Mother Screening for Relapse Using Mid-upper Arm Circumference Among Children Recovered From Severe Acute Malnutrition (Full Scale Trial)
- Conditions
- Malnutrition, ChildMalnutrition, InfantMalnutrition or Risk of MalnutritionHemoglobin Level MeasurementAnemia
- Interventions
- Behavioral: Training caregivers to screen children for malnutrition relapseOther: Reduced follow-up schedule
- Registration Number
- NCT06599580
- Lead Sponsor
- University of California, San Francisco
- Brief Summary
A 1:1:1 individually randomized unmasked controlled trial is proposed in which caregivers will be trained to screen their children who have recovered from an episode of SAM (severe acute malnutrition) using MUAC (mid-upper arm circumference) tapes. One arm will include caregiver screening with a mid-upper arm circumference tape and usual monthly follow-up schedule for the first 3 months post enrollment and a final follow-up at 6 months. Another arm will include caregiver screening with a mid-upper arm circumference tape and a reduced follow-up schedule for one visit at 3 months and a final visit at 6 months. The third arm will adhere to the current standard of care, which is no caregiver training to conduct mid-upper arm circumference screenings and monthly clinic-based follow-up appointments for 3 months with a final visit at 6 months post enrollment. Children aged 6-54 months with a documented recovery from uncomplicated severe acute malnutrition that was managed in a participating outpatient nutritional program and their caregivers will be eligible for inclusion in the trial. Caregivers will be trained to screen their children weekly for 6 months following discharge from the nutritional program and will be counseled to bring their child back to the nutritional program should their mid-upper arm circumference value fall in the red zone of the mid-upper arm circumference tape (\< 11.5 cm). All children will be seen at 3 and 6 months for the primary outcome assessment. By conducting this study, our primary goal is to determine if training caregivers to screen their children for relapse to MAM (moderate acute malnutrition) or SAM (severe acute malnutrition) using mid-upper arm circumference tapes following recovery from SAM (severe acute malnutrition) will reduce the risk of relapse. An additional aim is to assess the level of acceptability of caregivers screening children for malnutrition using mid-upper arm circumference tapes from both a clinic and caregiver perspective.
- Detailed Description
A pilot randomized controlled trial for MAMAN was conducted to find if training caregivers to perform mid-upper arm circumference measurements to screen for malnutrition is feasible. This research will be expanded by assessing caregiver screening for detection of moderate acute malnutrition or severe acute malnutrition relapse with a 1:1:1 randomized controlled trial enrolling caregiver-child dyads of an increased sample size of 1200 dyads, totaling 2400 individuals. This study will address the need for evidence of the effectiveness of caregiver administered mid-upper arm circumference screening in the improvement of outcomes for children who have recovered from severe acute malnutrition. The effectiveness of training caregivers to screen for child malnutrition relapse using mid-upper arm circumference tapes, risk of relapse, speed of relapse detection, and anthropometric outcomes of the children will be analyzed. This will assist in providing evidence to incorporate the routine inclusion of mid-upper arm circumference screening training for all caregivers of children who are being discharged from severe acute malnutrition treatment.
SPECIFIC AIM 1: Determine the effectiveness of training caregivers to screen for relapse to moderate acute malnutrition or severe acute malnutrition using mid-upper arm circumference tapes following recovery from severe acute malnutrition for improving anthropometric outcomes and improving time to relapse detection. It is hypothesized that caregiver screening will be effective for reducing time to detection of relapse and that children receiving caregiver screening will have better anthropometric measures at 6 months post recovery and faster time to detection of relapse among those who relapse.
* Specific Aim 1A: Determine if detection of relapse in children who have recently recovered from severe acute malnutrition is more expeditious when caregivers are trained to screen for relapse to moderate acute malnutrition or severe acute malnutrition using mid-upper arm circumference tapes compared to current standard of care. It is hypothesized that a reduction in time to relapse detection will occur when caregivers are trained to screen for relapse to moderate acute malnutrition or severe acute malnutrition using mid-upper arm circumference tapes.
* Specific Aim 1B: Determine the effectiveness of caregivers screening mid-upper arm circumference measurements on improving anthropometric outcomes for children. It is hypothesized that training for caregiver screening of mid-upper arm circumference will lead to earlier intervention and improved anthropometric outcomes for children at 12 months post-admission.
SPECIFIC AIM 2: Determine the acceptability caregiver mid-upper arm circumference training. It is hypothesized that most survey responses at the 3 and 6-month visits will show high levels of acceptance towards caregiver screening of children using mid-upper arm circumference tapes.
Recruitment & Eligibility
- Status
- RECRUITING
- Sex
- All
- Target Recruitment
- 2400
- Caregiver's aged 18 years old or older or a legal guardian or a relative aged 18 or older
- Child aged 6-54 months
- Child has recovered from an episode of severe acute malnutrition per Burkinabè national guidelines (weight-for-height ≥ -2 and/or mid-upper arm circumference ≥ 12.5 cm in the past month, with the criterion used for admissions corresponding to the original admission criteria)
- Family is planning to stay in the study area for 6 months
- Appropriate consent from the caregiver or guardian.
