Cohort profile: The mature adults cohort of the Malawi longitudinal study of families and health (MLSFH-MAC)

Purpose The Mature Adults Cohort of the Malawi Longitudinal Study of Families and Health (MLSFH-MAC) contributes to global ageing studies by providing a rare opportunity to study the processes of individual and population ageing, the public health and social challenges associated with ageing and the coincident shifts in disease burdens, in a low-income, high HIV prevalence, sub-Saharan African (SSA) context. Participants The MLSFH-MAC is an open population-based cohort study of mature adults aged 45+ years living in rural communities in three districts in Malawi. Enrolment at baseline is 1266 individuals in 2012. Follow-ups were in 2013, 2017 and 2018 when the cohort size reached 1626 participants in 2018. Findings to date Survey instruments cover ageing-related topics such as cognitive and mental health, non-communicable diseases (NCDs) and related health literacy, subjective survival expectations, measured biomarkers including HIV, grip strength, hypertension, fasting glucose, body mass index (BMI), broad individual-level and household-level social and economic information, a 2018 qualitative survey of mature adults and community officials, 2019 surveys of village heads, healthcare facilities and healthcare providers in the MLSFH-MAC study areas. Across many domains, MLSFH-MAC allows for comparative research with global ageing studies through harmonised measures and instruments. Key findings to date include a high prevalence of depression and anxiety among older adults, evidence for rapid declines in cognitive health with age, a low incidence of HIV among mature adults, rising prevalence of HIV due to increased survival of HIV-positive individuals and poor physical health with high NCD prevalence. Future plans An additional wave of MLSFH-MAC is forthcoming in 2021, and future expansions of the cohort are planned. MLSFH-MAC data will also be publicly released and will provide a wealth of information unprecedented for ageing studies in a low-income SSA context that broadly represents the socioeconomic environment of millions of individuals in south-eastern Africa.We gratefully acknowledge the generous support for the Mature Adults Cohort of the Malawi Longitudinal Study of Families and Health (MLSFH-MAC) by the Swiss Programme for Research on Global Issues for Development (SNF r4d Grant 400640_160374), National Institute on Aging (NIA R21 AG0537630), and pilot funding received through the Population Aging Research Center (PARC), supported by NIA P30 AG 012836, the Center for AIDS Research (CFAR), supported by NIAID AI 045008 and the Institute on Aging, all at the University of Pennsylvania. We are also grateful for support for the Malawi Longitudinal Study of Families and Health (MLSFH) by the Rockefeller Foundation, the National Institute of Child Health and Human Development (NICHD R03 HD058976, R21 HD050653, R01 HD044228, R01 HD053781, R01 HD087391), the Boettner Center for Pensions and Retirement Security and the NICHD Population Research Infrastructure Program (R24 HD044964)