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The Health Impacts of Artificial Reef Advancement (HIARA; in the Malagasy language, "together") study cohort was set up in December 2022 to assess the economic and nutritional importance of seafood for the coastal Malagasy population living along the Bay of Ranobe in southwestern Madagascar. Over the course of the research, which will continue until at least 2026, the primary question we seek to answer is whether the creation of artificial coral reefs can rehabilitate fish biomass, increase fish catch, and positively influence fisher livelihoods, community nutrition, and mental health. Through prospective, longitudinal monitoring of the ecological and social systems of Bay of Ranobe, we aim to understand the influence of seasonal and long-term shifts in marine ecological resources and their benefits to human livelihoods and health. Fourteen communities (12 coastal and two inland) were enrolled into the study including 450 households across both the coastal ( n  = 360 households) and inland ( n  = 90 households) ecosystems. In the ecological component, we quantify the extent and health of coral reef ecosystems and collect data on the diversity and abundance of fisheries resources. In the social component, we collect data on the diets, resource acquisition strategies, fisheries and agricultural practices, and other social, demographic and economic indicators, repeated every 3 months. At these visits, clinical measures are collected including anthropometric measures, blood pressure, and mental health diagnostic screening. By analyzing changes in fish catch and consumption arising from varying distances to artificial reef construction and associated impacts on fish biomass, our cohort study could provide valuable insights into the public health impacts of artificial coral reef construction on local populations. Specifically, we aim to assess the impact of changes in fish catch (caused by artificial reefs) on various health outcomes, such as stunting, underweight, wasting, nutrient intake, hypertension, anxiety, and depression., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Golden, Hartmann, Gibbons, Todinanahary, Troell, Ampalaza, Behivoke, David, Durand, Falinirina, Frånberg, Declèrque, Hook, Kelahan, Kirby, Koenen, Lamy, Lavitra, Moridy, Léopold, Little, Mahefa, Mbony, Nicholas, Nomenisoa, Ponton, Rabarijaona, Rabearison, Rabemanantsoa, Ralijaona, Ranaivomanana, Randriamady, Randrianandrasana, Randriatsara, Randriatsara, Rasoanirina, Ratsizafy, Razafiely, Razafindrasoa, Romario, Solofoarimanana, Stroud, Tsiresimiary, Volanandiana, Volasoa, Vowell and Zamborain-Mason.)