Health Outcomes, Pathogenesis and Epidemiology of Severe Acute Malnutrition (HOPE-SAM)

Rationale and methods of a longitudinal observational study

Mutsa Bwakura-Dangarembizi, Beatrice Amadi, Claire D. Bourke, Ruairi C. Robertson, Benjamin Mwapenya, Kanta Chandwe, Chanda Kapoma, Kapula Chifunda, Florence Majo, Deophine Ngosa, Pamela Chakara, Nivea Chulu, Faithfull Masimba, Idah Mapurisa, Ellen Besa, Kuda Mutasa, Simutanyi Mwakamui, Thompson Runodamoto, Jean Hawes Humphrey, Robert Ntozini & 7 others Jonathan C.K. Wells, Amee R. Manges, Jonathan R. Swann, A. Sarah Walker, Kusum J. Nathoo, Paul Kelly, Andrew J. Prendergast

Research output: Contribution to journalArticle

Abstract

Introduction Mortality among children hospitalised for complicated severe acute malnutrition (SAM) remains high despite the implementation of WHO guidelines, particularly in settings of high HIV prevalence. Children continue to be at high risk of morbidity, mortality and relapse after discharge from hospital although long-term outcomes are not well documented. Better understanding the pathogenesis of SAM and the factors associated with poor outcomes may inform new therapeutic interventions. Methods and analysis The Health Outcomes, Pathogenesis and Epidemiology of Severe Acute Malnutrition (HOPE-SAM) study is a longitudinal observational cohort that aims to evaluate the short-term and long-term clinical outcomes of HIV-positive and HIV-negative children with complicated SAM, and to identify the risk factors at admission and discharge from hospital that independently predict poor outcomes. Children aged 0-59 months hospitalised for SAM are being enrolled at three tertiary hospitals in Harare, Zimbabwe and Lusaka, Zambia. Longitudinal mortality, morbidity and nutritional data are being collected at admission, discharge and for 48 weeks post discharge. Nested laboratory substudies are exploring the role of enteropathy, gut microbiota, metabolomics and cellular immune function in the pathogenesis of SAM using stool, urine and blood collected from participants and from well-nourished controls. Ethics and dissemination The study is approved by the local and international institutional review boards in the participating countries (the Joint Research Ethics Committee of the University of Zimbabwe, Medical Research Council of Zimbabwe and University of Zambia Biomedical Research Ethics Committee) and the study sponsor (Queen Mary University of London). Caregivers provide written informed consent for each participant. Findings will be disseminated through peer-reviewed journals, conference presentations and to caregivers at face-to-face meetings.

Original languageEnglish (US)
Article numbere023077
JournalBMJ open
Volume9
Issue number1
DOIs
StatePublished - Jan 1 2019
Externally publishedYes

Fingerprint

Observational Studies
Longitudinal Studies
Epidemiology
Zimbabwe
Research Ethics Committees
Health
Zambia
HIV
Caregivers
Biomedical Research
Morbidity
Child Mortality
Bioethics
Hospitalized Child
Metabolomics
Mortality
Informed Consent
Tertiary Care Centers
Ethics
Severe Acute Malnutrition

Keywords

  • Africa
  • enteropathy
  • HIV
  • malnutrition
  • microbiota
  • mortality

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Bwakura-Dangarembizi, M., Amadi, B., Bourke, C. D., Robertson, R. C., Mwapenya, B., Chandwe, K., ... Prendergast, A. J. (2019). Health Outcomes, Pathogenesis and Epidemiology of Severe Acute Malnutrition (HOPE-SAM): Rationale and methods of a longitudinal observational study. BMJ open, 9(1), [e023077]. https://doi.org/10.1136/bmjopen-2018-023077

Health Outcomes, Pathogenesis and Epidemiology of Severe Acute Malnutrition (HOPE-SAM) : Rationale and methods of a longitudinal observational study. / Bwakura-Dangarembizi, Mutsa; Amadi, Beatrice; Bourke, Claire D.; Robertson, Ruairi C.; Mwapenya, Benjamin; Chandwe, Kanta; Kapoma, Chanda; Chifunda, Kapula; Majo, Florence; Ngosa, Deophine; Chakara, Pamela; Chulu, Nivea; Masimba, Faithfull; Mapurisa, Idah; Besa, Ellen; Mutasa, Kuda; Mwakamui, Simutanyi; Runodamoto, Thompson; Humphrey, Jean Hawes; Ntozini, Robert; Wells, Jonathan C.K.; Manges, Amee R.; Swann, Jonathan R.; Walker, A. Sarah; Nathoo, Kusum J.; Kelly, Paul; Prendergast, Andrew J.

