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Nash-wo-Numa (childhood growth & development) study protocol: factors that impact linear growth in children 9 to 15 years of age in Matiari, Pakistan
  1. Susan C Campisi1,2,
  2. Yaqub Wasan3,
  3. Sajid Soofi3,
  4. Suneeta Monga4,5,
  5. Daphne J Korczak4,5,
  6. Wendy Lou6,
  7. Olle Soder7,
  8. Ashley Vandermorris1,8,
  9. Khadija N Humayun9,
  10. Ayesha Mian10,
  11. Peter Szatmari4,5,11,
  12. Zulfiqar A Bhutta1,2,3,6
  1. 1 Centre for Global Child Health, The Hospital for Sick Children, Toronto, Ontario, Canada
  2. 2 Faculty of Medicine, Department of Nutritional Sciences, University of Toronto, Toronto, Ontario, Canada
  3. 3 Division of Women and Child Health, Aga Khan University, Karachi, Pakistan
  4. 4 Psychiatry, The Hospital for Sick Children, Toronto, Ontario, Canada
  5. 5 Psychiatry, University of Toronto, Toronto, Ontario, Canada
  6. 6 Dalla Lana School of Public Health, University of Toronto Dalla Lana School of Public Health, Toronto, Ontario, Canada
  7. 7 Department of Women’s and Children’s Health, Karolinska Universitetssjukhuset, Stockholm, Sweden
  8. 8 Division of Adolescent Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
  9. 9 Paediatrics, Aga Khan University Hospital, Karachi, Pakistan
  10. 10 Psychiatry, Aga Khan University, Karachi, Pakistan
  11. 11 Centre for Child and Youth Depression, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
  1. Correspondence to Dr Susan C Campisi; susan.campisi{at}


Introduction Adolescence is a time of significant physical and emotional change, and there is emerging concern that adolescents living in low- and middle-income countries (LMIC) may face substantial challenges in relation to linear growth and mental health. Data on the global burden of stunting after 5 years of age are limited, but estimates suggest up to 50 per cent of all adolescents in some LMIC are stunted. Additionally, many LMIC lack robust mental health care delivery systems. Pakistan has one of the world’s largest populations of adolescents (10 to 19 years) at approximately 40 million. The Nash-wo-Numa study’s primary objective is to assess the prevalence and risk factors for stunting among early adolescents in rural Pakistan. The study also aims to determine the prevalence of poor mental health and identify factors associated with common mental health concerns during the childhood to adulthood transition.

Methods This cross-sectional study will include girls (n= 738) 9.0 to 14.9 years of age and boys (n=687) 10.0 to 15.9 years of age who live in the rural district of Matiari, Pakistan. Participants will be assessed for anthropometrical measures, puberty development, nutritional biomarkers as well as symptoms of depression, anxiety and trauma using validated scales.

Ethics and dissemination The proposed study aims to complete the picture of child and adolescent health concerning linear growth and mental health by including puberty indicators. Ethics approval has been granted by the Ethics Review Committee at the Aga Khan University, Karachi, Pakistan, #5251-WCH-ERC-18 and Research Ethics Board at SickKids Hospital, Toronto, Canada, #:1000060684. Study results will be presented at relevant conferences and published in peer-reviewed journals.

Trial registration number NCT03647553; Pre-results.

  • stunting
  • puberty
  • undernutrition
  • adolescents
  • depression
  • anxiety

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  • Contributors SCC and ZAB conceived the study. SCC, ZAB, SS and YW initiated the study design. AM, PS, DK and SM assisted with the mental health assessment scales and safety protocol. KNH, AV and OS assisted with formulating culturally acceptable accurate puberty assessment procedures. KNH conducted field training for the physician puberty assessments. WL and SCC developed the statistical analysis plan. All authors contributed to the refinement of the study protocol and approved the final manuscript.

  • Funding This study is supported by the Cundill Centre for Child and Youth Depression. SCC is supported by the SickKids Restracomp doctoral award.

  • Competing interests None declared.

  • Ethics approval Ethics approval was granted by the Aga Khan University’s, Karachi, Pakistan, Ethics Review Committee (#5251-WCH-ERC-18) and SickKids Hospital, Toronto, Canada, Research Ethics Board (#1000060684).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Patient consent for publication Parental/guardian consent obtained.

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