Integrated Research on Acute Malnutrition in Chad
Condition: Acute Malnutrition in Childhood; Wasting
MeSH terms: Malnutrition; Wasting Syndrome; Cachexia
Study type: Interventional

Summary: 
      The IRAM Chad impact evaluation will be based on a cluster randomized controlled trial to
      study the impact of the integrated and multisectoral services package (PASIM), aimed at
      reducing the incidence and prevalence of wasting through integrated interventions, including,
      among other things, strengthening the activity of community care groups, food
      supplementation, water treatment, and screening for wasting conducted by families.
    

Detailed description: 
      The general objective of the integrated and multisectoral services package (PASIM) is to
      reduce the incidence and prevalence of wasting through integrated interventions, including,
      among other things, strengthening the activity of community care groups. The members of the
      care groups conduct home visits to children aged 6-23 months (or up to 59 months when the
      children are under treatment for wasting or have been discharged in the previous 6 months) to
      deliver messages for behavioral change related to complementary feeding, health and hygiene ;
      deliver nutritional supplement and water purification inputs; improve screening coverage
      (training and supervision of families to take the Mid-Upper Arm Circumference measurements,
      referral of malnourished cases); and verify adherence to treatment of malnourished cases, in
      the health district of Mongo, Guéra province, Chad, Central Africa.

      The evaluation of the impact of PASIM will be based on a cluster randomized controlled trial,
      consisting of 100 villages or clusters of villages. The selected evaluation model will be
      that of a comparison of control groups (n=50; no implementation of the intervention) and
      intervention (n=50) through the follow-up of 3 cohorts :

        1. Longitudinal in-home follow-up of a semi-open cohort of 1,750 children aged 6 months at
           enrollment (included continuously for 7 months and all followed through to the end of
           the study, which will last 9 months in total).

        2. Longitudinal follow-up of all children aged 6-23 months enrolled for wasting treatment,
           based on health system records.

        3. Longitudinal follow-up at home for 6 months of a closed cohort of 700 children aged 6-23
           months at inclusion, discharged from a treatment for acute malnutrition.

      The primary impact results are as follows:

        -  The longitudinal prevalence of wasting at the end of the study (Cohort 1).

        -  The recovery rate (Cohort 2).

        -  The incidence of relapse during the 11 months of the intervention (Cohort 3).

      Secondary impact results include, but are not limited to :

        -  The incidence of wasting during the 11 months of the intervention (Cohort 1) ;

        -  The screening coverage (cohorts 1 and 3);

        -  The proportion of wasting cases enrolled in a treatment program (cohorts 1 and 3);

        -  The adherence to treatment (cohort 2) during the 11 months of the intervention.
    

Intervention name(s): BCC; Preventive supplement; MNP; Water purification input; Family MUAC; Screening by care group; CMAM compliance
Intervention type(s): Behavioral; Dietary Supplement; Dietary Supplement; Other; Behavioral; Behavioral; Behavioral
Intervention description(s): Behavior change communication on Nutrition, Health & Hygiene, including (but not limited to) awareness of dietary diversification from 6 months of age and adequate complementary feeding; and raising awareness of good water and hygiene practices.; Monthly delivery of a nutritional supplement: enriched flour (CSB++), at a dose of 3 kg/month/beneficiary child. The nutritional supplement is limited to [6-11] months old children diagnosed as non-wasted (green MUAC); or children [12-59] months old for 6 months after discharge from a CMAM treatment or consolidation program.; Delivery of micronutrient powders to [12-23] months old children (30 sachets per month for 2 months, every 6 months, according to international recommendations).; Monthly delivery of a water purification input: bleach or flocculant/decontamination sachets for the potabilization of the water of the whole household. The water treatment input is limited to households with [6-11] months old children, or children [12-59] months old enrolled in a CMAM treatment program and for 6 months after discharge.; One-time delivery of a mid-upper arm circumference (MUAC) measuring tape and training of families in its use, and actions to be taken based on the results. This will involve distributing Shakir bands to all households with [6-59] months old children and training mothers/guardians, or any other family members who express an interest, in screening for wasting using the MUAC criteria, and explaining the procedure to follow if the child tests positive in the family.
Formative supervision of MUAC measurement in families. The training will be carried out by the members of the care groups and at each home visit, they will be able to ensure that the MUAC measurement technique is well mastered by the mother (or another member) and correct the technique if necessary.; Monthly screening by the care group volunteers of the children they follow, using the MUAC.
Referral to the health center of [6-59] months old children screened as malnourished (result of MUAC orange or red), and follow-up on referral to confirm child was enrolled; Weekly follow-up of [6-59] months old children under treatment and for 6 months after discharge from the national treatment and consolidation program : care group volunteers follow children under treatment until they recover and for the whole duration of their consolidation (for children cured of severe emaciation) through weekly home visits.
They monitor treatment adherence (i.e., families follow the planned schedule of visits and receive inputs for treatment or consolidation) and treatment compliance (i.e., the malnourished or consolidating child receives the planned dose of therapeutic or supplementary food each day).
Allocation: Randomized
Intervention model: Parallel Assignment
Intervention model description: Non-blinded cluster randomized controlled trial
Masking: None (Open Label)
Primary purpose: Other