In: BMJ open, Vol. 9, No. 1, e023077, 01.01.2019.

Research output: Contribution to journalArticle

Bwakura-Dangarembizi, M, Amadi, B, Bourke, CD, Robertson, RC, Mwapenya, B, Chandwe, K, Kapoma, C, Chifunda, K, Majo, F, Ngosa, D, Chakara, P, Chulu, N, Masimba, F, Mapurisa, I, Besa, E, Mutasa, K, Mwakamui, S, Runodamoto, T, Humphrey, JH, Ntozini, R, Wells, JCK, Manges, AR, Swann, JR, Walker, AS, Nathoo, KJ, Kelly, P & Prendergast, AJ 2019, 'Health Outcomes, Pathogenesis and Epidemiology of Severe Acute Malnutrition (HOPE-SAM): Rationale and methods of a longitudinal observational study', BMJ open, vol. 9, no. 1, e023077. https://doi.org/10.1136/bmjopen-2018-023077
Bwakura-Dangarembizi, Mutsa ; Amadi, Beatrice ; Bourke, Claire D. ; Robertson, Ruairi C. ; Mwapenya, Benjamin ; Chandwe, Kanta ; Kapoma, Chanda ; Chifunda, Kapula ; Majo, Florence ; Ngosa, Deophine ; Chakara, Pamela ; Chulu, Nivea ; Masimba, Faithfull ; Mapurisa, Idah ; Besa, Ellen ; Mutasa, Kuda ; Mwakamui, Simutanyi ; Runodamoto, Thompson ; Humphrey, Jean Hawes ; Ntozini, Robert ; Wells, Jonathan C.K. ; Manges, Amee R. ; Swann, Jonathan R. ; Walker, A. Sarah ; Nathoo, Kusum J. ; Kelly, Paul ; Prendergast, Andrew J. / Health Outcomes, Pathogenesis and Epidemiology of Severe Acute Malnutrition (HOPE-SAM) : Rationale and methods of a longitudinal observational study. In: BMJ open. 2019 ; Vol. 9, No. 1.
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AU - Bwakura-Dangarembizi, Mutsa

AU - Amadi, Beatrice

AU - Bourke, Claire D.

AU - Robertson, Ruairi C.

AU - Mwapenya, Benjamin

AU - Chandwe, Kanta

AU - Kapoma, Chanda

AU - Chifunda, Kapula

AU - Majo, Florence

AU - Ngosa, Deophine

AU - Chakara, Pamela

AU - Chulu, Nivea

AU - Masimba, Faithfull

AU - Mapurisa, Idah

AU - Besa, Ellen

AU - Mutasa, Kuda

AU - Mwakamui, Simutanyi

AU - Runodamoto, Thompson

AU - Humphrey, Jean Hawes

AU - Ntozini, Robert

AU - Wells, Jonathan C.K.

AU - Manges, Amee R.

AU - Swann, Jonathan R.

AU - Walker, A. Sarah

AU - Nathoo, Kusum J.

AU - Kelly, Paul

AU - Prendergast, Andrew J.

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N2 - Introduction Mortality among children hospitalised for complicated severe acute malnutrition (SAM) remains high despite the implementation of WHO guidelines, particularly in settings of high HIV prevalence. Children continue to be at high risk of morbidity, mortality and relapse after discharge from hospital although long-term outcomes are not well documented. Better understanding the pathogenesis of SAM and the factors associated with poor outcomes may inform new therapeutic interventions. Methods and analysis The Health Outcomes, Pathogenesis and Epidemiology of Severe Acute Malnutrition (HOPE-SAM) study is a longitudinal observational cohort that aims to evaluate the short-term and long-term clinical outcomes of HIV-positive and HIV-negative children with complicated SAM, and to identify the risk factors at admission and discharge from hospital that independently predict poor outcomes. Children aged 0-59 months hospitalised for SAM are being enrolled at three tertiary hospitals in Harare, Zimbabwe and Lusaka, Zambia. Longitudinal mortality, morbidity and nutritional data are being collected at admission, discharge and for 48 weeks post discharge. Nested laboratory substudies are exploring the role of enteropathy, gut microbiota, metabolomics and cellular immune function in the pathogenesis of SAM using stool, urine and blood collected from participants and from well-nourished controls. Ethics and dissemination The study is approved by the local and international institutional review boards in the participating countries (the Joint Research Ethics Committee of the University of Zimbabwe, Medical Research Council of Zimbabwe and University of Zambia Biomedical Research Ethics Committee) and the study sponsor (Queen Mary University of London). Caregivers provide written informed consent for each participant. Findings will be disseminated through peer-reviewed journals, conference presentations and to caregivers at face-to-face meetings.

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