Effectiveness of community-based treatment programs for treatment of uncomplicated severe acute malnourished children aged 6–59 months using locally produced nutrient dense foods: protocol for a multicentric longitudinal quasi-experimental study

BMC Nutrition

Anil Kumar Goel¹  Arun Kokane²  Ankur Joshi²  Aditya Mohapatra³  Samik Ghosh⁴  Hemang Shah⁴  Manjula Singh⁴  Mihretab Salasibew⁴  Rashmi Ranjan Nayak⁵  Raja Sriswan⁶  N. Arlappa⁶  Praveen Kumar⁷  Virendra Kumar⁷  Shikha Sinha⁸  Rajesh Kumar Sinha⁸  Asha Kiran⁹  Vivek Kashyap⁹  Arjan de Wagt^1,10  Abner Daniel^1,10  Sanjay Kumar Sahoo^1,11  Sourav Bhattacharjee^1,11  Mahendra Prajapati^1,12  Farhat Saiyed^1,12  Khyati Tiwari^1,13  Sameer Manikrao Pawar^1,14  Tarun Shrikrishna Patel^1,14  Preetu Mishra^1,15  Pritish Kumar Nayak^1,15 

[1] AIIMS Campus, Gate No, 1, Great Eastern Rd, opposite Gurudwara, Tatibandh, 492099, Raipur, Chhattisgarh, India;All India Institute of Medical Sciences, Saket Nagar, AIIMS Campus, Saket Nagar, BaghSwaniya, 462020, Bhopal, Madhya Pradesh, India;Annex Building, SIHFW, BiraMaharana Ln, Nilakantha Nagar, Nayapalli, 751012, Bhubaneswar, Odisha, India;Children’s Investment Fund Foundation, The Crescent, Level 3, Lado Sarai, 110030, New Delhi, India;Department of Women and Child Development and Mission Shakti, Government of Odisha, Mission Shakti Bhawan, At-Gandamunda, PO-Baramunda, Pin-751030, Bhubaneswar, Odisha, India;ICMR-National Institute of Nutrition, Beside Tarnaka Metro Station, Osmania University, PO, 500007, Hyderabad, Telangana, India;Lady Hardinge Medical College and associated Kalawati Saran Children’s Hospital, C-604 Connaught Circus, DIZ Area, Connaught Place, 110001, New Delhi, India;National Centre of Excellence for Management of Children with Severe Acute Malnutrition (NCoE-SAM), Kalawati Saran Children’s Hospital, C-604 Connaught Circus, DIZ Area, Connaught Place, 110001, New Delhi, India;Rajendra Institute of Medical Sciences, 834001, Ranchi, Jharkhand, India;UNICEF India Country Office, 73, Lodi Estate, 110003, New Delhi, India;UNICEF, 44 Surya Nagar, 751003, Bhubaneswar, Odisha, India;UNICEF, Chhattisgarh, India;UNICEF, Flat No. 1104, Block B, Indis One City, KPHB, 500072, Hyderabad, Telangana, India;UNICEF, Plot No.41-42, Polytechnic Colony, Shyamla Hills, 462013, Bhopal, Madhya Pradesh, India;UNICEF, VISHWA Complex, Ground Floor, Near IICM, Kanke Road, 834006, Ranchi, Jharkhand, India;

关键词: Community based Management of Acute Malnutrition;    Severe acute malnutrition;    Locally produced nutrient dense food supplements;    Cure rate;    Body composition;   

DOI  :  10.1186/s40795-021-00489-1

来源: Springer

【 摘 要 】

BackgroundSevere acute malnutrition (SAM) is a major underlying cause of mortality among children. Around one third of the world’s acutely malnourished children live in India. The WHO recommends community-based management of acute malnutrition (CMAM) for managing children with SAM. In India, different states are implementing community-based SAM treatment programme, hereinafter called CSAM, using varieties of locally produced nutrient dense food items with different nutrient compositions. The study will assess the effectiveness of these state specific CSAM interventions.MethodsThe longitudinal quasi-experimental study will be undertaken in two purposively selected blocks of one district each in the four intervention states and one comparison state. From each state, 200 SAM children identified using weight-for-length/height z-score (WHZ) < − 3 criteria will be enrolled in the study. Their anthropometric data and skinfold thickness will be taken on admission, at sixth week and at discharge by trained field investigators. Other child details, incidence of morbidity and socio-economic details will be collected on admission. To assess food consumption pattern including consumption of locally produced nutrient dense food supplements, dietary assessment, using 24-h dietary recall will be conducted on admission, at sixth week and at discharge. In addition, body composition parameters will be assessed for a sub-set of children using bio-electrical impedance analysis on admission and at discharge to analyse changes in total body water, fat-free mass, and fat mass. Post discharge, all study participants will be followed up monthly until 6 months. Atleast 10% of the sample will be checked for quality assessment.The study’s primary outcome is cure rate defined as children attaining WHZ ≥ -2. Secondary outcomes include mean weight gain, mean length of stay, body composition parameters, relapse and mortality rates. Additionally, process evaluation and cost effectiveness analysis will be conducted.DiscussionThere is a shortage of robust evidence regarding the effectiveness of locally produced nutrient dense food supplements provided as part of the CSAM intervention in India. This study will contribute to evidence on effective strategies to manage children with uncomplicated SAM in India. The study protocol has all necessary ethical approvals. Written informed consent will be obtained from caregivers of the children.Trial registrationThe study is registered with Clinical Trial Registration of India (Registration No.: CTRI/2020/09/028013) Date of registration 24/09/2020.

【 授权许可】

CC BY