Benefits of a Household WASH Package to Community-based Management of Acute Malnutrition (CMAM) Program, Chad
- Conditions
- Severe Malnutrition
- Interventions
- Behavioral: Hygiene promotion sessionsBehavioral: Group discussions after successful dischargeDevice: Household WASH packageProcedure: Outpatient Therapeutic ProgrammeBehavioral: Household visit
- Registration Number
- NCT02486523
- Lead Sponsor
- Action Contre la Faim
- Brief Summary
The objective of the research is to assess the effectiveness of adding a Household WASH component to the standard outpatient treatment of severe acute malnutrition.
Study design: cluster-randomized controlled trial comparing two interventions:
1. Control group: outpatient management of children diagnosed for severe acute malnutrition only
2. Intervention group: outpatient management of children diagnosed for severe acute malnutrition + "household WASH package"
2000 children, aged between 6 and 59 months, admitted to 20 OTP (Outpatient Therapeutic Program) centers for SAM will be included into the study and followed for 8 months (2 months of treatment, and 6 months after successful discharge).
- Detailed Description
The Action Contre la Faim (ACF) nutrition project in Kanem started in 2008, and now is set up in 35 health facilities divided across 2 health districts: Mao and Mondo. The management of severe acute malnutrition is done in both OTP (Outpatient Therapeutic Programme) and in TFC (Therapeutic Feeding Center). Between the treatment of SAM in OTPs and TFCs, and the number of curative consultations, the total number of beneficiaries is expected to be 45,065 in 2014 (without double counting).
Clear evidence exists that some Water, Sanitation and Hygiene (WASH) interventions can successfully prevent diarrhea. For instance, interventions aiming at improving water quality at household level or at promoting hand washing with soap do reduce significantly diarrhea incidence. Estimations showed that WASH interventions have a small but measurable benefit on length growth, but not on weight or weight/height. Yet, to our knowledge, no impact of WASH interventions has been assessed, neither during nutritional rehabilitation where children are particularly vulnerable to infections, nor after discharge where immune recovery is still incomplete.
In the context of nutritional rehabilitation of SAM (Severe Acute Malnutrition), the investigators hypothesize that improving water quality and hygiene-related care practices at household level would decrease incidence of WASH-related infections, such as diarrhea, nematode and environmental enteropathy. As such, it would improve weight gain, decrease relapses after successful discharge, and overall, could decrease over time the incidence of acute malnutrition in the community.
The proposed WASH intervention will be added to already existing nutritional activities and it will include: i/ Household water treatment and hygiene kit (water container, water disinfection consumables, soap, cup, hygiene promotion leaflet) provided at beginning of SAM treatment; ii/ sessions of Hygiene promotion provided weekly at health center level iii/ Household visits and hygiene sessions made during the treatment; // group discussion on hygiene and care practices made with mother at community level after successful discharge.
