Integrated and simplified approaches to community management of acute malnutrition in rural Kenya: a cluster randomized trial protocol

Kimani‐Murage, Elizabeth; Pythagore, Hermann; Mwaniki, Elizabeth; Daniel, Tewoldeberha; Samburu, Betty; Charle-Cuéllar, Pilar; Mbochi, Regina; Njiru, James; Wangare, Lucy; Karimurio, Lydia; Agutu, Olivia; Maina, Lucy Gathigi; Okoth, Peter; Raburu, Judith; Wanjohi, Milka; Macharia, Triza; Zerfu, Taddese Alemu

doi:10.1186/s12889-019-7497-3

Cited by 4 publications

(3 citation statements)

References 11 publications

(7 reference statements)

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“…The criteria, however, may be too stringent to estimate the effectiveness of the regimen, whereas (WHZ ≥ −2) might be a more operational milestone to assume that the child is no longer in the danger zone of moderate acute malnutrition (MAM) on the way to severe acute malnutrition (SAM). Nevertheless, this study confirmed the effectiveness of managing children with MAM at home as through a community‐based control strategy (Kimani‐Murage et al, 2019 ).…”

Section: Discussionsupporting

confidence: 79%

Three‐arm clinical trial of improved flour targeting intestinal microbiota (MALINEA)

Vray,

Tondeur,

Hedible

et al. 2024

Maternal & Child Nutrition

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The main objective of this project was to compare in the field conditions two strategies of re‐nutrition of children with moderate acute malnutrition (MAM) aged from 6 to 24 months, targeting the microbiota in comparison with a standard regimen. A three‐arm, open‐label, pragmatic randomised trial was conducted in four countries (Niger, CAR, Senegal and Madagascar). Children received for 12 weeks either fortified blended flour (FBF control) = arm 1, or FBF + azithromycin (oral suspension of 20 mg/kg/day daily given with a syringe) for the first 3 days at inclusion = arm 2 or mix FBF with inulin/fructo‐oligosaccharides (6 g/day if age ≥12 months and 4 g if age <12 months) = arm 3. For each arm, children aged from 6 to 11 months received 100 g x 2 per day of flours and those aged from 12 to 24 months received 100 g × 3 per day of FBF. The primary endpoint was nutritional recovery, defined by reaching a weight‐for‐height z‐score (WHZ) ≥ −1.5 within 12 weeks. Overall, 881 children were randomised (297, 290 and 294 in arm 1, arm 2 and arm 3, respectively). Three hundred and forty‐four children were males (39%) and median/mean age were 14.6/14.4 months (SD = 4.9, IQR = 10.5–18.4). At inclusion, the three arms were comparable for all criteria, but differences were observed between countries. Overall, 44% (390/881) of the children recovered at week 12 from MAM, with no significant difference between the three arms (41.4%, 45.5% and 45.9%, in arm 1, arm 2 and arm 3, respectively, p = 0.47). This study did not support the true advantages of adding a prebiotic or antibiotic to flour. When using a threshold of WHZ ≥ −2 as an exploratory endpoint, significant differences were observed between the three arms, with higher success rates in arms with antibiotics or prebiotics compared to the control arm (66.9%, 66.0% and 55.2%, respectively, p = 0.005).

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Section: Discussionsupporting

confidence: 79%

Three‐arm clinical trial of improved flour targeting intestinal microbiota (MALINEA)

Vray,

Tondeur,

Hedible

et al. 2024

Maternal & Child Nutrition

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“…This qualitative study was nested within a broader study on integrating the treatment of acute malnutrition by CHVs into iCCM. The qualitative study was cross-sectional among participants of the treatment arm of a cluster randomized controlled trial [ 17 ]. In the treatment group, 16 CHVs in Turkana and 17 CHVs in Isiolo were trained by implementing non-governmental organizations (NGOs) on how to use simplified tools and protocols to identify and treat eligible malnourished children (127 in Turkana and 107 in Isiolo) at home in addition to providing the usual iCCM package.…”

