Efficacy of in-service nutrition training for mid-level providers to improve feeding practices among HIV-positive children in Tanga, Tanzania: study protocol for a cluster randomized controlled trial

Trials

Junko Yasuoka³  Masamine Jimba³  David P Urassa¹  Linda B Mlunde³  Krishna C Poudel²  Bruno F Sunguya³ 

[1] School of Public Health and Social Sciences, Muhimbili University of Health and Allied Sciences, P.O. Box 65489, Dar es Salaam, Tanzania;Department of Public Health, School of Public Health and Health Sciences, University of Massachusetts Amherst, Arnold House, 715 North Pleasant St, Amherst, MA 01003-9304, USA;Department of Community and Global Health, Graduate School of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo 113-0033, Japan

关键词: Undernutrition;    Nutrition status;    Mid-level providers;    Feeding practices;    HIV/AIDS;    Children;   

Others  :  834782
DOI  :  10.1186/1745-6215-14-352

 received in 2013-07-03, accepted in 2013-10-15,  发布年份 2013

【 摘 要 】

Background

Feeding practices and child undernutrition can be improved when trained health workers provide proper nutrition counseling to caregivers. However, this important management component is difficult to achieve in countries where trained health workers are limited; Tanzania is no exception. In rural and semi-urban areas, mid-level providers (MLPs) are left to manage diseases such as HIV/AIDS.

Training health workers in nutrition has been shown to be an effective intervention among HIV-negative children elsewhere, but no studies have been conducted among HIV-positive children. Furthermore, in Tanzania and other countries with MLPs, no evidence currently exists demonstrating an improvement in nutrition among children who receive health services given by MLPs. This study thus aims to examine the efficacy of nutrition training of MLPs on feeding practices and the nutrition status of HIV-positive children in Tanga, Tanzania.

Methods/Design

We will conduct a cluster randomized controlled trial in care and treatment centers (CTCs) in Tanga, Tanzania. The CTCs will be the unit of randomization. We will select 16 CTCs out of 32 for this study, of which we will randomly assign 8 to the intervention arm and 8 to the control arm by coin flipping. From the selected CTCs we will attempt to recruit a total of 800 HIV-positive children aged 6 months to 14 years, half of whom will be receiving care and/or treatment in the CTCs of the intervention arm, and the other half of whom will be receiving care and/or treatment in the CTCs of the control arm (400 children in each condition).

We will provide nutrition training to MLPs of the CTCs selected for the intervention arm. In this intervention, we will use the World Health Organization guidelines on nutrition training of health workers for HIV-positive children aged 6 months to 14 years. The trained MLPs will then provide tailored nutrition counseling to caregivers of children being treated at the 8 CTCs of the intervention arm. We will measure nutrition status and child feeding practices monthly for a total of six months.

Conclusions

Results of this trial will help expanding undernutrition interventions among HIV-positive children in Tanzania and other countries.

Trial registration

Current Controlled Trials: ISRCTN65346364.