Recruitment & Eligibility
- Status
- COMPLETED
- Sex
- All
- Target Recruitment
- 1572
Not provided
- Signs of medical complications requiring inpatient management,
- Bilateral oedema (+++),
- Transfer from another OTP: treatment already started and child has a identification number (ID) for SAM
- Refusal of caretaker to participate
- Children from families outside the health center coverage
Study & Design
- Study Type
- INTERVENTIONAL
- Study Design
- PARALLEL
- Arm && Interventions
Group Intervention Description Intervention group Hygiene promotion sessions Outpatient management of children diagnosed with severe acute malnutrition + "household WASH package" Interventions allocated: Behavioral: Hygiene promotion sessions Device: Household WASH package The content of the kit: soap and aquatab for 3 months, 20 liters Jerry can, a cup, a plastic kettle for hand washing and the instructions leaflet. Behavioral: Household visits during the OTP phase Behavioral: Group discussions after successful discharge Procedure/Surgery: Outpatient Therapeutic Programme Intervention group Household visit Outpatient management of children diagnosed with severe acute malnutrition + "household WASH package" Interventions allocated: Behavioral: Hygiene promotion sessions Device: Household WASH package The content of the kit: soap and aquatab for 3 months, 20 liters Jerry can, a cup, a plastic kettle for hand washing and the instructions leaflet. Behavioral: Household visits during the OTP phase Behavioral: Group discussions after successful discharge Procedure/Surgery: Outpatient Therapeutic Programme Intervention group Household WASH package Outpatient management of children diagnosed with severe acute malnutrition + "household WASH package" Interventions allocated: Behavioral: Hygiene promotion sessions Device: Household WASH package The content of the kit: soap and aquatab for 3 months, 20 liters Jerry can, a cup, a plastic kettle for hand washing and the instructions leaflet. Behavioral: Household visits during the OTP phase Behavioral: Group discussions after successful discharge Procedure/Surgery: Outpatient Therapeutic Programme Control group Outpatient Therapeutic Programme Outpatient management of children diagnosed with severe acute malnutrition. Interventions allocated: Behavioral: Group discussions after successful discharge Procedure/Surgery: Outpatient Therapeutic Programme Control group Group discussions after successful discharge Outpatient management of children diagnosed with severe acute malnutrition. Interventions allocated: Behavioral: Group discussions after successful discharge Procedure/Surgery: Outpatient Therapeutic Programme Intervention group Group discussions after successful discharge Outpatient management of children diagnosed with severe acute malnutrition + "household WASH package" Interventions allocated: Behavioral: Hygiene promotion sessions Device: Household WASH package The content of the kit: soap and aquatab for 3 months, 20 liters Jerry can, a cup, a plastic kettle for hand washing and the instructions leaflet. Behavioral: Household visits during the OTP phase Behavioral: Group discussions after successful discharge Procedure/Surgery: Outpatient Therapeutic Programme Intervention group Outpatient Therapeutic Programme Outpatient management of children diagnosed with severe acute malnutrition + "household WASH package" Interventions allocated: Behavioral: Hygiene promotion sessions Device: Household WASH package The content of the kit: soap and aquatab for 3 months, 20 liters Jerry can, a cup, a plastic kettle for hand washing and the instructions leaflet. Behavioral: Household visits during the OTP phase Behavioral: Group discussions after successful discharge Procedure/Surgery: Outpatient Therapeutic Programme
- Primary Outcome Measures
Name Time Method Difference in the proportion of post-recovery relapse cases 2 months and 6 months after successful OTP discharge This is a dichotomous variable based on whether a child discharged as cured from the OTP program has a new event of acute malnutrition during the 6 months following the discharge. The relapse proportion for each group = \[Total number of relapsing children\] / \[total number of discharged children that have been followed up\] Relative reduction of 42% (from 12% to 7%) is expected.
- Secondary Outcome Measures
Name Time Method Difference in the average weight gain at the OTP discharge an expected average is between 7 and 8 weeks The weight gain (g/kg/day) = \[weight (g) at discharge - minimum weight (g)\] / \[Duration from minimum weight to discharge\] \* \[minimum weight (kg)\]. The average weight gain (g/kg/day) for each group = \[Sum of weight gains of cured children\] / \[total number of cured children\].
Increase of 3 g/kg/day is expected.Diarrhoea Incidence up to 6 months follow up Loose or watery stools at least three times per day during the week/month prior to the consultation or visit.
Difference in the length of stay in the OTP an expected average is between 7 and 8 weeks. The OTP length of stay is the total number of days spent in the program, from admission of the child to the discharge of a cured child. The average length of stay for all children in each group = \[total number of days of cured children\] / \[number of cured children\].
Reduction of 5 days is expected.Difference in the anthropocentric measurements (WHZ, HAZ, WAZ) up to 6 months after OTP discharge Weight for Height Z-score (WHZ), Height for age Z-score (HAZ) and Weight for age Z-score (WAZ) and Mid-upper-arm circumference (MUAC) Increase of 0,2 Z-score 6 months after OTP discharge is expected.
Trial Locations
- Locations (1)
Health centers
🇹🇩Mao, Kanem, Chad