Abstract
BackgroundIn many low income countries, the majority of acutely malnourished children are either brought to the health facility late or never at all due to reasons related to distance and associated costs. Integrated community case management (iCCM) is an integrated approach addressing disease and malnutrition through use of community health volunteers (CHVs) in children under-5 years. Evidence on the potential impact and practical experiences on integrating community-based management of acute malnutrition as part of an iCCM package is not well documented. In this study, we aim to investigate the effectiveness and cost effectiveness of integrating management of acute malnutrition into iCCM.MethodsThis is a two arm parallel groups, non-inferiority cluster randomized community trial (CRT) employing mixed methods approach (both qualitative and quantitative approaches). Baseline and end line data will be collected from eligible (malnourished) mother/caregiver-child dyads. Ten community units (CUs) with a cluster size of 24 study subjects will be randomized to either an intervention (5 CUs) and a control arm (5 CUs). CHV in the control arm, will only screening and refer MAM/SAM cases to the nearby health facility for treatment by healthcare professionals. In the intervention arm, however; CHVs will be trained both to screen/diagnose and also treat moderate acute malnutrition (MAM) and severe acute malnutrition (SAM) without complication. A paired-matching design where each control group will be matched with intervention group with similar characteristics will be matched to ensure balance between the two groups with respect to baseline characteristics. Qualitative data will be collected using key informant and in-depth interviews (KIIs) and focused group discussions (FGDs) to capture the views and experiences of stakeholders.DiscussionOur proposed intervention is based on an innovative approach of integrating and simplifying SAM and MAM management through CHWs bring the services closer to the community. The trial has received ethical approval from the Ethics Committee of AMREF Health Africa - Ethical and Scientific Review Committee (AMREF- ESRC), Nairobi, Kenya. The results will be disseminated through workshops, policy briefs, peer-reviewed publications, and presented to local and international conferences.Trial registrationPACTR201811870943127; Pre-results. 26 November 2018.
Highlights
In many low income countries, the majority of acutely malnourished children are either brought to the health facility late or never at all due to reasons related to distance and associated costs
Our proposed intervention is based on an innovative approach of integrating and simplifying severe acute malnutrition (SAM) and moderate acute malnutrition (MAM) management through CHWs bring the services closer to the community
Conceptual framework and operationalization This implementation research seeks to test the conceptual theory of change as shown in Fig. 1 Under the Integrated community case management (iCCM), we argue that an effective training of community health volunteers (CHVs) to screen, treat malnutrition combined with an adequate provision of commodities: readyto-use therapeutic food (RUTF), Ready to Use Supplementary Food (RUSF), adequate supportive supervision will trigger a timely case-finding of MAM/SAM cases which will result to an early treatment to uncomplicated cases of malnourished children, increased treatment coverage
Summary
In many low income countries, the majority of acutely malnourished children are either brought to the health facility late or never at all due to reasons related to distance and associated costs. We aim to investigate the effectiveness and cost effectiveness of integrating management of acute malnutrition into iCCM. Malnourished children, those with severe acute malnutrition, have a higher risk of death from common childhood illness such as diarrhea, pneumonia, and malaria. Nutrition-related factors contribute to about 45% of deaths in children under 5 years of age [1, 2] The direct relationship between illness and malnutrition in children is well documented and evidence has shown that malnutrition is a factor in more than half of the children who die after the first month of life [2, 3]. In Northern Kenya counties where the prevalence of malnutrition is high, the prevalence of stunting, wasting and underweight has been consistently higher for a long time
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