The Effect of Integrated Prevention and Treatment on Child Malnutrition and Health in Mali: a Cluster Randomized Intervention Study
Condition: Child Acute Malnutrition
MeSH terms: Malnutrition; Child Nutrition Disorders
Study type: Interventional
Phase: Phase 4

Summary: 
      Globally, child undernutrition is the underlying cause for 3.1 million deaths of children
      younger than 5 years. 18.7 million children under five years of age suffer from severe acute
      malnutrition (SAM) and an additional 33 million children suffer from moderate acute
      malnutrition, and are at risk of developing SAM

      In Sub-Saharan Africa, there is often poor integration between programs to treat child acute
      malnutrition and programs that focus on the prevention of acute and chronic undernutrition -
      resulting in many missed opportunities for using prevention platforms to screen and refer SAM
      children, or for using screening and referral platforms to provide prevention services.

      This project will address two critical gaps related to the integration of preventive and
      treatment programs: 1) screening and treatment of MAM/SAM have not yet been systematically
      integrated into routine health-center visits or mainstreamed into community outreach
      programs; and 2) screening programs do not offer any preventive services for those children
      found not to be suffering from MAM/SAM at the time of screening; mothers of children
      identified as non-MAM/SAM case are usually sent home without receiving any health or
      nutrition inputs and as a result, may fail to come back for screening because they do not see
      any tangible benefit associated with their participation in the screening. This project will
      specifically address these gaps by assessing the effect of an integrated approach consisting
      of higher screening coverage and preventive Behavior Change Communication (BCC) +
      Small-Quantity Lipid-based Nutrient supplementation (SQ-LNS) on both prevention and treatment
      of child undernutrition.
    

Detailed description: 
      Because of the intended dual role of BCC/SQ-LNS on child undernutrition in this study - e.g.
      to help prevent child undernutrition and enhance the coverage of screening, referral and
      treatment of SAM/MAM, it is necessary to combine two study designs to rigorously evaluate the
      impact of the proposed intervention and to tease out the contribution of prevention and
      enhanced coverage/treatment to the overall impact on child malnutrition.

      The proposed study will therefore use two types of study designs. The first one is a repeated
      cross-sectional design that will compare select study outcomes between intervention and
      control groups at endline, after 24 months of program implementation. These cross-sectional
      surveys among children 6-23 months, at baseline and after 24 months (on different children)
      will be used to assess the impact of the intervention on the prevalence of several outcomes,
      including the prevalence of MAM/SAM and stunting, the coverage of MAM/SAM screening and
      maternal ENA/IYCF/WASH knowledge and practices. The second study design entails a
      longitudinal design whereby individual children will be recruited at 6 months of age and
      followed-up monthly until they reach 24 months of age.This design will allow us to assess the
      intervention's effects on the incidence, recovery and recurrence rates of MAM/SAM.
    

Intervention name(s): Small-Quantity Lipid-based nutrient supplement; Child's health and nutrition topics
Intervention type(s): Dietary Supplement; Behavioral
Intervention description(s): A monthly dose of SQ-LNS (31 sachets of 20g) will be distributed to mothers attending counselling sessions; Monthly group counselling meetings organized at village level. Caregivers of participating children are invited to attend monthly counselling meetings that treat topics on child nutrition, health, hygiene and good sanitary practices. During these visits children are also screened for acute malnutrition measuring arm circumference.
Other intervention name(s): SQ-LNS
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Primary purpose: Prevention
Keywords: child acute malnutrition prevention; behavior change communication; lipid-based nutrient supplement; screening coverage