Please select the eligibility criteria that correspond to the clinical trial below.
Title: Proactive Community Case Management and Child Survival: A Cluster-Randomized Controlled Trial
Brief Summary: The purpose of this study is to evaluate whether the addition of Proactive Case Detection to Community Case Management will provide an increase in early access to health care and a reduction in deaths among children aged 0-59 months. Integrated Community Case Management is the package of community-based services for children delivered by Community Health Workers (CHW), including diagnosis and treatment of malaria, pneumonia, diarrheal disease and malnutrition. In many iCCM interventions, CHWs are stationed in their villages and available in a passive, reactive manner to provide care to patients who seek them out. This study seeks to determine whether the addition of proactive case detection by CHWs to a standard iCCM intervention (ProCCM), in which they conduct daily door-to-door home visits to find and care for patients, will improve early access to care and reduce child mortality.

Village-clusters will be randomised to receive Integrated Community Case Management (iCCM) from a passive CHW or Proactive Community Case Management (ProCCM) from a CHW that conducts daily active case finding home visits. All villages in both study arms will receive additional interventions that could significantly reduce under-five mortality, including removal of point-of-care fees, clinical staff training at primary health centres, and improvement in primary health centre infrastructure.

All women of reproductive age eligible for inclusion in the study will be surveyed at baseline, and again at 12, 24 and 36 months. The study hypothesis is a significant reduction in child mortality in both study arms, with a significantly larger reduction where there is proactive case detection, or ProCCM, by CHWs. A survey of all women enrolled in the three-year study (eligible and consenting) has 82% power to detect an absolute difference in under-five mortality of 0.75% (a relative difference of 25%) between the two study arms.


Options:
A: Inclusion Criteria:

* Reproductive age women (aged 15-49 years)
* Permanently living in the study area
* No plans to leave the study area in the subsequent three years
* Written informed consent is obtained

Exclusion Criteria:

* Non-permanent community members (i.e. seasonal migrants)
* Plans to leave study area in the subsequent three years
B: Inclusion Criteria:

* Children with MAM or non-complicated SAM aged 6-59 months.
* Have an acceptable appetite.judged by giving the child 30 g of RUTF and asking the mother to feed this food to the child over 20 minutes. Children with SAM who are able to consume this RUTF will be eligible for the study. Children unable to consume the RUTF or presenting with IMCI warning signs (convulsions, altered mental status, respiratory distress) will be considered to have complicated SAM and will be referred for inpatient treatment.
* Only the youngest child with malnutrition in each household will be enrolled; older siblings with MAM or SAM will be treated operationally using the same protocol.

Exclusion Criteria:

* Children with obvious chronic debilitating illness like cerebral palsy or congenital abnormalities
* Children having received treatment for MAM or SAM in the previous two months.
C: Inclusion Criteria:

* Born in the study area
* Presence of severe acute malnutrition (SAM).
* Ability of the parents or guardians to provide informed consent.

Exclusion Criteria:

* Presence of chronic debilitating illness.
* Residence outside of study areas.
* Inability or refusal of the parents or guardians to give informed consent, or refusal of assessment.
* Internally displaced population
D: Inclusion Criteria:

* Infants aged 6-7 months at the time of recruitment into the study
* Infants currently being breastfed
* Parents (or caregivers) anticipated local residence for the study duration

Exclusion Criteria:

* Congenital or chronic abnormalities impairing feeding or physical growth measurements
* Oedema
* Severely ill or clinical complications warranting hospitalisation

Answer: A