NutriVax-Measles: Increasing Measles Vaccination Coverage Through Supplementation With an SQ-LNS Incentive in Children Aged 6-23 Months, a Pragmatic Parallel Cluster-randomized Controlled Trial in Yobe State, Northern Nigeria
Trial Snapshot
- Phase
- Not Applicable
- Status
- Completed
- Enrollment
- 3,814
- Locations
- 1
- Primary Endpoint
- Measles vaccine coverage in children aged 12-23 months
Study Overview
Brief Summary
Provision of SQ-LNS also holds promise in incentivizing vaccination as well as other health services.
The investigators will estimate 1) the effectiveness of a SQ-LNS mass supplementation program added to routine immunization program compared to routine immunization program alone in terms of measles vaccine coverage, after 12 months of program implementation, 1) in children aged 12-23 months in the end line cross-sectional household survey, 2) in children aged 6-12 months at inclusion, in a longitudinal 12 months follow-up survey.
Secondary objectives are to assess the barriers and facilitators from the perspectives of parents/legal guardian of children, health care providers and community health workers and to assess the cost-efficiency of the
This study will be implemented in 20 wards covering the Karasuwa and Nguru Local Government Areas (LGAs) in Yobe state, Northeast Nigeria.
This is a pragmatic parallel cluster randomized trial (PCT) with baseline measure with different populations and data collection modes: 1) baseline and end line cross-sectional household surveys of children aged 12-23 months, 2) a longitudinal follow-up survey (LS) of children aged 6-12 months at inclusion, 3) a qualitative feasibility and acceptability survey of parents of children aged 6-23 months, of health providers, of community health workers and community representatives and 4) a cost survey of parents/legal guardian of children from the longitudinal follow-up cohort, and 5) a health facility cost survey of a randomized subsample of health facilities.
Clusters will be randomly allocated at a ratio of 1:1 either to the standard arm or to the NutriVax arm:
- The standard Expanded Program on Immunization (EPI) in children aged 6-23 months delivered according to the Ministry of Health's routine plans in the community and at health centres and health posts, named the standard EPI arm;
- The NutriVax program combining the EPI in children aged 6-23 months according to the Ministry of Health's routine plans in the community and at health centres (i.e. PHCCs) and health posts associated with SQ-LNS mass supplementation integrated into pre-existing services delivered at health centres (i.e. PHCCs) for children 6-23 months of age, named the NutriVax arm.
Detailed Description
Background/ Rational
Every year, hundreds of thousands of children are treated for severe wasting while experiencing repeated and prolonged outbreaks of vaccine-preventable illnesses, most notably measles. At least 20 million children annually still do not receive immunizations. Northeast Nigeria is at the epicentre of this dynamic, recording some of the worst malnutrition indicators and lowest vaccination coverage rates in the world.
Small-quantity lipid-based nutrient supplements (SQ-LNS) are a class of ready-to-use food supplements which are highly nutrient-dense and fortified designed for preventing malnutrition and improving child survival, growth, and development. A recent meta-analysis on SQ-LNS reveals that feeding a child just one sachet of SQ-LNS a day for a year can reduce their risk of mortality by 27%, and reduce cases of severe wasting by 31% and severe stunting by 17%. The overall strength of evidence on SQ-LNS benefits led the authors of a 2021 Lancet review to call scaling-up SQ-LNS a priority action.
Provision of SQ-LNS also holds promise in incentivizing vaccination as well as other health services.
Primary objective
Study Design
- Study Type
- Interventional
- Allocation
- Randomized
- Intervention Model
- Parallel
- Primary Purpose
- Prevention
- Masking
- None
Masking Description
No possible to mask intervention due to the specifity of the intervention tested
Eligibility Criteria
- Ages
- 6 Months to 23 Months (Child)
- Sex
- All
- Accepts Healthy Volunteers
- Yes
Inclusion Criteria
- •Baseline and endline cross-sectional household surveys Inclusion criteria
- •Aged 12-23 months;
- •With oral informed consent of parent or legal guardian;
- •Residing in the catchment settlements of wards included in the study.
Exclusion Criteria
- •Included in the longitudinal follow-up.
- •Longitudinal follow-up survey Inclusion criteria
- •Aged 6-12 months;
- •With written informed consent of parent or legal guardian;
- •Residing in the catchment settlements of wards included in the study. Exclusion criteria
- •Acute malnutrition criteria as per the WHO definition (i.e. MUAC< 125 or WHZ < -2 or nutritional edema);
- •- Known medical complication that requires referral for hospitalization;
- •Known allergies to SQ-LNS or SQ-LNS contraindication;
- •Any other condition interfering with protocol adherence or the ability to give informed consent, in the judgment of the Field Investigator Sampling for HHS and LS will be carried out in three stages in each LGA using probability proportional to size (PPS).
- •Qualitative feasibility and acceptability survey Inclusion
- •Parent or legal guardian of a child aged 6-23 months and residing in the catchment settlements of wards included in the study, or Health worker of the ministry of health involved in the study,or Community representative or Community health workers;
- •With written informed consent.
Arms & Interventions
Standard Expanded program on immunization
The standard Expanded Program on Immunization (EPI) in children aged 6-23 months delivered according to the Ministry of Health's routine plans in the community and at health centres and health posts.
Intervention: Sensitization on vaccination and on Infant and Young Child Feeding (IYCF) practices (Behavioral)
NutriVax
The NutriVax strategy combines the EPI in children aged 6-23 months according to the Ministry of Health's routine plans in the community and at health centres and health posts associated with SQ-LNS mass supplementation integrated into pre-existing services delivered at health centres for children 6-23 months of age.
Intervention: Small-quantity lipid-based nutrition supplements (SQ-LNS) NutriVax (Dietary Supplement)
NutriVax
The NutriVax strategy combines the EPI in children aged 6-23 months according to the Ministry of Health's routine plans in the community and at health centres and health posts associated with SQ-LNS mass supplementation integrated into pre-existing services delivered at health centres for children 6-23 months of age.
Intervention: Sensitization on vaccination and on Infant and Young Child Feeding (IYCF) practices (Behavioral)
Outcomes
Primary Outcomes
Measles vaccine coverage in children aged 12-23 months
Time Frame: Measured after one year after of intervention implementation.
The proportion of children aged 12-23 months in the endline survey who have received at least one dose of measles vaccine, as reported on their vaccination card.
Measles vaccine coverage in children 6-12 months at inclusion
Time Frame: Measured after one year after of intervention implementation.
The proportion of children aged 6-12 months at inclusion in the longitudinal follow-up survey, who have received at least one additional dose of measles vaccine, as reported on their vaccination card, administered between inclusion and the end of follow-up.
Secondary Outcomes
- Measles vaccine coverage : two doses(Measured after one year after of intervention implementation.)
- Fully immunization(Measured after one year after of intervention implementation.)
- Timeliness of measles 1 vaccination(Measured after one year after of intervention implementation.)
- Other infant vaccines coverage(Measured after one year after of intervention implementation.)
- Measles vaccine coverage: at least one dose(Measured after one year after of intervention implementation.)
- Acceptability(Measured after 2 months and one year after of intervention implementation.)
- Cost-efficiency(Measured after one year after of intervention implementation.)
- Zero-dose(Measured after one year after of intervention implementation.)