Mental Health

Generation Malawi: a family-based birth cohort investigating physical and mental health conditions in rural and urban Malawi - study protocol.

TL;DR

Generation Malawi establishes a unique multigenerational birth cohort across contrasting rural and urban settings in Malawi to examine how pregnancy, early-life, and intergenerational factors shape long-term mental and physical health.

Key Findings

Malawi faces a dual burden of persistent infectious disease and undernutrition alongside emerging non-communicable long-term physical and mental health conditions.

  • Changes in urbanisation, modern diets, medical treatments, and climate change are driving the emergence of non-communicable conditions.
  • 75% of families in Malawi live in poverty with limited access to basic resources.
  • Very limited research has been undertaken into determinants of physical and mental health-related trajectories over time in this context.

The Generation Malawi cohort is designed to enrol up to 5000 pregnant women and their spouses across rural and urban settings in Malawi.

  • Eligible participants are pregnant women aged 16 years and above and their spouses, enrolled during early pregnancy.
  • The study is based within open health and demographic surveillance sites in rural southern Karonga District and urban high-density sectors of Area 25, Lilongwe.
  • The contrasting rural and urban settings allow for comparison of health determinants across different socioeconomic and environmental contexts.

The study follows a multigenerational design tracking pregnant women, their spouses, and their children at multiple time points from birth through 36 months.

  • Babies are recruited into the study at delivery, after which children and parents are followed up at 1 week, 6 weeks, 4, 12, 24, and 36 months after delivery.
  • At each time point, the study conducts detailed interviewer-led questionnaires, physical measurements, and collection of bio-samples for immediate analysis and long-term storage.
  • The multigenerational design specifically investigates the role of prenatal and early life exposures in predetermining long-term conditions in later life.

The study received ethical approval from both Malawian and UK ethics committees.

  • Approved by the National Health Science Research Committee in Malawi (number: 21/01/2653).
  • Approved by the Ethics Committee of the College of Medical, Veterinary and Life Sciences at the University of Glasgow, UK (protocol number: 200190183).
  • Formative work was granted ethical clearance by the College of Medicine Research Ethics Committee (protocol number P.11/19/2865).

The cohort data are intended to inform future interventions for preventing and treating long-term ill health in Malawi.

  • The study aims to understand causes of long-term ill health in the context of Malawi's unique epidemiological transition.
  • Results will be presented at relevant conferences and published in peer-reviewed journals.
  • The study specifically examines intergenerational factors shaping both mental and physical health trajectories.

What This Means

This research describes the design and methods of a large, long-term study called 'Generation Malawi,' which is tracking thousands of families in both rural and urban areas of Malawi to understand what shapes people's physical and mental health over their lifetimes. The study enrolls pregnant women and their partners early in pregnancy and then follows both parents and their newborn children at regular intervals for up to three years after birth, collecting health information, physical measurements, and biological samples. The study is set up to capture Malawi's unique situation where traditional health problems like infectious diseases and malnutrition still exist alongside growing rates of non-communicable conditions like diabetes and mental health disorders — a combination driven by changes in diet, city living, and other modern factors. This research suggests that experiences during pregnancy and the earliest years of life may have lasting effects on health across a person's entire life, and even into the next generation. By comparing families in contrasting rural and urban environments, the researchers hope to identify specific factors — such as nutrition, poverty, stress, or environmental exposures — that increase or decrease the risk of developing long-term health conditions. The study is notable for including mental health alongside physical health, and for involving both mothers and fathers, which is relatively uncommon in low-income country research settings. This research matters because Malawi has very limited existing data on what drives long-term health outcomes, particularly how conditions originating before birth or in early childhood contribute to disease later in life. With 75% of Malawian families living in poverty and the country undergoing rapid social and environmental change, understanding these pathways could eventually help guide more effective public health policies and interventions targeted at improving health outcomes for future generations in Malawi and similar settings.

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Citation

Nakanga W, Stewart R, Malava J, Nindi P, Nzawa-Soko R, Nyanjagha I, et al.. (2026). Generation Malawi: a family-based birth cohort investigating physical and mental health conditions in rural and urban Malawi - study protocol.. BMJ open. https://doi.org/10.1136/bmjopen-2026-122132