For TNO’s Prof. Stef van Buuren, who specialises in the health of young children and in statistics, the request from the Bill & Melinda Gates Foundation (BMGF) came right out of the blue. “We were very interested to hear about your work in the field of the growth and development of children. Would you be prepared to come to Washington DC in a couple of weeks’ time to discuss this topic with a select group of scientists?”
That was two years ago. TNO has since set up a team to help this major charitable organisation combat the problem of stunted growth and development in children. The essence of the problem: the first thousand days of a child’s life, starting from conception. This is because, at two years of age, there are huge differences in height and weight between children in prosperous countries and those in less developed parts of the world.
“What appealed to me most was the multidisciplinary approach advocated by Bill Gates, which became clear after the meeting in Washington DC. It involves bringing experts from various fields together so they can learn from one another, inspire each other, add to each other’s knowledge, and arrive at better solutions more quickly. This is an issue that you need to approach from a range of disciplines, which is exactly how we do things here at TNO. Cooperation between scientists in all those areas is the only way to effectively tackle this problem.”
Unique Dutch approach
“Dr Shasha Jumbe, Director of the Foundation’s Healthy Birth, Growth and Development knowledge integration programme (HBGDki) was clear about what was needed. Our knowledge could help them develop the methodology and tools needed to analyse data on the growth of children. While carrying out extensive literature reviews, they had come across our long-term study into the growth of children. Our system of children’s health clinics is unique to the Netherlands. These clinics accurately record and monitor the details of each child’s height and weight, as well as other developmental parameters. This yields a wealth of valuable data, such as growth charts. In this country, we have traditionally collected large amounts of data on children, and this information is potentially very useful to the Foundation.”
A combined knowledge of youth health care and statistics was exactly what the BMGF was looking for, and that was what it found in the person of TNO’s Stef van Buuren. Some time ago, Stef developed a statistical method that can be used to draw robust conclusions about ‘missing data’ in scientific studies. The basic concept behind this had been suggested by a professor of statistics at Harvard University. Stef then developed it into a software package, which is now frequently used by statisticians around the world. “In time, we will develop better analyses that will enable us to monitor children’s growth right up until puberty. Children’s health clinics or doctors send child growth data to a TNO server, which uses special algorithms to calculate and interpret growth curves.”
Early deficit with lifelong effects
Drawing on TNO’s knowledge of youth health care and statistics, a new method is being developed to determine which interventions, at which places in the world, are the most effective in terms of substantially reducing mortality and poor development among children. “The first thousand days are critical”, says Stef. “At birth, children everywhere are all about the same height and weight. Yet, two years later, you see that children in many developing countries are well below the World Health Organization’s (WHO) standard. Once you have a deficit like that, you can never catch up. A poor start will affect you for the rest of your life. The goal of the BMGF programme is to change this situation.”
“A poor start will affect you for the rest of your life. The goal of the BMGF programme is to change this situation”
Ideal mix of interventions
There are plenty of measures that could potentially improve this lamentable situation, such as a healthy diet, clean drinking water, sanitation, good hygiene, information and education, medicine, and the eradication of diseases such as malaria. However, these measures are often difficult to implement. Furthermore, a method is needed to determine which interventions (or combinations thereof) are most effective. We need to find out what works for a given individual or a given group, in a given village, town or region. “And that is where we come in”, says Stef. “We are developing a tool that will provide answers to such questions. That involves collecting huge amounts of data and building statistical models to determine the ideal mix of interventions for any given location in the world. It is the biggest challenge of my career so far. Our goal is to deliver a functional tool that scientists and individuals working in everyday practice can use to effectively improve the health of young children.”
‘Exporting’ health knowledge
The HBGD programme will run until mid-2017. By that time, Stef and his team hope to have at least produced a prototype. “We are deeply honoured and very motivated by this opportunity to contribute our unique Dutch knowledge and expertise to this ambitious programme. The Netherlands has an enviable reputation for export products in the field of agriculture and horticulture, for innovative solutions for flood protection, and much more besides. What could be better than disseminating knowledge about young children’s health to bring about tangible improvements to their situation?”
Healthy Birth, Growth, and Development
The BMGF has concluded that, in 2011, 165 million children throughout the world were affected by stunted growth. That leads to illness, premature death, physical and psychological problems, as well as poverty. For this reason, in early 2015, the Foundation set up the Healthy Birth, Growth, and Development programme. Across the world, scientists from a range of disciplines are cooperating on this issue. This work combines data on life cycles, diseases and interventions.