About

Christopher Duggan, M.D., M.P.H., is a Samuel Meltzer, MD Professor of Pediatrics in the Field of Gastroenterology at the Department of Pediatrics, as well as a Professor of Nutrition and Global Health and Population at Harvard T.H. Chan School of Public Health. He has been performing clinical trials in pediatric nutrition, gastroenterology, and global health for the past 25 years. His research includes evaluating the efficacy of micronutrient supplementation in infants and young children born to women with or at risk of HIV infection, with nearly 5,000 infants recruited in urban Dar es Salaam, Tanzania. Recent studies involve the development of new biomarkers of environmental enteric dysfunction and the assessment of nutritional status on neurodevelopment. Dr. Duggan's research support has been provided by the National Institutes of Health, the Gates Foundation, and the World Health Organization. He is a pediatric gastroenterologist and nutrition physician at Boston Children's Hospital, where he directs the Center for Nutrition and serves as Medical Director of the Center for Advanced Intestinal Rehabilitation, one of the largest centers in the US for children with intestinal failure and chronic diarrhea syndromes. Dr. Duggan also co-directs the Harvard College course 'Nutrition and Global Health' and mentors students at Harvard Medical School and Harvard T.H. Chan School of Public Health. His international engagements include being an adjunct professor at St John’s Research Institute in Bangalore, India, and an honorary lecturer at Muhimbili University. He has received the Physician Nutrition Specialist Award twice from the American Society of Nutrition and the Fomon Nutrition Award from the American Academy of Pediatrics in 2015. Additionally, he has served as a visiting professor in China, India, Tanzania, and other countries.

Research topics

• Medicine
• Biology
• Internal medicine
• Sociology
• Demography
• Environmental health
• Pediatrics
• Physiology
• Ecology
• Economics
• Nursing
• Immunology
• Obstetrics
• Socioeconomics
• Economic growth
• Gastroenterology

Selected publications

• Maternal Aflatoxin Exposure, Birth Outcomes, and Infant Growth in Uganda

  American Journal of Tropical Medicine and Hygiene · 2026-05-07

  articleOpen access

  The association between maternal aflatoxin exposure and infant anthropometric birth and growth outcomes was investigated in the present study, controlling for possible confounders. Pregnant women (N = 1,210) from 16 Ugandan subcounties were enrolled in a birth cohort study to track birth outcomes and subsequent growth of infants. Serum concentrations of aflatoxin B1 (AFB1)-lysine adduct, environmental enteric dysfunction markers of anti-lipopolysaccharide and anti-flagellin IgG and IgA, and markers of systemic inflammation, alpha-1 acid glycoprotein, and C-reactive protein were measured in mothers at birth and infants at 6 months of age. A generalized estimating equations model with an exchangeable correlation matrix was used to assess associations between maternal AFB1 blood concentration and weight, length, weight-for-age (WAZ), length-for-age (LAZ), and weight-for-length (WLZ) Z scores. Multivariable linear and logistic regressions were used to assess the association between infant aflatoxin concentrations and growth outcomes at 3 to 6 months of age. Serum aflatoxin concentrations in women at parturition were associated with reduced birth weight (P = 0.037) and WAZ (P = 0.034), but not with other birth outcomes. Aflatoxin concentrations in infants 6 months of age were not associated with changes in weight, height, WAZ, LAZ, or WLZ between 3 and 6 months of age. The present study confirmed an association between maternal aflatoxin and specific birth outcomes, but not between infant serum aflatoxin and infant early growth, which may be due to low exposure to aflatoxin-contaminated foods in early life. This finding highlights the importance of promoting national policy actions that minimize aflatoxin contamination of local food supplies, both on farms and in markets.

