The impact of integrated prevention and treatment on child malnutrition and health: the PROMIS project, a randomized control trial in Burkina Faso and Mali

Abstract

BackgroundEvidence suggests that both preventive and curative nutrition interventions are needed to tackle child acute malnutrition (AM) in developing countries. In addition to reducing the incidence of AM, providing preventive interventions may also help increase attendance (and coverage) of AM screening, a major constraint in the community-based management of child acute malnutrition (CMAM) model. There is a paucity of evidence-based strategies to deliver integrated preventive and curative interventions effectively and affordably at scale. The aim of the Innovative Approaches for the Prevention of Childhood Malnutrition (PROMIS) study is to assess the feasibility, quality of implementation, effectiveness and cost-effectiveness of an integrated child malnutrition prevention and treatment intervention package implemented through a community-based platform in Mali and a facility-based platform in Burkina Faso.Methods/DesignThe PROMIS intervention entails a comprehensive preventive package offered on a monthly basis to caregivers of children, while children are screened for acute malnutrition (AM). The package consists of behavior change communication on essential nutrition and hygiene actions, and monthly preventive doses of small quantity lipid-based nutrient supplements (SQ-LNS) for children aged 6 to 23.9 months. Positive AM cases are referred to treatment services offered by first-line health services according to the CMAM model.The PROMIS intervention will be evaluated using a mixed methods approach. The impact study encompasses two types of study design: i) repeated cross-sectional surveys conducted at baseline and at endline after 24 months of program implementation and ii) a longitudinal study with a monthly follow-up for 18 months. Primary study impact measures include the incidence and endpoint prevalence of AM, AM screening coverage and treatment compliance. A process evaluation will assess the feasibility and quality of implementation of the intervention guided by country specific program impact pathways (PIPs). Cost-effectiveness analysis will assess the economic feasibility of the intervention.DiscussionThe PROMIS study assesses the effectiveness of an innovative model to integrate prevention and treatment interventions for greater and more sustainable impacts on the incidence and prevalence of AM using a rigorous, theory-based randomized control trial approach. This type of programmatic research is urgently needed to help program implementers, policy makers, and investors prioritize, select and scale-up the best program models to prevent and treat AM and achieve the World Health Assembly goal of reducing childhood wasting to less than 5% globally by the year 2025.Trial registrationClinicaltrials.gov NCT02323815 (registered on December 18, 2014) and NCT02245152 (registered on September 16, 2014)Electronic supplementary materialThe online version of this article (doi:10.1186/s12889-017-4146-6) contains supplementary material, which is available to authorized users.

Filling the Gaps for Enhancing the Effectiveness of Community-Based Programs Combining Treatment and Prevention of Child Malnutrition: Results from the Rainbow Project 2015–17 in Zambia

“…The Rainbow experience in Zambia supports the hypothesis that monitoring and evaluating activities improve the sustainability and effectiveness of community-based programs for child malnutrition that already exist and are well-implemented in the field [ 5 , 37 , 38 , 39 ]. Integrated community-based programs that promote general child malnutrition treatment and prevention, hold the potential to reduce the prevalence of acute malnutrition by reducing the incidence and enhancing treatment effectiveness [ 8 , 40 , 41 ]. Nutritional rehabilitation has not been considered a stand-alone intervention within nutritional programs: nutritional counseling, IYCF knowledge, health education, HIV/AIDS counseling, testing and diagnosis, immunization sensitization and awareness, control of infections and malaria, TB prevention and screening, must be integrated in CMAM protocols as these are critical primary care elements [ 42 , 43 , 44 ].…”

“…Within the CMAM, targeted Supplementary Feeding Programs (SFPs) are recognized as best practice for treating MAM and preventing the deterioration into SAM in the emergency nutrition response [ 7 ]. However, more evidence-based research is needed to evaluate the effectiveness of a combined approach integrating preventive and curative interventions [ 8 ], adapted to different scenarios and non-emergency settings [ 6 ].…”

Improving diets and nutrition through an integrated poultry value chain and nutrition intervention (SELEVER) in Burkina Faso: study protocol for a randomized trial

“…Hygiene knowledge will be assessed using a questionnaire previously tested in Burkina Faso and practices will be measured by 24-h recall methods. The survey will include an assessment of women’s knowledge, attitudes, and practices regarding IYCF and sanitation and hygiene, using a questionnaire and 24-h recall methods previously tested in Burkina Faso [ 24 ].…”

Impact of stakeholder perspectives on cost-effectiveness estimates of four specialized nutritious foods for preventing stunting and wasting in children 6–23 months in Burkina Faso

“…An activity-based costing with ingredients approach (ABC-I) was used for estimating all costs associated with each arm [22][23][24]. Major activities along food procurement, supply chain, and the blanket supplementary feeding program were identified, and the information on quantities and prices to value all resources (ingredients) needed was assigned to each activity to calculate costs.…”