Peer-reviewed article

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

Nakanga WP, Stewart RC, Malava JK, Nindi P, Nzawa-Soko R et al. · 15 Sept 2026

Abstract

Introduction Malawi is at a unique time point when infectious disease and undernutrition persist while modern diets, and changes in urbanisation, medical treatments and climate change, non-communicable long-term physical and mental health conditions are emerging. Malawi faces high socioeconomic hardships with 75% of families living in poverty with limited access to basic resources. With these demographic changes, very limited research has been undertaken into the determinants of physical and mental health-related trajectories over time, and in particular the role of prenatal and early life exposures in predetermining long-term conditions in later life.The study will establish 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 METHODS AND ANALYSIS: Generation Malawi is based within the open, health and demographic surveillance sites in rural (southern Karonga District) and urban (high-density sectors of Area 25, Lilongwe) Malawi. The study seeks to enrol up to 5000 pregnant women aged 16 years and above, and their spouses, during early pregnancy. Pregnant women and their spouses are followed up until the delivery date at which time their baby is recruited into the study. Children and their parents are then followed up at 1 week, 6 weeks, 4, 12, 24 and 36 months after delivery. At each point, we conduct detailed interviewer-led questionnaires, physical measurements and collection of bio-samples for immediate analysis and long-term storage.The data from this cohort will help us understand the causes of long-term ill health and, in the future, help develop effective interventions to prevent and promptly treat these conditions. Ethics and dissemination This study protocol was approved by the National Health Science Research Committee in Malawi (number: 21/01/2653) and the Ethics Committee of the College of Medical, Veterinary and Life Sciences at the University of Glasgow, UK (protocol number: 200190183). The formative work for this study was granted ethical clearance by the College of Medicine Research Ethics Committee (protocol number P.11/19/2865). Results will be presented at relevant conferences and published in peer-reviewed journals.