  PublisherOA PDFDOI

• Hypertensive disorders of pregnancy and perinatal outcomes: two prospective cohort studies of nulliparous women in India and Tanzania

  BMJ Global Health · 2025-07-01 · 3 citations

  articleOpen access

  INTRODUCTION: Hypertensive disorders of pregnancy (HDP) have been linked with increased risk for maternal and offspring complications in high-income settings. However, in resource-limited settings, studies with robust measurement of HDP, including severity and timing, and perinatal outcomes are limited. METHODS: We analysed data from two prospective cohorts of nulliparous women in India (n=10 570 pregnancies) and Tanzania (n=10 299 pregnancies) who were enrolled in calcium supplementation trials and had blood pressure and proteinuria assessments throughout pregnancy and at the time of labour and delivery. Generalised estimating equations were used to assess the relationship between HDP severity categories (gestational hypertension, preeclampsia without severe features and preeclampsia with severe features) and timing of HDP onset (early-onset <34 weeks vs late-onset ≥34 weeks gestation) with adverse perinatal outcomes. RESULTS: The cumulative incidence of HDP was 3.7% and 4.5% in the India and Tanzania cohorts, respectively. All HDP severity categories were associated with a significantly higher risk for perinatal death in both cohorts (p values<0.05). Pregnancies complicated by pre-eclampsia with severe features had the largest magnitude of increased risk for perinatal death as compared with pregnancies without an HDP (India RR 8.60; 95% CI 5.90 to 12.53; Tanzania RR 4.05; 95% CI 2.91 to 5.66). In both cohorts, pre-eclampsia with and without severe features, but not gestational hypertension, was associated with increased risks for preterm birth and low birth weight. Pregnancies with early-onset HDP had a high absolute risk of perinatal death (India 25.6% and Tanzania 36.9%), and the risk was markedly increased as compared with late-onset HDP (India RR 4.79; 95% CI 2.68 to 8.54; Tanzania RR 5.79; 95% CI 3.56 to 9.41). CONCLUSION: HDP were differentially associated with risks for perinatal outcomes by severity and timing of onset. Interventions that prevent, reduce the severity or delay the onset of HDP may improve perinatal outcomes in resource-limited settings. TRIAL REGISTRATION NUMBER: ClinicalTrials.gov number, NCT03350516.

  PublisherOA PDFDOI

• Efficacy of zinc supplementation for young infants with clinical severe infection in Tanzania: study protocol for a randomised controlled trial

  BMJ Paediatrics Open · 2025-08-01

  articleOpen access

  INTRODUCTION: Innovative interventions will be essential for countries in sub-Saharan Africa to achieve the 2030 Sustainable Development Goal for child mortality. Infections among young infants, including sepsis, meningitis and pneumonia, continue to cause a large burden of morbidity and mortality in low-income and middle-income countries. Zinc is an essential micronutrient with a well-established role in human health and immune system function, and supplementation may improve survival and treatment outcomes for infants with bacterial infections. METHODS AND ANALYSIS: We will conduct an individually randomised, quadruple-blind trial of zinc supplementation among 3250 infants 0-59 days old with clinical severe infection (CSI) in Dar es Salaam, Tanzania. Infants with CSI will be randomised to receive either (1) zinc citrate supplementation consisting of 5 mg elemental zinc taken two times per day for 14 days or (2) a matching placebo supplementation taken two times per day for 14 days. Infants will be followed for 90 days postrandomisation. The coprimary outcomes are (1) infant death (all-cause mortality to 90 days) and (2) treatment failure (composite outcome of death during initial hospitalisation, need for additional respiratory support, use of vasoactive medicines or change of antibiotics). Secondary outcomes include important infant health and nutritional outcomes. ETHICS AND DISSEMINATION: The trial protocol was approved by Harvard T. H. Chan School of Public Health Institutional Review Board, the Muhimbili University of Health and Allied Sciences Institutional Review Board, the National Health Research Ethics Sub-Committee and the Tanzania Medicine and Medical Device Authority. Findings will be disseminated locally, regionally and internationally at scientific conference presentations and as peer-reviewed publications. TRIAL REGISTRATION NUMBER: NCT06102044; ClinicalTrials.gov identifier.