【 授权许可】

   
2013 Sunguya et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

【 参考文献 】

• [1]UNAIDS: AIDS Epidemic Update. Geneva: World Health Organization; 2009.
• [2]NBS, ORC-Macro: Tanzania Demographic and Health Survey 2009–2010. Dar es Salaam: National Bureau of Statistics and ORC Macro; 2010.
• [3]Sunguya BF, Poudel KC, Otsuka K, Yasuoka J, Mlunde LB, Urassa DP, Mkopi NP, Jimba M: Undernutrition among HIV-positive children in Dar es Salaam, Tanzania: antiretroviral therapy alone is not enough. BMC Public Health 2011, 11:869. BioMed Central Full Text
• [4]Santos I, Victora CG, Martines J, Gonçalves H, Gigante DP, Valle NJ, Pelto G: Nutrition counseling increases weight gain among Brazilian children. J Nutr 2001, 131(11):2866-2873.
• [5]Pelto GH, Santos I, Gonçalves H, Victora C, Martines J, Habicht JP: Nutrition counseling training changes physician behavior and improves caregiver knowledge acquisition. J Nutr 2004, 134(2):357-362.
• [6]Global Atlas of the Health Workforce. [http://apps.who.int/globalatlas/default.asp webcite]
• [7]McDonald CM, Kupka R, Manji KP, Okuma J, Bosch RJ, Aboud S, Kisenge R, Spiegelman D, Fawzi WW, Duggan CP: Predictors of stunting, wasting and underweight among Tanzanian children born to HIV-infected women. Eur J Clin Nutr 2012, 66(11):1265-1276.
• [8]Global Health Workforce Alliance: Mid-level Health Providers a Promising Resource to Achieve the Health Millennium Development Goals. Global Health Workforce Alliance, Report. Geneva: World Health Organization; 2010.
• [9]WHO: Midlevel Providers: A Promising Resource to Achieve the Health Millennium Development Goals. Geneva: World Health Organization; 2010.
• [10]Sunguya BF, Poudel KC, Mlunde LB, Shakya P, Urassa DP, Jimba M, Yasuoka J: Effectiveness of nutrition training of health workers toward improving caregivers’ feeding practices for children aged six months to two years: a systematic review. Nutr J 2013, 12:66. BioMed Central Full Text
• [11]Imdad A, Yakoob MY, Bhutta ZA: Impact of maternal education about complementary feeding and provision of complementary foods on child growth in developing countries. BMC Public Health 2011, 11(Suppl 3):S25. BioMed Central Full Text
• [12]Shi L, Zhang J: Recent evidence of the effectiveness of educational interventions for improving complementary feeding practices in developing countries. J Trop Pediatr 2011, 57(2):91-98.
• [13]Dewey KG, Adu-Afarwuah S: Systematic review of the efficacy and effectiveness of complementary feeding interventions in developing countries. Matern Child Nutr 2008, 4(Suppl 1):24-85.
• [14]ICF-Macro NBS: Micronutrients: Results of the 2010 Tanzania Demographic and Health Survey. Dar es Salaam: NBS and ICF Macro; 2011.
• [15]NACP: HIV/AIDS/STI Surveillance Report No. 21. Dar es Salaam: Ministry of Health, Tanzania Mainland: National AIDS Control Programme (NACP); 2009.
• [16]TACAIDS, ZAC, NBS, OCGS, ICF-Macro: Tanzania HIV/AIDS and Malaria Indicator Survey 2011–12. Dar es Salaam: Tanzania Commission for AIDS (TACAIDS), Zanzibar AIDS Commission (ZAC), National Bureau of Statistics (NBS), Office of the Chief Government Statistician (OCGS), and ICF International; 2013.
• [17]NACP, Ministry of Health: National Guideline for Management of HIV/AIDS. Dar es Salaam: Ministry of Health; 2009.
• [18]WHO: Management of Childhood Illness, Counsel the Mother. Geneva: WHO Division of Diarrhea and Acute Respiratory Disease Control; 1995.
• [19]WHO: Guidelines for an Integrated Approach to the Nutritional Care of HIV-infected Children (6 months to 14 years). Geneva: World Health Organization; 2009.
• [20]Sunguya BF, Poudel KC, Mlunde LB, Otsuka K, Yasuoka J, Urassa DP, Mkopi NP, Jimba M: Ready to use therapeutic foods (RUTF) improves undernutrition among ART-treated, HIV-positive children in Dar es Salaam, Tanzania. Nutr J 2012, 11:60. BioMed Central Full Text
• [21]Shi L, Zhang J, Wang Y, Caulfield LE, Guyer B: Effectiveness of an educational intervention on complementary feeding practices and growth in rural China: a cluster randomised controlled trial. Public Health Nutr 2010, 13(4):556-565.
• [22]De Onis M, Onyango AW, Van den Broeck J, Chumlea WC, Martorell R: Measurement and standardization protocols for anthropometry used in the construction of a new international growth reference. Food Nutr Bull 2004, 25(1 Suppl):S27-S36.
• [23]Roche AF, Davila GH: Differences between recumbent length and stature within individuals. Growth 1974, 38(3):313-320.
• [24]Dibley MJ, Staehling N, Nieburg P, Trowbridge FL: Interpretation of Z-score anthropometric indicators derived from the international growth reference. Am J Clin Nutr 1987, 46(5):749-762.
• [25]WHO: A Growth Chart for International Use in Maternal and Child Health Care. Geneva: World Health Organization; 1978.
• [26]Van den Broeck J, Willie D, Younger N: The World Health Organization child growth standards: expected implications for clinical and epidemiological research. Eur J Pediatr 2009, 168(2):247-251.
