Characterising school-age health and function in rural Zimbabwe using the SAHARAN toolbox

Abstract

Introduction We developed the School-Age Health, Activity, Resilience, Anthropometry and Neurocognitive (SAHARAN) toolbox to address the shortage of school-age assessment tools that combine growth, physical and cognitive function. Here we present i) development, acceptability and feasibility of the SAHARAN toolbox; ii) characteristics of a pilot cohort; and iii) associations between the domains measured in the cohort. Methods Growth was measured with anthropometry, knee-heel length and skinfold thicknesses. Bioimpedance analysis measured lean mass index and phase angle. Cognition was assessed using the mental processing index, derived from the Kaufman Assessment Battery for Children version 2, a fine motor finger-tapping task, and School Achievement Test (SAT). Physical function combined grip strength, broad jump and the 20m shuttle-run test to produce a total physical score. A caregiver questionnaire was performed in parallel. Results The SAHARAN toolbox was feasible to implement in rural Zimbabwe, and highly acceptable to children and caregivers following some minor modifications. Eighty children with mean (SD) age 7.6 (0.2) years had mean height-for-age (HAZ) and weight-for-age Z-scores (WAZ) of -0.63 (0.81) and -0.55 (0.85), respectively. Lean mass index and total skinfold thicknesses were related to WAZ and BMI Z-score, but not to HAZ. Total physical score was associated with unit rises in HAZ (1.29, 95% CI 0.75, 1.82, p<0.001), and lean mass index (0.50, 95% CI 0.16, 0.83, p = 0.004), but not skinfold thicknesses. The SAT was associated with unit increases in the mental processing index and child socioemotional score. The caregiver questionnaire identified high levels of adversity and food insecurity. Conclusions The SAHARAN toolbox provided a feasible and acceptable holistic assessment of child growth and function in mid-childhood. We found clear associations between growth, height-adjusted lean mass and physical function, but not cognitive function. The SAHARAN toolbox could be deployed to characterise school-age growth, development and function elsewhere in sub-Saharan Africa.

The Sanitation Hygiene Infant Nutrition Efficacy (SHINE) Trial: Protocol for school-age follow-up

“…All assessment tools were integrated into a single assessment lasting 4–5 hours, using the School Age Health, Activity, Resilience, Anthropometry and Neurocognitive (SAHARAN) toolbox, which was developed, refined and piloted by our team 12 . Briefly, SAHARAN includes a caregiver questionnaire, child questionnaire and direct tests undertaken with the child, focused on three domains: cognitive function, growth and body composition, and physical function.…”

“…Internal consistency of outcomes across cognitive domains will be compared, including the primary outcome (KABC-II total score) and other cognitive measurements. Similarly, consistency of physical function measurements and their associations with growth will also be measured, as previously described 12 . Univariable analysis will explore associations between school-age growth, cognitive and physical function ( Table 1 to Table 3 ) and current environmental, schooling, nurturing and caregiving exposures ( Table 4 ).…”