CHANGE Cohort 2: Chronic disease outcomes after Severe Acute Malnutrition (ChroSAM). Malawi – User Guide and Codebook

Permanent identifier

https://doi.org/10.17037/DATA.00002657

Data Creators

Kerac, M, Anujuo, K, Lelijveld, N, Kanjala, C, Chimwezi, E and Nyirenda, M

Description

A dataset containing information collected from a prospective cohort of children originally admitted for treatment of severe acute malnutrition (SAM) in Blantyre, Malawi during 2006 and 2007. It includes health and anthropometric data from admission to care, during treatment, at discharge, at 1 year post-discharge, and at 7-years post-discharge. During original admission to care, data was collected as part of a randomised controlled trial into the effects of pre- and probiotics on treatment recovery – findings were null (trial registry number ISRCTN19364765). At the most recent follow-up in 2013/14, data pertaining to NCD risk were also collected, and data on 1 sibling control and 1 community control (age and sex matched) was also added.

Description of data capture

The data comes from a prospective cohort of children, recruited during a randomised controlled trial with null findings, while they were being treated for severe malnutrition (PRONUT study). They were then followed up at 1 year post-discharge (FuSAM).

This was a secondary analysis of data collected from children treated for severe wasting and/or nutritional oedema in 2006/7 in Malawi, and followed up seven years later to assess risk of NCD. The objectives of the current analysis were to:

The original data comes from a prospective cohort of children, recruited during a randomised controlled trial with null findings, while they were being treated for severe malnutrition (PRONUT study). They were then followed up at 1 year post-discharge (FuSAM study) and again at 7-years post-discharge (ChroSAM study), where the focus was more on indicators of NCD risk.

Interviews were conducted face-to-face by trained nurses and data collectors, on the ward and then at the households of each participant, in the local language. Details of the data collection methods including anthropometry methods, lab tests, and questionnaires can be found in a number of publications (Kerac et al., 2009, Kerac et al., 2014, Lelijveld et al., 2016).

Key features include:

All children admitted for treatment during the recruitment period were eligible for inclusion. Admission criteria for treatment were weight-for-length z-score <70% median (using NCHS reference) and/or MUAC<110 mm and/or bilateral oedema. All patients were admitted for initial inpatient treatment, following the WHO 3-stage protocol at that time: stabilisation with F75 therapeutic milk, transition phase where RUTF was introduced to the diet alongside F75, and then rehabilitation phase where children were discharged with a 2-week ration of RUTF to continue their recovery at home and return to the ward for monitoring and to collect another ration every 2 weeks until recovery. Children were discharged from outpatient therapeutic care following 2 consecutive fortnightly visits at or above target weight of 80% median weight-for-height. Minimum time in outpatient care was therefore 4 weeks. Maximum time was 10 weeks.

This analysis was coordinated with similar analyses of cohort data for children treated for severe malnutrition in Jamaica and Ethiopia – this had some bearing on the methodology.

Data access

This dataset is not held in the LSHTM repository. Data management and access arrangements for this dataset are handled in-country by the study investigators, in accordance with the study ethics approvals.

Please read the data codebook and make a note of variables that you wish to request prior to applying for access. Access requests submitted through the LSHTM repository will be passed onto the relevant research team for follow-up.

Data codebook

The following data table has been provided for the ‘ChroSAM_CHANGE’ dataset. However, as noted above, the dataset has not been deposited to the LSHTM repository and repository staff are unable to verify its completeness or accuracy. Please refer all questions to the research team.

