Expanding Coverage of Severe Acute Malnutrition (SAM) Treatment in Kenya

ConditionsAcute Malnutrition, Severe Malnutrition, Child Wasting

Trial statusRecruiting

Trial phaseNot applicable

Trial typeInterventional

Biological sexAll

Age6-5

SponsorInternational Food Policy Research Institute

About this trial

Child wasting is a type of malnutrition which occurs when a child becomes too thin. This medical condition increases the risk of becoming sick or dying. A child with severe wasting needs to be seen in a medical consultation to check on health status and to receive some medicine and a medical food supplement for daily consumption until cured. Yet, only a small proportion of children suffering from severe wasting are presently receiving appropriate treatment.

In Kenya, there is an opportunity to build on the existing network of community health promoters (CHPs) to increase the number of children with wasting who are identified and treated. In intervention areas, CHPs will be equipped with smartphones and an application which provides guidance on household members to visit and simple actions to take, related to health. CHPs will distribute color-coded mid-upper arm circumference tapes to households with young children and train caregivers on how to use it. After training, CHPs will send Short Message Services (SMS) to remind caregivers to regularly measure the arm circumference of the child. In addition, CHPs will receive a scale to measure the weight of children every month. Finally, wasted children registered in the treatment program who fail to attend a planned consultation will be flagged to their CHP through the phone application, and CHPs will conduct a specific home visit to investigate and help solve potential issues.

The study will assess whether this community intervention (called SWITCH) allows to identify and treat more children suffering from severe wasting. Before the start of the intervention, the proportion of wasted children receiving treatment in 40 community units in Turkana South, Turkana East and Aroo will be assessed. After this survey, a computer will randomly select 20 community units where the intervention will be scaled up. The survey will be repeated after 2 years to assess if the proportion of severely wasted children receiving treatment is higher in the area where the intervention was scaled up compared to the area where it was not scaled up.

In addition, after 1 year of implementation, the study will assess how the intervention was scaled up, what are the main challenges, and what are the overall perceptions on the intervention in the community among those who receive it and those who deliver it. Finally, costs of the various components of the intervention will be measured for all actors involved, including for caregivers.

Eligibility criteria

This trial accepts healthy volunteers

Qualifiers

Household in a village of the study area covered by a CHP (although the child may or may not be registered by a CHP) AND

Child is 6-59.9 months of age AND

Caregiver consents to be part of the study AND

WHZ < -3 (relative to WHO 2006 reference) OR

Disqualifiers

Congenital malformation that makes anthropometric measurements impossible.

Length is below 54 cm or height is above 120cm.

Trial design

Design model

Parallel

Treatments tested in this trial

SWITCH intervention package
Behavioral
* Addition of digital monitoring \& supervision by CHA * Digitized registration of households by CHPs every 6 months * Digital reminders to CHP to conduct home visit if a child has never been visited in 3 mo. * Digital reminder for timely training to family MUAC of all family members through home visit by CHP when child turns 6 months of age. * Platform for 2-ways messaging: biweekly SMS reminders to caregivers through the CHP's app; feedback by caregiver * Community level screening based on weight and weight-for-age (WAZ) led by CHP every other month (aligned with Community Action Days), * Digital calculation of WAZ. * CHP and Growth Monitoring and Promotion refer to health facility if WAZ\<-3 to check on WHZ eligibility * At the end of every wasting treatment consultation, compilation of the list of defaulters and non-respondents, for immediate transmission by CHA to relevant CHP through digital task of an instruction for immediate follow-up.

Treatment groups

1,600 Participants

are divided into 2 treatment groups

Group A: Standard of CareNo intervention 0 interventions

Group B: SWITCH intervention packageExperimental treatment 1 intervention

Trial outcomes

Primary outcomes

Period prevalence of severe wasting (SAM) treatment coverage in children 6-59 months of age

defined as the proportion of children suffering from SAM or recovering from SAM who currently receive treatment. • SAM defined by weight-for-height Z-score (WHZ) \<-3 (relative to World Health Organization (WHO) 2006 reference) or MUAC \<115 mm or by the presence of bilateral edema. Children recovering from SAM through treatment will be considered to receive treatment for an initial SAM condition if they both attended an IMAM consultation in the previous 15 days (as reported by caregiver OR by a consultation card) AND either: * consumed RUTF at least once in the previous 3 days (as reported by the caregiver AND confirmed by observation of \>= 1 full or 2 empty RUTF sachets) OR * consumed RUSF at least once in the previous 3 days (as reported by the caregiver AND confirmed by observation by the enumerator of \>= 1 full or 2 empty RUSF sachets) AND child was previously enrolled for SAM treatment immediately prior to MAM treatment (as confirmed by treatment card OR reported by the mother

Time frame