  PublisherOA PDFDOI

• Effect of vitamin D supplementation during pregnancy and lactation on the development of infants born to Tanzanian women living with HIV: a secondary analysis of a randomised controlled trial

  BMJ Open · 2025-10-01

  articleOpen access

  BACKGROUND: Infants born to pregnant women living with HIV (WLHIV) are at greater risk for morbidity and mortality and may also have poorer developmental outcomes as compared with infants who are not exposed to HIV. Nutrition interventions in pregnancy may affect developmental outcomes. OBJECTIVES: This study evaluated the effect of maternal vitamin D supplementation on infant development outcomes. DESIGN: We conducted a secondary analysis of a randomised, triple-blind, placebo-controlled trial of maternal vitamin D supplementation from June 2015 to October 2019. SETTING: Antenatal care clinics in Dar es Salaam, Tanzania. PARTICIPANTS: Pregnant WLHIV and their offspring. INTERVENTIONS: or placebo supplements taken during pregnancy and lactation. OUTCOME MEASURES: Infants were assessed for cognitive, language and motor development at 1 year of age with the Caregiver Reported Early Development Instruments (CREDI). RESULTS: A total of 2167 infants were eligible, and 1312 of them completed CREDI assessments at 1 year of age. Vitamin D supplementation had no effect on overall CREDI z-scores (standardised mean difference (SMD) 0.03, 95% CI -0.09, 0.15, p value 0.66). There was also no evidence of a difference between vitamin D and placebo groups in language (SMD 0.06, 95% CI -0.08, 0.21, p value 0.40), motor (SMD 0.02, 95% CI -0.09, 0.14, p value 0.69) or cognitive domain z-scores (SMD 0.05, 95% CI -0.08, 0.17, p 0.48). CONCLUSIONS: Maternal vitamin D supplementation during pregnancy and lactation did not affect infant development outcomes. TRIAL REGISTRATION NUMBER: ClinicalTrials.gov identifier: NCT02305927.

  PublisherOA PDFDOI

• Inpatient versus outpatient management of young infants with a single low-mortality-risk sign of possible serious bacterial infection in sub-Saharan Africa and south Asia: an open-label, multicentre, two-arm, randomised controlled trial

  The Lancet Global Health · 2025-10-15

  articleOpen access

  BACKGROUND: Research has shown low mortality in young infants with a single low-mortality-risk possible serious bacterial infection (PSBI) sign. Outpatient treatment of young infants (age <2 months) with a single low-mortality-risk PSBI sign might be as effective and safe as hospitalisation. Outpatient treatment overcomes the challenges of hospitalisation and improves access in low-resource settings. Our aim was to assess clinical outcomes in patients with one low-mortality-risk PSBI sign treated as outpatients compared with inpatient treatment. METHODS: We did an open-label, multicentre, two-arm, randomised controlled trial at seven sites across Bangladesh, Ethiopia, India, Nigeria, Pakistan, and Tanzania. Young infants presenting to study hospitals with one of three low-mortality-risk PSBI signs (ie, fast breathing if age <7 days, body temperature ≥38°C, or severe chest indrawing) were randomly assigned (1:1) to the outpatient treatment group (2-day injectable gentamicin plus 7-day oral amoxicillin) or the inpatient treatment group (7-day injectable ampicillin plus gentamicin, with supportive care). The primary outcome was poor clinical outcome, which was a composite of any one of the following: death, critical illness, signs of other serious infections, new PSBI signs on days 2, 4, 8, and 15 or persistence of the presenting sign on day 8 after randomisation. We evaluated superiority and non-inferiority using the Farrington-Manning score test. The trial is registered with the ISRCTN Registry (ISRCTN44033252). FINDINGS: Between June 24, 2021, and April 26, 2024, 7001 young infants were enrolled and randomly assigned to the outpatient treatment group (n=3501) or the inpatient treatment group (n=3500), and were part of the intention-to-treat (ITT) population. Poor clinical outcomes occurred in 269 (7·7%) of 3501 outpatients and 272 (7·8%) of 3500 inpatients in the ITT analysis (risk difference -0·0009 [95% CI -0·0134 to 0·0116]; p=1·0000 for superiority analysis). Deaths were significantly lower in the outpatient group (nine [0·3%] of 3501) than in the inpatient group (23 [0·7%] of 3500; risk difference -0·0040 [-0·0072 to -0·0008]). In the per-protocol analysis, outpatient treatment (266 [7·7%] of 3455) was non-inferior to inpatient treatment (269 [7·9%] of 3416) for poor clinical outcomes (risk difference -0·0018 [-0·0144 to 0·0109]; p=0·0012 for non-inferiority). Apart from deaths, there were no treatment-related serious adverse events. INTERPRETATION: Outpatient treatment (gentamicin injection and oral amoxicillin) for infants with a single low-mortality-risk PSBI sign was non-inferior to standard inpatient treatment, with significantly lower mortality in the outpatient treatment group. FUNDING: Bill and Melinda Gates Foundation.

