Establishment of the MAL-ED Birth Cohort Study Site in Vellore, Southern India

Abstract

The Indian Etiology, Risk Factors and Interactions of Enteric Infections and Malnutrition and the Consequences for Child Health and Development (MAL-ED) site is in Vellore, Tamil Nadu, in south India and is coordinated by the Christian Medical College, Vellore, which has many years of experience in establishing and following cohorts. India is a diverse country, and no single area can be representative with regard to many health and socioeconomic indicators. The site in Vellore is an urban semiorganized settlement or slum. In the study site, the average family size is 5.7, adults who are gainfully employed are mostly unskilled laborers, and 51% of the population uses the field as their toilet facility. Previous studies from Vellore slums have reported stunting in well over a third of children, comparable to national estimates. The infant mortality rate is 38 per 1000 live births, with deaths due mainly to perinatal and infectious causes. Rigorous staff training, monitoring, supervision and refinement of tools have been essential to maintaining the quality of the significantly large quantity of data collected. Establishing a field clinic within the site has minimized inconvenience to participants and researchers and enabled better rapport with the community and better follow-up. These factors contribute to the wealth of information that will be generated from the MAL-ED multisite cohort, which will improve our understanding of enteric infections and its interactions with malnutrition and development of young children.

Vaccine coverage and adherence to EPI schedules in eight resource poor settings in the MAL-ED cohort study

“…The MAL-ED cohorts were selected to represent a broad range of low and middle income country settings including a mix of urban and rural locations where malnutrition and enteric disease burden were high [8], [9], [10], [11], [12], [13], [14], [15]. The median monthly household income across all sites was $113 (range $0–1648/month) ranging from $14 in TZH to $347 in BRF and the median maternal age was 26 years (range 14–49 years) while the median maternal education was 7 years (range 0–20 years) (Supplementary Table 1).…”

“…Children in the MAL-ED cohorts, located in Dhaka, Bangladesh (BGD), Fortaleza, Brazil (BRF), Vellore, India (INV), Bhaktapur, Nepal (NEB), Loreto, Peru (PEL), Naushero Feroze, Pakistan (PKN), Venda, South Africa (SAV), and Haydom, Tanzania (TZH), were followed for the first two years of life providing an opportunity to assess adherence to national EPI schedules in diverse settings [8], [9], [10], [11], [12], [13], [14], [15]. Here we describe vaccination coverage in the MAL-ED cohorts and examine adherence to country-specific EPI schedules.…”

The Influence of Household- and Community-Level Sanitation and Fecal Sludge Management on Urban Fecal Contamination in Households and Drains and Enteric Infection in Children

“…The study site consisted of two neighborhoods in Vellore, Chinnallapuram and Old Town, which were chosen because of their low socioeconomic status, poor sanitation, and long-standing relationship with the Christian Medical College (CMC), which provided access to spatial and demographic data from previous studies 25,26. The Old Town neighborhood is the site for the Interactions of Malnutrition and Enteric Infections: Consequences for Child Health and Development (MAL-ED) study in Vellore 25.…”

“…The Old Town neighborhood is the site for the Interactions of Malnutrition and Enteric Infections: Consequences for Child Health and Development (MAL-ED) study in Vellore 25. Of the seven contiguous sub-neighborhood areas selected for the MAL-ED study, five were selected for the SaniPath Tool deployment.…”

Methods Employed in Monitoring and Evaluating Field and Laboratory Systems in the ANISA Study

“…2,3,[6][7][8][9][10][11][12][13] Although the coordination team in Dhaka has to ensure that the protocol is properly implemented, the team relies on the experience and innovation of the site teams to apply the protocol and fulfill study objectives while taking local conditions into account. Thus, the monitoring and evaluation system needs to be vigilant enough to provide useful feedback to sites while taking their different contexts into account.…”