Please note that the study team will only provide access to fully anonymised data, subject to eligibility criteria being met. The study will not provide access to any personal or confidential information that has been collected.

position name type value labels variable description
1 uniqueid int   unique id
2 fusam_waz double   fusam WAZ _1 year
3 fusam_haz double   fusam HAZ 1 year
4 fusam_bmiz double   fusam BAZ 1 year
5 hiv_admission byte 1=positive, 0=negative HIV status at admission (restricted)
6 ward_reg byte 1-intervention 2=control pronut study group
7 Wardout byte WARDOUT ward outcome
8 otp_outcome byte FINALOUT otp outcome (after each individual admission episode)
9 moyoadm long   Admission date
10 dtminwgt long   date of minimum weight
11 trdate long   date started transitional phase feeds
12 ph2date long   date started phase 2 feeds
13 discdate_ward long   date of discharge from ward (any outcome)
14 oedyesno_admission byte 1= oedema 2=no oedema any oedema on admission (yes or no)
15 oedema_admission byte   admission oedema (grade)
16 DxMK byte 0=not marasmic-kwash, 1=marasmic kwash marasmic-kwash at admission
17 weight_transition_phase double   weight at transitional phase on ward
18 totalotp byte   total otp visits
19 agecomp_admission   byte   age complentary food 1st started
20 stillbf_admission byte 0= no 1=yes is child still breastfed (asked at admission)
21 mnbfstop_admission byte   if not bf, months when stopped
22 whybfs_admission byte   if no bf, why bf stopped
23 birthwt byte 1=normal, 2=small 3=very small reported birthweight
24 deaths_during_treatment byte   1=died either on ward, during otpor during defaulter follow up
25 weight_admission double   admission weight (kg)
26 muac_admission double   admission muac (cm)
27 weight_minimum double   minimum weight on ward (kg)
28 weight_ward_discharge double   weight at discharge from ward
29 height_OTP_dicharge double   height (length adjusted) at OTP discharge
30 weight_otp_discharge double   final weight from otp programme
31 weight_fusam double   weight at 1 year post-discharge visit
32 muac_fusam double   muac at 1 year follow up visit (fusam)
33 height_fusam double   height at 1 year fup visit
34 id str8   id across all chrosam data
35 datefinalOTPvisit int   date final OTP visit
36 agemonthsadmission int   age (months) admission
37 height_admission double   height_admission
38 height_discharge_ward double   height/length_ at discharge from ward
39 muac_discharge double   muac_discharge
40 final_treatment_outcome str8   final treatment outcome _after otp
41 fusamdate int   fusam date of interview 1 year fup
42 WAZ_minimum_weight double   WAZ_minimum_weight  (WHO)
43 HAZ_minimum_weight double   HAZ_minimum_weight  (WHO)
44 BAZ_minimum_weight double   BAZ_minimum_weight  (WHO)
45 age_m_minimum double   age months when minimum weight
46 Age_m_fusam double   Age_m_fusam 1 year fup
47 A14WELL_7years byte 1=died, 2=well, 3=sick How is child, dead/well/sick
48 b03intdt str10   interview date 7 year fup
49 weight_7years double   weight chrosam (7_years) (kg)
50 height_chrosam double   height at 7 years post discharge _chrosam
51 sitting_height_chrosam double   sitting height at chrosam (7 year) follow up
52 head_circ double   head circumference final 7 year fup
53 muac_chrosam double   muac at 7 year follow up (chrosam)
54 waist_circ double   waist circumference final 7 year fup
55 chest_circ double   chest circumference final 7 year fup
56 calf_circ double   calf circumference final 7 year fup
57 hip_circ double   hip circumference final 7 year fup
58 H6BP int   child systolic BP 7 year fup
59 H6BP2 int   child diastolic BP 7 year fup
60 H7SpO2 byte   Oxygen Saturation 7 year fup
61 bicep_sf double   bicep skinfold thickness final 7 year fup
