Malnutrition, Child Clinical Trial
Official title:
Improving the Quality of Care for Children With Acute Malnutrition: Cluster Randomised Controlled Trial in West Nile Region, Uganda
This is a cluster RCT in 6 health centres in Uganda, testing supportive supervision to improve health outcomes and quality of care of children with malnutrition
Introduction Malnutrition in children is highly prevalent in West Nile Region. According to
a recent analysis of data available from the health management information system (HMIS) and
official registers, the health outcomes of children suffering from malnutrition and treated
at health center (HC) level in Arua Region are not reaching the international standards (75%
cured rate as for the international SPHERE standards). This despite the availability of
clear national guidelines for treatment, thus suggesting possible deficiencies in the
quality of care provided. Lack of supportive supervision may be one of the reason explaining
substandard outcomes.
Methods This is a cluster randomised controlled trail (RCT) with health centers (HC) as unit
of randomisation. The six largest HC in Arua district will be randomised in two groups,
intervention (quality improvement group) and control. The intervention will aim at improving
the quality of care provided at HC level, and as a consequence, the health outcomes of
children. The main intervention will consist of enhances nutritional supervision (high
frequency supervision, specific to nutritional services), while the control will be standard
care (no intervention). Complementary intervention will include training and networking
activities for HC staff. Outcomes of the study will include: health outcomes (recovered, non
recovered, defaulters, transferred, died); process outcomes (satisfaction and knowledge of
staff); cost outcomes (cost for the health system and for the families) and equity outcomes
(access to care and health outcomes by wealth quintile).
Relevance of the study The study will inform, with a robust design, about the efficacy and
cost-efficacy of a quality improvement intervention for ameliorating the health of children
suffering from malnutrition in Uganda.
Currently no other study with RCT design explored the efficacy of supportive supervision as
a quality improvement intervention. This study will therefore fill an important knowledge
gap.
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