A study that started 50 years ago with 8,181 babies now spans three generations, and provides vital clues about infant mortality, nutrition

A study has been tracking the height, weight, nutrition and development of 8,181 babies born in Delhi’s

between 1969 and 1973, and of their children and grandchildren. It is the oldest such study in India, covering nearly 50 years and three generations, in some cases even the fourth.

The project has provided material for several studies whose results are now so well accepted that their origins have been forgotten. Such as the finding that high child mortality has an adverse impact on family planning, or that children are getting taller with every generation because of better nutrition. Originally intended to study the problem of low birthweight, it has gone on to become a major study on how poor nutrition in the womb and early childhood increased the risk of diabetes and early onset of chronic cardiovascular diseases in adult life.

The study was initiated by Dr Shanti Ghosh, then head of paediatrics in Safdarjung Hospital, with a four-year grant from the US and the Indian Council for Medical Research. Dr Ghosh was then working on criteria for defining low birthweight and India was struggling to bring infant mortality down from 140 deaths for every 1,000 live births.

A group of individuals born in a given time period within a specific geographical area is called a birth cohort. India’s first birth cohort came to be called the New Delhi Birth Cohort (NDBC). Dr Santosh Bhargava, former head of paediatrics in Safdarjung and the only surviving founding member of the NDBC, says he is amazed at how long the study has been able to track those babies. “We have never offered them compensation for being part of the study, as is done in many parts of the world, and no medical care. Yet, they allowed us into their homes and lives. People were different in the 1960s. They would support an effort if they were convinced it is for the general good,” explains Dr Bhargava.

Even today, many subjects spend from their own pocket to attend the clinics organised periodically to collect data. Deepak Alagh, a 47-year-old garment exporter, came to one organised recently in a temple in Amar Colony and spent two hours patiently filling out forms and answering the researchers’ questions. Why does he still come? “They used to come home from the time I was a baby. We have got busy with our lives, but they have stayed in touch regularly. So, we have a sense of commitment. I also come in the hope of seeing childhood friends and neighbours,” says Alagh nostalgically. “Statistically, what they are checking will give information to future generations, about changing food habits, health etc,” he adds.

Dinesh Dewani came with his 17-year-old daughter, both going through blood tests, ECG and scans. Dewani says that as a child he remembered the project staff coming home and doing check-ups on him and his mother.

Not everyone is as generous, says Bhaskar Singh, project coordinator since 1998. Some saw no reason to be ‘free guinea pigs’. “In the case of girls from the original cohort who grew up and got married, the parents warned us not to contact them at their in-laws’ houses as they might think she is suffering from some disease. We had to gradually win the confidence of the husbands so that the women could keep coming,” says Singh. He also recounts how entire families travel from Meerut and Ghaziabad to attend the clinic.

It has taken 22 grants to keep the project alive. In the 1970s, India did not even have quality standardised instruments such as infant weighing scales, infantometers for measuring length (height), and tapes for measuring head and chest circumference. The import of such equipment was banned because of forex constraints, and it had to be requisitioned locally from an anthropologist turned manufacturer.

The NDBC and another cohort run by CMC Vellore, also since 1969, provided valuable guidelines on the training, manpower and technical difficulties involved in such studies. Several more have followed — the Hyderabad Nutrition Trial from 1987-90, the Pune Birth Cohort from 1991, and the Mysore Birth Records Cohort from 1993, to name a few.

At the end of this year, Dr Bhargava will hand the NDBC over to Dr H P S Sachdev, a noted paediatrician and researcher. The cohort has suffered over 73% attrition for various reasons, but it still follows up over 2,000 from the original cohort. “We will continue to search for solutions to problems relevant to our context so that they can in form our policy and practice. Thus, we will not be dependent on Western datasets, which may not be applicable to the Indian scenario,” says Dr Sachdev.