Effectiveness and cost-effectiveness of 4 supplementary foods for treating moderate acute malnutrition: results from a cluster-randomized intervention trial in Sierra Leone

Griswold, Stacy; Langlois, Breanne K.; Shen, Ye; Cliffer, Ilana; Suri, Devika; Walton, Shelley; Chui, Ken; Rosenberg, Irwin H.; Koroma, Aminata Shamit; Wegner, Donna; Hassan, Anjum; Manary, Mark; Vosti, Stephen A.; Webb, Patrick; Rogers, Beatrice Lorge

doi:10.1093/ajcn/nqab140

Cited by 12 publications

(9 citation statements)

References 16 publications

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“…While there is a growing evidence base on the costs of treating AM [ 17 – 19 ], currently there is no evidence on the sustainability of these programmatic investments. Inefficiencies arise when scarce resources are used in re-treating children who relapse to AM after recovery and program discharge.…”

Section: Discussionmentioning

confidence: 99%

A multi-country, prospective cohort study to evaluate the economic implications of relapse among children recovered from severe acute malnutrition: a study protocol

2022

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Background Community-based management of acute malnutrition (CMAM) is an effective intervention at recovering children from severe acute malnutrition (SAM) and preventing mortality. However, there is growing evidence that for many children recovery is not sustained post-discharge. This study will assess the economic implications of relapse by calculating the average cost of treating a case of SAM that relapses after initial CMAM treatment compared to the cost of a case that remains recovered for 6 months post-discharge. Methods This protocol outlines the methods for a cost-efficiency analysis to assess cost per episode of treatment for acute malnutrition for children enrolled in CMAM programs for initial SAM treatment in Mali, Somalia and South Sudan. Cost data will be collected and analyzed on a monthly basis for each CMAM service component (outpatient treatment program for SAM, supplementary feeding program for moderate acute malnutrition, and inpatient stabilization care for SAM with medical complications). Financial data will be extracted from expenditure records from institutional accounting systems where possible. Where these are not present, cost data will be collected via interview and review of financial documents. Staff time allocation interviews will be conducted. This data will be applied to quantify personnel costs, to apportion costs that are shared between programs and to exclude staff time spent on research activities. Discussion This study will provide the first estimates to address the limited evidence on the economic implications of SAM relapse in CMAM programs. Data from this economic analysis will help raise awareness and provide actionable data for the global nutrition community to address the financial burden of relapse. Estimating the cost of relapse in three countries representing different geographic and operational contexts will help in generalizing these results. Trial registration Registration # IORG0007116, Date of registration: 06/09/2020. This study is not registered as a clinical trial as it is observational research and does not include an intervention. The study has received the required ethical approvals as outlined in the declarations.

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Section: Discussionmentioning

confidence: 99%

A multi-country, prospective cohort study to evaluate the economic implications of relapse among children recovered from severe acute malnutrition: a study protocol

2022

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“…Data for children were collected as a part of a larger intervention study comparing the cost-effectiveness of four supplementary foods in the treatment of moderate acute malnutrition (MAM) in Pujehun District, Sierra Leone, while data for adults were collected as part of a study assessing treatment approaches for MAM based on severity of wasting ( figure 1 ). 34 In the study setting, 29.9% of the population falls in the lowest quintile for income and 27.3% in the second lowest. The four foods intervention study was implemented in 29 Peripheral Health Units (PHUs), which were randomised to administer one of four supplementary foods to children 6–59 months of age diagnosed with MAM.…”

Section: Methodsmentioning

confidence: 98%

Assessing infant cognition in field settings using eye-tracking: a pilot cohort trial in Sierra Leone