Section: Methodsmentioning

confidence: 99%

“…In the control group, CHVs provided the usual iCCM package, which involves only screening and then referring malnourished children to health facilities. Details of this intervention are available in the published protocol [ 17 ]. Data were collected in Septemeber 2019 at the end of the intervention period using in-depth interviews (IDIs), focus group discussions (FGDs) and key informant interviews (KIIs).…”

Section: Methodsmentioning

confidence: 99%

Perceptions towards management of acute malnutrition by community health volunteers in northern Kenya

Wambui,

Wilunda,

Donfouet

et al. 2024

PLOS Glob Public Health

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Child undernutrition is a persistent challenge in arid and semi-arid areas due to low and erratic rainfall, recurrent droughts and food insecurity. In these settings, caregivers face several challenges in accessing health services for sick and/or malnourished children, including long distances to health facilities, harsh terrain, and lack of money to pay for transportation costs to the health facilities, leading to low service coverage and sub-optimal treatment outcomes. To address these challenges and optimize treatment outcomes, the World Health Organization recommends utilizing community health volunteers (CHVs) to manage acute malnutrition in the community. This study explored the perceptions of community members regarding acute malnutrition treatment by CHVs in Turkana and Isiolo counties in Kenya. The study utilized a cross-sectional study design and included a purposive sample of caregivers of children, CHVs, officers who trained and supervised CHVs and community leaders in the intervention area. Focus group discussions and key informant interviews were used to explore perceptions towards the management of acute malnutrition by CHVs. Generally, caregivers and CHVs perceived the intervention to be beneficial as it readily addressed acute malnutrition treatment needs in the community. The intervention was perceived to be acceptable, effective, and easily accessible. The community health structure provided a platform for commodity supply and management and CHV support supervision. This was a major enabler in implementing the intervention. The intervention faced operational and systemic challenges that should be considered before scale-up.

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The impacts of task shifting on the management and treatment of malnourished children in Northern Kenya: a cluster-randomized controlled trial

Donfouet,

Daniel,

Wilunda

et al. 2024

Health Policy and Planning

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Treating children with acute malnutrition can be challenging, particularly regarding access to healthcare facilities during treatment. Task shifting, a strategy of transferring specific tasks to health workers with shorter training and fewer qualifications, is being considered as an effective approach to enhancing health outcomes in primary healthcare. This study aimed to assess the effectiveness of integrating the treatment of acute malnutrition by community health volunteers into integrated community case management in two sub-counties in northern Kenya (Loima and Isiolo). We conducted a two-arm non-inferiority cluster-randomized controlled trial across 20 community health units. Participants were children aged 6–59 months with uncomplicated acute malnutrition. In the intervention group, community health volunteers used simplified tools and protocols to identify and treat eligible children at home and provided the usual integrated community case management package. In the control group, community health volunteers provided the usual integrated community case management package only (screening and referral of the malnourished children to the health facilities). The primary outcome was recovery (MUAC ≥12.5 cm for 2 consecutive weeks). Results show that children in the intervention group were more likely to recover than those in the control group [73 vs 50; risk difference (RD) = 26% (95% CI 12 to 40) and risk ratio (RR) = 2 (95% CI 1.2 to 1.9)]. The probability of defaulting was lower in the intervention group than in the control group: RD = −21% (95% CI −31 to −10) and RR = 0.3 (95% CI 0.2 to 0.5). The intervention reduced the length of stay by about 13 days, although this was not statistically significant and varied substantially by sub-county. Integrating the treatment of acute malnutrition by community health volunteers into the integrated community case management programme led to better malnutrition treatment outcomes. There is a need to integrate acute malnutrition treatment into integrated community case management and review policies to allow community health volunteers to treat uncomplicated acute malnutrition.

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Integrated and simplified approaches to community management of acute malnutrition in rural Kenya: a cluster randomized trial protocol

Cited by 4 publications

References 11 publications

Three‐arm clinical trial of improved flour targeting intestinal microbiota (MALINEA)

Three‐arm clinical trial of improved flour targeting intestinal microbiota (MALINEA)

Perceptions towards management of acute malnutrition by community health volunteers in northern Kenya

The impacts of task shifting on the management and treatment of malnourished children in Northern Kenya: a cluster-randomized controlled trial

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