62 tricep_sf double   tricep skinfold thickness final 7 year fup
63 subscap_sf double   subscapular skinfold thickness final 7 year fup
64 waist_sf double   waist skinfold thickness final 7 year fup
65 mum_weight double   mum weight 7 year fup
66 hiv_status float 0=known negative 1=known positive, 2=unknown HIV status 7 year fup  (restricted)
67 age_7years_months double   age months chrosam 7 year fup
68 Oedema_7years str2   Oedema at ChroSAM (7 years)
69 WAZ double   WAZ 7 year fup
70 HAZ double   HAZ 7 year fup
71 BAZ double   BAZ 7 year fup
72 waist_hip_r float   waist hip ratio 7 year fup
73 sit_height_ratio_chrosam float   sitting height % of standing height, at chrosam visit
74 sfold_ratio float   skinfold thickness ratio 7 year fup
75 grip_best float   hand grip strength best attempt 7 year fup
76 pca_score1 float   Wealth Scores for component 1 7 year fup
77 wealth1 byte 1=poorest, 5=richest wealth index using pca 7 year fup
78 orphan float 1=yes 2=no 7 year fup
79 A6DOB float   Date of Birth (ChroSAM) 7 year fup
80 impedance float   Z 7 year fup
81 resistance float   R 7 year fup
82 reactance float   Xc 7 year fup
83 phase_angle float   PA 7 year fup
84 bmi_residual float   Fat mass (based on LMI) 7 year fup
85 outcome_7years float chrosam_loss1 final outcome at chrosam 7 year follow up
86 finaloutcome_chrosam_date float   date of last visit or death (chrosam and fusam combo)
87 admission_WHZ_all double   WHZ at admission (WHO) all
88 admission_HAZ_all double   HAZ at admission (WHO) all children
89 admission_WAZ_all double   WAZ at admission WHO reference all children
90 admission_BAZ_all double   BAZ at admission (WHO) all children
91 sex float 0=female 1=male 1 = male
92 age_months_discharge float   AGE IN MONTHS OTP discharge
93 discharge_waz double   WAZ otp discharge
94 discharge_haz double   HAZ otp discharge
95 discharge_baz double   BAZ otp discharge
96 discharge_whz double   WHZ otp discharge
97 glucose_mmol_L0 double   BASE glucose_mmol_L (venous) 7 year fup
98 glucose_mmol_L120 double   120MIN glucose_mmol_L  (venous) 7 year fup
99 HDL double   27.HDL 7 year fup
100 LDL double   28.LDL 7 year fup
101 CHOL double   35.CHOL 7 year fup
102 HbA1c double   54.HbA1c 7 year fup
103 haemoglobin double   haemoglobin 7 year fup
104 salivary_cortisol double   salivary_cortisol 7 year fup
105 hdl_ldl_ratio float   hdl:ldl ratio
106 tc_hdl_ratio float   total cholesterol to hdl ratio
107 fusam_whz double   whz at 1 year
108 days_to_discharge float    
109 change_WAZ_discharge float    
110 weight_gain_grams_discharge float    
111 g_kg_day_discharge float   g/kg/day min weight to discharge
112 dis_months_to_fusam float    
113 change_WAZ_dis_1year float    
114 weight_gain_grams_1year float    
115 g_kg_month_1year float   g/kg/month discharge to fusam
116 change_HAZ_1year float    
117 g_day_discharge float   g/day min weight to discharge
118 lm_index_change float   lean mass index, 7 years, for change study
119 case_control_7years int 0=SAM survivor 1=sibling 2=community control case, sibling, community control at 7 year fup

Keywords

Post-malnutrition growth, Childhood, Non-communicable diseases (NCD), Anthropometry, Malnutrition, Severe acute malnutrition, Growth condition, Rehabilitation, Diabetes, Hypertension, Obesity, Risk factors, Long-term outcome

Data Collection Period

12 July 2006 - 1 January 2014

Participating Institutions

Funders

Project name Funder Funder grant number
Chronic Disease Outcome following Severe Acute Malnutrition (ChroSAM study) Wellcome Trust 101113/Z/13/A
CHild malnutrition & Adult NCDs: Generating new Evidence on mechanistic links to inform future policy and practice (CHANGE project) Medical Research Council MR/V000802/1