Leppänen

Butcher²,

Godbout

et al. 2022

BMJ Open

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ObjectivesTo investigate the feasibility of eye-tracking-based testing of the speed of visual orienting in malnourished young children at rural clinics in Sierra Leone.DesignProspective dual cohort study nested in a cluster-randomised trial.Setting8 sites participating in a cluster-randomised trial of supplementary feeding for moderate acute malnutrition (MAM).ParticipantsFor the MAM cohort, all infants aged 7–11 months at the eight sites were enrolled, 138 altogether. For controls, a convenience sample of all non-malnourished infants aged 7–11 months at the same sites were eligible, 60 altogether. A sample of 30 adults at the sites also underwent eye-tracking tests as a further control.InterventionsInfants with MAM were provided with supplementary feeding.Outcome measuresThe primary outcomes were feasibility and reliability of eye-tracking-based testing of saccadic reaction time (SRT). Feasibility was assessed by the percent of successful tests in the infants. Reliability was measured with intraclass correlation coefficients (ICCs). Secondary outcomes were mean SRT based on nutritional state as well as and changes in mean SRT after supplementary feeding of MAM children.ResultsInfants exhibited consistent orienting to targets on a computer screen (>95% of valid trials). Mean SRTs had moderate stability within visits (ICCs 0.60–0.69) and across the 4-week test–retest interval (0.53) in infants; the adult control group had greater SRT stability (within visit ICC=0.92). MAM infants had a trend toward higher adjusted SRT at baseline (difference=12.4 ms, 95% CI −2 to 26.9, p=0.09) and improvement in SRT 4 weeks thereafter (difference=−14 ms, 95% CI −26.2 to −1.7, p=0.025) compared with age-matched controls.ConclusionsThe results demonstrate the feasibility of eye-tracking-based testing in a resource-poor field setting and suggest eye-tracking measures have utility in the detection of group level effects of supplementary feeding.

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“…Details of the parent study have been described previously. 17 The four foods were 1) corn soy blend plus with fortified vegetable oil (CSB+ w/oil), serving as the reference group; 2) super cereal plus with amylase (SC+A); 3) corn soy whey blend with fortified vegetable oil (CSWB w/oil); and 4) a lipid-based ready-to-use supplementary food (RUSF).…”

Section: Methodsmentioning

confidence: 99%

Host Fecal mRNAs Predicted Environmental Enteric Dysfunction among Children with Moderate Acute Malnutrition in Sierra Leone

Singh

Potani

Griswold

et al. 2021

The American Journal of Tropical Medicine and Hygiene

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Examining the role of environmental enteric dysfunction (EED) in child growth requires noninvasive, field-appropriate biomarkers. Alternatives to the traditionally used lactulose:mannitol (L:M) test have been explored, but few studies have compared the L:M test to host fecal mRNA transcripts. The objectives of this study were to examine whether 1) host fecal mRNA transcripts could predict presence and severity of EED, measured using the L:M test, and 2) EED modifies the effect of specialized nutritious foods (SNFs) on recovery from moderate acute malnutrition (MAM). This substudy was nested within a cluster randomized trial comparing four SNFs in the treatment of MAM among children 6 to 59 months in Sierra Leone. EED was assessed at enrollment using the L:M test and 15 host fecal mRNA transcripts on 522 children. Recovery from MAM was defined as achieving mid-upper arm circumference ≥ 12.5 cm within 12 weeks of supplementation. Random forest classification models were used to examine prediction of presence and severity of EED by host fecal mRNA transcripts. Logistic regression was used to test for effect modification by L:M test variables including % lactulose excreted (%L). Eight host fecal mRNA transcripts (AQP9, REG3A, IFI30, DECR1, BIRC3, SELL, PIK3AP1, DEFA6) identified EED (%L ≥ 0.2) and severe EED (%L ≥ 0.45) with high sensitivity and specificity. The L:M test variables did not modify the effect of SNFs on recovery from MAM. In this study, we found host fecal mRNA transcripts that could be biomarkers of EED but did not find EED to modify the effect of SNFs on MAM treatment.

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Effectiveness and cost-effectiveness of 4 supplementary foods for treating moderate acute malnutrition: results from a cluster-randomized intervention trial in Sierra Leone

Cited by 12 publications

References 16 publications

A multi-country, prospective cohort study to evaluate the economic implications of relapse among children recovered from severe acute malnutrition: a study protocol

A multi-country, prospective cohort study to evaluate the economic implications of relapse among children recovered from severe acute malnutrition: a study protocol

Assessing infant cognition in field settings using eye-tracking: a pilot cohort trial in Sierra Leone

Host Fecal mRNAs Predicted Environmental Enteric Dysfunction among Children with Moderate Acute Malnutrition in Sierra Leone

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