  PublisherOA PDFDOI

• Maternal Aflatoxin Exposure, Birth Weight and Infant Growth in Uganda

  Current Developments in Nutrition · 2025-05-01

  articleOpen access
  PublisherDOI

• Adverse Effects on Child Health from United States Retrenchment on Global Scientific Collaboration: Examples from Gastroenterology, Hepatology, and Nutrition

  The Journal of Pediatrics · 2025-07-18

  article1st authorCorresponding
  PublisherDOI

• Is rotavirus aetiology in young children with acute diarrhoea associated with sociodemographic and clinical factors, including rotavirus vaccination status? A secondary cross-sectional analysis of the ABCD trial

  BMJ Global Health · 2025-07-01

  articleOpen access

  INTRODUCTION: One of the leading causes of global child mortality continues to be diarrhoea where rotavirus contributed to about 24% of deaths among all diarrhoeal deaths, mostly in low-income and middle-income countries. Rotavirus vaccination programmes have contributed to the reduction of mortality from 24% to 19% in rotavirus infections among hospitalised children, but the burden of rotaviral diarrhoea remains high, especially in settings with undernutrition. We aimed to determine the association of rotaviral diarrhoea aetiology with prior vaccination, socioeconomic status and clinical factors in children to see their utility in clinical settings. METHODS: We analysed secondary data from a multicentre clinical trial on antibiotic impact in children with diarrhoea and increased risk of mortality. We used stored stool samples of 6697 children aged 2-23 months old, presenting to a health facility with diarrhoea and increased risk of mortality. We determined rotavirus aetiology prevalence using quantitative PCR (qPCR) and looked at its association with the patient's rotaviral vaccination status, clinical symptoms and sociodemographic characteristics. Prevalence ratios (PR) were calculated with log-binomial regression models; if they did not converge, log-Poisson models were used. RESULTS: Rotavirus prevalence of 21.1% was observed. There was a weak and statistically non-significant inverse association between rotavirus vaccination and rotaviral diarrhoea aetiology (adjusted PR: 0.71, 95% CI 0.49 to 1.03). Of the five tested clinical symptoms, shorter diarrhoea duration was associated with rotaviral aetiology (PR: 2.65; 95% CI: 1.29 to 5.45). Of the seven tested socioeconomic characteristics, only maternal and paternal secondary education compared with no formal education were associated with rotaviral aetiology (PR: 0.86; 95% CI: 0.74 to 1.00, PR: 0.87, 95% CI: 0.75 to 1.00 respectively). CONCLUSION: Rotaviral diarrhoea aetiology cannot accurately be determined with prior receipt of rotavirus vaccination among children presenting to facilities with diarrhoea and increased risk of mortality. Short diarrhoea duration and parental secondary education were associated with increased prevalence of rotaviral aetiology; however, their utility in clinical care remains unclear.

  PublisherOA PDFDOI

• Machine learning approaches to identify neonates and young children at risk for postdischarge mortality in Dar es Salaam, Tanzania and Monrovia, Liberia