• [27]WHO: Multicenter Growth Reference Study Group: WHO child growth standards based on length, weight and age. Acta Paediatr 2006, 450:76-84.
• [28]NBS, ORC-Macro: Tanzania Demographic and Health Survey 2004–2005. Dar es Salaam: National Bureau of Statistics (Tanzania) and ICF-Macro; 2005.
• [29]Lukmanji Z, Hertzmark E, Mlingi N, Assey V, Ndossi G, Fawzi W: Tanzania Food Composition Tables. Dar es Salaam: MUHAS-TFNC, HSPH; 2008.
• [30]Coates J, Swindale A, Bilinsky P: Household Food Insecurity Access Scale (HFIAS) for Measurement of Household Food Access: Indicator Guide (v. 3). Washington, D.C: Food and Nutrition Technical Assistance Project, Academy for Educational Development; 2007.
• [31]Kadiyala S, Rawat R: Food access and diet quality independently predict nutritional status among people living with HIV in Uganda. Public Health Nutr 2013, 16(1):164-170.
• [32]Nagata JM, Magerenge RO, Young SL, Oguta JO, Weiser SD, Cohen CR: Social determinants, lived experiences, and consequences of household food insecurity among persons living with HIV/AIDS on the shore of Lake Victoria. Kenya. AIDS Care 2012, 24(6):728-736.
• [33]Tsai AC, Bangsberg DR, Emenyonu N, Senkungu JK, Martin JN, Weiser SD: The social context of food insecurity among persons living with HIV/AIDS in rural Uganda. Soc Sci Med 2011, 73(12):1717-1724.
• [34]Tsai AC, Bangsberg DR, Frongillo EA, Hunt PW, Muzoora C, Martin JN, Weiser SD: Food insecurity, depression and the modifying role of social support among people living with HIV/AIDS in rural Uganda. Soc Sci Med 2012, 74(12):2012-2019.
• [35]Weiser SD, Young SL, Cohen CR, Kushel MB, Tsai AC, Tien PC, Hatcher AM, Frongillo EA, Bangsberg DR: Conceptual framework for understanding the bidirectional links between food insecurity and HIV/AIDS. Am J Clin Nutr 2011, 94(6):1729S-1739S.
• [36]Weiser SD, Gupta R, Tsai AC, Frongillo EA, Grede N, Kumbakumba E, Kawuma A, Hunt PW, Martin JN, Bangsberg DR: Changes in food insecurity, nutritional status, and physical health status after antiretroviral therapy initiation in rural Uganda. J Acquir Immune Defic Syndr 2012, 61(2):179-186.
• [37]WHO: WHO Case Definitions of HIV for Surveillance and Revised Clinical Staging and Immunological Classification of HIV-related Disease in Adults and Children. Geneva: World Health Organization; 2006.
• [38]Yeung S, Wilkinson D, Escott S, Gilks C: Paediatric HIV infection in a rural South African district hospital. J Trop Pediatr 2000, 46(2):107-110.
• [39]Bachou H, Tylleskär T, Downing R, Tumwine J: Severe malnutrition with and without HIV-1 infection in hospitalised children in Kampala, Uganda: differences in clinical features, haematological findings and CD4+ cell counts. Nutr J 2006, 5:27. BioMed Central Full Text
• [40]Berkley J, Bejon P, Mwangi T, Gwer S, Maitland K, Williams T, Mohammed S, Osier F, Kinyanjui S, Fegan G, Lowe BS, English M, Peshu N, Marsh K, Newton CR: HIV infection, malnutrition, and invasive bacterial infection among children with severe malaria. Clin Infect Dis 2009, 49(3):336-343.
• [41]Weigel R, Phiri S, Chiputula F, Gumulira J, Brinkhof M, Gsponer T, Tweya H, Egger M, Keiser O: Growth response to antiretroviral treatment in HIV-infected children: a cohort study from Lilongwe, Malawi. Trop Med Int Health 2010, 15(8):934-944.
• [42]Sunguya B, Koola J, Atkinson S: Infections associated with severe malnutrition among hospitalised children in East Africa. Tanzan Health Res Bull 2006, 8(3):189-192.
• [43]Saloojee H, De Maayer T, Garenne M, Kahn K: What’s new? Investigating risk factors for severe childhood malnutrition in a high HIV prevalence South African setting. Scand J Public Health Suppl 2007, 69:96-106.
• [44]Biondi D, Kipp W, Jhangri GS, Alibhai A, Rubaale T, Saunders LD: Risk factors and trends in childhood stunting in a district in Western Uganda. J Trop Pediatr 2011, 57(1):24-33.
• [45]Gibbons T, Fuchs GJ: Nutrition Support for Infants and Children at Risk, Volume 59. Basel: Karger; 2007.
• [46]Nyarango PM, Gebremeskel T, Mebrahtu G, Mufunda J, Abdulmumini U, Ogbamariam A, Kosia A, Gebremichael A, Gunawardena D, Ghebrat Y, Okbaldet Y: A steep decline of malaria morbidity and mortality trends in Eritrea between 2000 and 2004: the effect of combination of control methods. Malar J 2006, 5:33. BioMed Central Full Text
• [47]Howe DL, Hargreaves RJ, Huttly RS: Issues in the construction of wealth indices for the measurement of socio-economic position in low-income countries. Emerg Themes Epidemiol 2008, 5:3. BioMed Central Full Text
• [48]Gwatkin DR, Rutstein S, Johnson K, Pande RP, Wagstaff A: Socio-economic Difference in Health, Nutrition and Population in Ghana: HNP/Poverty Thematic Group of the World Bank. World Bank: Washington, D.C; 2000.
• [49]Vyas S, Kumaranayake L: Constructing socio-economic status indices: how to use principal components analysis. Health Policy Plan 2006, 21(6):459-468.
• [50]Department of State: International Religious Freedom Report 2007. Washington, D.C.: US Department of State; 2007.
• [51]World Health Organization: Global Atlas of the Health Workforce. Geneva: WHO; 2011.