- Caregiver age under 18 years old, or legal guardian or relatives under 18 years old
- Child age < 6 months or > 54 months
- Twins/multiple births
- Children with feeding issues
- Did not recover from severe acute malnutrition in the past month
- Family is planning to move out of the study area in the next 6 months
- Caregiver or guardian refuses to provide consent
Study & Design
- Study Type
- INTERVENTIONAL
- Study Design
- PARALLEL
- Arm && Interventions
Group Intervention Description Caregiver mid-upper arm circumference (MUAC) screening and a standard of care follow-up schedule Training caregivers to screen children for malnutrition relapse This arm will include caregiver screening with a mid-upper arm circumference tape at home weekly. Caregivers will be trained to screen their child for malnutrition relapse using mid-upper arm circumference tapes and requested to bring their child back to the clinic when relapse is detected. Additionally, this arm will receive the standard of care, which includes a monthly follow-up schedule for the first 3 months post enrollment and a final follow-up at 6 months. Caregiver mid-upper arm circumference (MUAC) screening and a reduced follow-up schedule Training caregivers to screen children for malnutrition relapse This arm will include caregiver screening with a mid-upper arm circumference tape at home weekly. Caregivers will be trained to screen their child for malnutrition relapse using mid-upper arm circumference tapes and requested to bring their child back to the clinic when relapse is detected. Additionally, this arm will receive a reduced follow-up schedule at the clinic, which will include one planned visit at 3 months post enrollment and a final follow-up visit at 6 months. Caregiver mid-upper arm circumference (MUAC) screening and a reduced follow-up schedule Reduced follow-up schedule This arm will include caregiver screening with a mid-upper arm circumference tape at home weekly. Caregivers will be trained to screen their child for malnutrition relapse using mid-upper arm circumference tapes and requested to bring their child back to the clinic when relapse is detected. Additionally, this arm will receive a reduced follow-up schedule at the clinic, which will include one planned visit at 3 months post enrollment and a final follow-up visit at 6 months.
- Primary Outcome Measures
Name Time Method Cumulative incidence of relapse 6 months The primary outcome will be defined as the proportion of children who relapse to global acute malnutrition (either moderate acute malnutrition with mid-upper arm circumference \< 12.5 cm to ≥ 11.5 cm and/or weight-for-height Z score \< -2 to ≥ -3 or severe acute malnutrition with mid-upper arm circumference \< 11.5 cm and/or weight-for-height Z score \< -3) by the 6 month primary endpoint randomized by study assignment.
- Secondary Outcome Measures
Name Time Method Anthropometric endpoints: growth in grams per day 6 months Weight measurements will be collected. Weight growth defined by body weight change in grams per day (g/day) over the study period will be measured. Anthropometric measures will be assessed as continuous variables by arm, with adjustment for baseline measures.
Anthropometric endpoints: height change in millimeters per day 6 months Height measurements will be collected. Growth defined by height change in millimeters per day (mm/day) over the study period will be measured. Anthropometric measures will be assessed as continuous variables by arm, with adjustment for baseline measures.
Anemia 6 months Hemoglobin measurements will be used to assess anemia. Children with hemoglobin \< 4 g/dL (or \< 5g/dL if they are known to have malaria) will be referred to the hospital for further treatment. Anemia will be evaluated both as a categorical outcome (e.g., no anemia, mild, moderate, and severe anemia) and continuous hemoglobin levels by arm.
Hospitalization 6 months Hospitalizations will be recorded at each study visit via caregiver report. In addition, hospitalizations will be measured via linking to hospital records at the district hospital. The cumulative incidence of all-cause and cause-specific hospitalizations will be assessed by arm.
Anthropometric endpoints: weight-for-age Z score (WAZ) 6 months Weight measurements will be collected. The weight-for-age Z score (WAZ) based on 2006 WHO (World Health Organization) child growth standards will be calculated. Anthropometric measures will be assessed as continuous variables by arm, with adjustment for baseline measures. Underweight (weight-for-age Z score \< -2) will be evaluated by arm.
Anthropometric endpoints: height-for-age Z score (HAZ) 6 months Height/length measurements will be collected. The height-for-age Z score (HAZ) based on 2006 WHO (World Health Organization) child growth standards will be calculated. Anthropometric measures will be assessed as continuous variables by arm, with adjustment for baseline measures. Stunting (height-for-age Z score \< -2) will be evaluated by arm.
Anthropometric endpoints: mid-upper arm circumference (MUAC) 6 months Mid-upper arm circumference measurements will be collected. Anthropometric measures will be assessed as continuous variables by arm, with adjustment for baseline measures.
Vital status 6 months Vital status will be recorded at each study visit. If a child does not return for a scheduled study visit, attempts will be made to reach the family via telephone call or home visit to assess the vital status. Vital status information may also be collected via community health worker report. The proportion of children who die by the end of the follow-up period will be assessed by arm.
Cumulative incidence of relapse to MAM or SAM separately 6 months The proportion of children by randomized allocation who relapse to MAM or to SAM analyzed separately.
Anthropometric endpoints: weight-for-height Z score (WHZ) 6 months Weight and height measurements will be collected. The weight-for-height Z score (WHZ) based on 2006 WHO (World Health Organization) child growth standards will be calculated. Anthropometric measures will be assessed as continuous variables by arm, with adjustment for baseline measures.
Time to detection of relapse 6 months The amount of time until the detection of malnutrition relapse will be assessed as a secondary outcome and will be defined as the time from the baseline visit until the planned or unplanned visit when malnutrition relapse is detected. This will be measured up until the 6 month visit and will be assessed by randomized study assignment.
Trial Locations
- Locations (1)
Centre de recherche en sante de nouna
🇧🇫Nouna, Burkina Faso