Benefits of a Household WASH Package to Community-based Management of Acute Malnutrition (CMAM) Program, Chad
Condition: Severe Malnutrition
MeSH terms: Malnutrition
Study type: Interventional

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.
    

Intervention name(s): Hygiene promotion sessions; Household WASH package; Household visit; Group discussions after successful discharge; Outpatient Therapeutic Programme
Intervention type(s): Behavioral; Device; Behavioral; Behavioral; Procedure
Intervention description(s): Hygiene promotion sessions are provided weekly to the caretakers at the health center level. They contain 7 main messages this study is trying to get across: Allocate a protected space for children to play, limiting the likelihood of them ingesting soil or animal feces; Wash the child with soap (hand, face) when outside the protected area; Cleaning and rapid burial of children's stools; Key times for hand washing with soap for the child caretaker; Store drinking water in a closed container located in an elevated place out of reach of animals; Drinking water provided to the child should be treated with chlorine or boiled; Once weaned, avoid giving to the child leftover food, or only after warming it again.; The content of the kit: 200 g soap, aquatab 67 g, 20 liters Jerry can, a cup, a plastic kettle for hand washing and the instructions leaflet.; A household visit conducted by village's community health volunteers and ACF intervention staff during and after the treatment, to provide refresh training on the messages and the use of the kit.; Group discussions on hygiene and care practices with mothers at the community level after successful discharge.; Home-based treatment and rehabilitation using Ready-to-use Therapeutic Food (RUTF) for children with severe acute malnutrition
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Primary purpose: Treatment
Keywords: SAM, severe acute malnutrition