Severe Malnutrition Clinical Trial
Official title:
Benefits of a Household WASH Package to Community-based Management of Acute Malnutrition (CMAM) Program, Chad
The objective of the research is to assess the effectiveness of adding a Household WASH
component to the standard outpatient treatment of severe acute malnutrition.
Study design: cluster-randomized controlled trial comparing two interventions:
1. Control group: outpatient management of children diagnosed for severe acute
malnutrition only
2. Intervention group: outpatient management of children diagnosed for severe acute
malnutrition + "household WASH package"
2000 children, aged between 6 and 59 months, admitted to 20 OTP (Outpatient Therapeutic
Program) centers for SAM will be included into the study and followed for 8 months (2 months
of treatment, and 6 months after successful discharge).
The Action Contre la Faim (ACF) nutrition project in Kanem started in 2008, and now is set
up in 35 health facilities divided across 2 health districts: Mao and Mondo. The management
of severe acute malnutrition is done in both OTP (Outpatient Therapeutic Programme) and in
TFC (Therapeutic Feeding Center). Between the treatment of SAM in OTPs and TFCs, and the
number of curative consultations, the total number of beneficiaries is expected to be 45,065
in 2014 (without double counting).
Clear evidence exists that some Water, Sanitation and Hygiene (WASH) interventions can
successfully prevent diarrhea. For instance, interventions aiming at improving water quality
at household level or at promoting hand washing with soap do reduce significantly diarrhea
incidence. Estimations showed that WASH interventions have a small but measurable benefit on
length growth, but not on weight or weight/height. Yet, to our knowledge, no impact of WASH
interventions has been assessed, neither during nutritional rehabilitation where children
are particularly vulnerable to infections, nor after discharge where immune recovery is
still incomplete.
In the context of nutritional rehabilitation of SAM (Severe Acute Malnutrition), the
investigators hypothesize that improving water quality and hygiene-related care practices at
household level would decrease incidence of WASH-related infections, such as diarrhea,
nematode and environmental enteropathy. As such, it would improve weight gain, decrease
relapses after successful discharge, and overall, could decrease over time the incidence of
acute malnutrition in the community.
The proposed WASH intervention will be added to already existing nutritional activities and
it will include: i/ Household water treatment and hygiene kit (water container, water
disinfection consumables, soap, cup, hygiene promotion leaflet) provided at beginning of SAM
treatment; ii/ sessions of Hygiene promotion provided weekly at health center level iii/
Household visits and hygiene sessions made during the treatment; // group discussion on
hygiene and care practices made with mother at community level after successful discharge.
;
Allocation: Randomized, Endpoint Classification: Efficacy Study, Intervention Model: Parallel Assignment, Masking: Open Label, Primary Purpose: Treatment
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