  BMJ Paediatrics Open · 2025-06-01 · 2 citations

  articleOpen access

  BACKGROUND: The time after hospital discharge carries high rates of mortality in neonates and young children in sub-Saharan Africa. Previous work using logistic regression to develop risk assessment tools to identify those at risk for postdischarge mortality has yielded fair discriminatory value. Our objective was to determine if machine learning models would have greater discriminatory value to identify neonates and young children at risk for postdischarge mortality. METHODS: We conducted a planned secondary analysis of a prospective observational cohort at Muhimbili National Hospital in Dar es Salaam, Tanzania and John F. Kennedy Medical Center in Monrovia, Liberia. We enrolled neonates and young children near the time of discharge. The outcome was 60-day postdischarge mortality. We collected socioeconomic, demographic, clinical, and anthropometric data during hospital admission and used machine learning (ie, eXtreme Gradient Boosting (XGBoost), Hist-Gradient Boost, Support Vector Machine, Neural Network, and Random Forest) to develop risk assessment tools to identify: (1) neonates and (2) young children at risk for postdischarge mortality. RESULTS: A total of 2310 neonates and 1933 young children enrolled. Of these, 71 (3.1%) neonates and 67 (3.5%) young children died after hospital discharge. XGBoost, Hist Gradient Boost, and Neural Network models yielded the greatest discriminatory value (area under the receiver operating characteristic curves range: 0.94-0.99) and fewest features, which included six features for neonates and five for young children. Discharge against medical advice, low birth weight, and supplemental oxygen requirement during hospitalisation were predictive of postdischarge mortality in neonates. For young children, discharge against medical advice, pallor, and chronic medical problems were predictive of postdischarge mortality. CONCLUSIONS: Our parsimonious machine learning-based models had excellent discriminatory value to predict postdischarge mortality among neonates and young children. External validation of these tools is warranted to assist in the design of interventions to reduce postdischarge mortality in these vulnerable populations.

  PublisherOA PDFDOI

• Systematic review of risk assessment tools for post-discharge mortality among children in sub-Saharan Africa

  PLOS Global Public Health · 2025-07-01 · 1 citations

  articleOpen access

  Post-discharge mortality is increasingly recognized as a major contributor to the high burden of childhood mortality in sub-Saharan Africa. Accurate identification of children at risk for post-discharge mortality is critically important to inform interventions to reduce deaths following hospital discharge. Our objective was to describe the current state of development, validation, or implementation for risk assessment tools for post-hospital discharge mortality (PDM) in sub-Saharan Africa. We conducted a systematic review of publications on risk assessment tools for PDM among children aged 0-18 years in sub-Saharan Africa. We searched CABI Global Health, Cochrane Reviews, Cochrane Trials, ProQuest Dissertations and Theses, Embase, PubMed, and Web of Science with no date or language restriction. We included publications if they described a tool/model with weights assigned to variables to quantify risk of PDM, included children, and were conducted in sub-Saharan Africa. We determined the level of evidence for tools using the Evidence-Based-Medicine Working Group hierarchy. Of 4,893 publications screened, 289 full texts were reviewed, and seven publications that reported 23 risk assessment tools for PDM among children in sub-Saharan Africa were identified. These studies enrolled 49,669 total participants (3.6%, n = 1,795 experienced PDM). There was substantial heterogeneity in identified risk factors, although all identified malnutrition as a risk factor for PDM. All risk assessment tools had fair (i.e., area under the receiver operating characteristic curve [AUC] ≥0.70) or good (AUC ≥ 0.80) discriminatory value in internal validation. Only two risk assessment tools had been externally validated, and none were implemented. Existing risk assessment tools to identify children at risk for PDM in sub-Saharan Africa lack broad validation and implementation. Malnutrition is a common risk factor for PDM. Further studies are needed to validate and implement such tools to reduce PDM among children.

  PublisherDOI

Recent grants

• NIH Grant R03HD052143

  NIH · $167k · 2011

• Boston Area Nutrition Obesity Research Center (NORC)

  NIH · $13.2M · 1997–2027

• Training Grant in Academic Nutrition

  NIH · $8.4M · 1994–2030

• NIH Grant R01HD048969

  NIH · $2.0M · 2012

• NIH Grant K24DK104676

  NIH · $903k · 2022

Frequent coauthors

• Wafaie Fawzi

  Harvard University

  346 shared

• Karim Manji

  Muhimbili University of Health and Allied Sciences

  205 shared

• Lori J. Bechard

  Boston Children's Hospital

  199 shared

• Tom Jaksic

  166 shared

• Rodrick Kisenge

  Muhimbili University of Health and Allied Sciences

  148 shared

• Said Aboud

  National Institute for Medical Research

  142 shared

• Christopher R. Sudfeld

  Harvard University

  138 shared

• Enju Liu

  103 shared

Awards & honors

• Physician Nutrition Specialist Award from the American Socie…
• Fomon Nutrition Award from the American Academy of Pediatric…