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Training caregivers to screen for relapse among children who have recovered from severe acute malnutrition: study
Clarisse Dah1, Aimée Kimfuema2, Mamadou Bountogo1
1Centre de Recherche en Santé de Nouna, Nouna, Burkina Faso.
Insights
Caregiver training in home-based mid-upper arm circumference (MUAC) screening can help detect relapsed severe acute malnutrition (SAM) early. This feasibility trial in Burkina Faso will assess the effectiveness of this approach for children recovering from SAM.
Area of Science:
- Pediatric Nutrition
- Global Health
- Malnutrition Research
Background:
- Children with severe acute malnutrition (SAM) face high mortality and morbidity risks.
- Relapse rates after initial SAM recovery can be high, with variable adherence to clinic-based surveillance.
- Delayed diagnosis of relapse can occur due to missed follow-up visits.
Purpose of the Study:
- To design a feasibility trial protocol for training caregivers in home-based MUAC screening for relapsed acute malnutrition.
- To generate preliminary evidence for a caregiver-led intervention to improve early detection of malnutrition relapse.
- To inform the design of a full-scale trial for managing SAM recovery.
Main Methods:
- A feasibility trial involving 200 caregiver-child dyads in Boromo, Burkina Faso, where children have recovered from SAM.
- Randomization to either weekly home MUAC screening by caregivers plus standard care, or standard care alone (monthly clinic visits).
- Primary endpoints focus on feasibility (acceptability, training time, enrollment, adherence), with secondary clinical endpoints (relapse rates, anthropometry, hospitalization, vital status) over 6 months.
Main Results:
- This feasibility trial aims to assess the acceptability and adherence of caregiver-led MUAC screening for SAM relapse.
- It will collect data on enrollment, training effectiveness, and adherence to screening protocols.
- Clinical data on relapse rates and child health outcomes will inform future large-scale trial design.
Conclusions:
- The trial will provide essential data for developing and testing a caregiver-centered intervention for detecting relapsed acute malnutrition.
- It supports the potential of empowering caregivers with MUAC screening tools for improved child health outcomes.
- This approach could enhance early detection and management of malnutrition relapse in resource-limited settings.
Background:
Children with severe acute malnutrition (SAM) have a high risk of mortality and morbidity. After recovery from an initial episode of SAM, the risk of relapse can be high, although estimates vary across settings. Post-recovery surveillance for relapsed SAM in Burkina Faso consists of monthly clinic-based follow-up visits. However, adherence to the follow-up schedule can be variable, and children with missed surveillance visits may have delayed diagnoses of relapse. Here, we describe the protocol for a feasibility trial design to provide preliminary evidence to support the training of caregivers to screen for relapsed acute malnutrition using mid-upper arm circumference (MUAC) screening at home.
Methods:
This feasibility trial will enroll 200 caregiver-child dyads in which the child has recovered in the past month from an episode of SAM in Boromo, Burkina Faso. Eligible children had an initial episode of SAM that they recovered from per Burkinabè guidelines (weight-for-height Z-score, WHZ ≥ -2 and/or MUAC ≥ 12.5 cm, depending on the admission criteria). Caregiver-child dyads are randomized to either weekly screening using a standard MUAC tape plus standard of care follow-up or standard of care alone, which consists of monthly clinic-based screening for relapse for 3 months. Caregiver-child dyads are followed for 6 months. Primary feasibility endpoints include acceptability, time for training, enrollment potential and refusals, adherence to the follow-up protocol, and adherence to the screening protocol. Clinical endpoints, measured to inform the design of a full-scale trial, include the proportion of children relapsing, anthropometric measurements at 6 months, hospitalization, and vital status.
Discussion:
This feasibility trial will generate data to support the development and full-scale testing of an intervention to train caregivers to screen for relapsed acute malnutrition using MUAC.
Trial Registration:
This trial is registered at clinicaltrials.gov (NCT05932992), first posted 27 June 2023.
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