, and the association of morbidity and care with stillbirths, prematurity, intrauterine growth restriction and neonatal mortality to identify a programmatically feasible method for accurate assessment of gestational age.
    Additionally a bio-repository was created to test hypothesized biological markers as predictors of important maternal and fetal outcomes. The AMANHI Biobank cohort was further extended to 4500 women, to find epigenetic and biological markers of linear growth and neurodevelopment in the first 3 years of life using biological samples from the mother and the infant collected during pregnancy, at the time of birth and at the end of the postnatal period, and accompanying information on maternal, newborn and family characteristics.
    Project Location: Pemba, Zanzibar, TZ
    Project Duration: June 2016 – Dec 2020
    Funded By: World Health Organization (WHO)


1.Effects of routine prophylactic supplementation with iron and folic acid or/and zinc on admission to hospital, morbidity and mortality in preschool children in a high malaria transmission setting: community-based, randomised, placebo-controlled trial. – This trial led to the revision of WHO recommendations on safety of universal iron supplementation among children in areas with high malarial transmission.

Project Duration: 2000 To 2005

Funded By: World Health Organization (WHO), The Bill and Melinda Gates Foundation (BMGF) & United Nations Fu

 2.Monitoring and Evaluation of President’s Malaria Initiative in Pemba for FY 07 and FY08

Project Duration: Round1: 2005 – 2008; Round 2: 2009 –Ongoing

Funded By: The Bill and Melinda Gates Foundation (BMGF)

3.Grand Challenge 13, Household Survey Study (Round-1 and Round 2) in collaboration with IHME (We were responsible for Pemba site)

Project Duration: Round1: 2005 – 2008; Round 2: 2009 –Ongoing

Funded By: The Bill and Melinda Gates Foundation (BMGF)

4. A Cognitive Testing to understand respondents nation of health to develop survey questionnaire for disability weights measurement. – Discussions to understand community’s perception on burden of different types of disability

Project Duration: 09/2009 – 10/2009

Funded By: The Bill and Melinda Gates Foundation (BMGF)

5. Multi-centric study on Global Disability Weights Measurement Survey (DWM Survey) of Institute of Health Metrics Evaluation, we were responsible for Pemba site

Project Duration: 11/2009 – 02/2010

Funded By: The Bill and Melinda Gates Foundation (BMGF)

6. A pilot study to conduct formative research to adapt and translate the updated Pathway Analysis verbal autopsy/social autopsy questionnaire for neonatal (0-27 days old) and young child (1-59 months old) deaths

Project Duration: Phase I: 06/2010 – 10/2010

Funded By: World Health Organization (WHO)

7. Efficacy of use of Chlorhexidine to clean umbilical cord of neonates in first 10 days for reduction in neonatal mortality and Omphalitis – A community based randomized, double masked controlled trial in Pemba Tanzania.

Phase I: An Ethnographic study on Maternal and Neonatal Practices- Pemba

Project Duration: Phase I for 1 year; Total study 5 years (June 2009-Jun 2014)

Funded By: The Bill and Melinda Gates Foundation (BMGF)