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Moderate Acute Malnutrition (MAM) and Severe Acute Malnutrition (SAM) in Sierra Leone

The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Read our disclaimer for details. Identifier: NCT01785680
Recruitment Status : Completed
First Posted : February 7, 2013
Last Update Posted : August 2, 2018
Information provided by (Responsible Party):
Washington University School of Medicine

Brief Summary:

The long-term objective of this proposal is to develop and demonstrate an effective, integrated and streamlined protocol to treat moderate acute malnutrition (MAM) and non-complicated severe acute malnutrition (SAM) in children during humanitarian emergencies.

Hypothesis: An integrated management protocol for MAM and SAM will achieve greater community coverage and a greater individual recovery rate than standard care.

Condition or disease Intervention/treatment Phase
Malnutrition Other: Integrated Protocol Other: Current protocol Not Applicable

  Show Detailed Description

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Study Type : Interventional  (Clinical Trial)
Actual Enrollment : 1957 participants
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)
Primary Purpose: Treatment
Official Title: Conducting Research on Moderate Acute Malnutrition in Humanitarian Emergencies Integrated Management of MAM and SAM in Sierra Leone With Ready to Use Theraputic Foods (RUTF)
Actual Study Start Date : January 2013
Actual Primary Completion Date : November 2013
Actual Study Completion Date : November 2013

Resource links provided by the National Library of Medicine

MedlinePlus related topics: Malnutrition

Arm Intervention/treatment
Active Comparator: Current protocol
These treatment arm is the standard care for moderate malnutrition. This includes a fortified cereal supplement treatment until the child reaches MUAC of above 12.5. Currently, MAM and SAM are treated separately, overseen by different agencies. Breastfeeding is often overlooked.
Other: Current protocol
Current protocol for treating MAM in emergencies is supplemental food distribution, often providing a fortified blended food (FBF) that requires cooking. This treatment is the standard today for treating children with MAM.

Experimental: Integrated Protocol
Integrated protocol for treatment of children with MAM and SAM in humanitarian emergencies has the potential to result in a more streamlined, cost-effective program, higher recovery, and higher program coverage, allowing easier access to malnourished children, thus curing more children of malnutrition and preventing its lifelong effects.
Other: Integrated Protocol
Implement an integrated protocol in Sierra Leone for the management of MAM and non-complicated SAM that uses a single anthropometric indicator as well as the same food but in different doses to treat the continuum of malnutrition. MAM children will be given 75 g/kg/day of RUTF whereas SAM will be given 175 gr/kg/day of RUTF until MUAC>12.5 cm is reached. Then child will be given LNS, a bed net, albendazole, zinc, referral for immunizations compliant with current WHO recommendations, oral rehydration salts to give if the child has more than three loose watery stools in 24 hours, and asked to return for follow-up in 1, 3 and 6 months. Caretakers will be instructed to seek medical care sooner if the child has fever, poor appetite or signs of an acute illness.

Primary Outcome Measures :
  1. Recovery under the integrated program and the standard protocol [ Time Frame: 12 weeks ]

    Recovery at 1, 3 and 6 months follow-up with the standard protocol will be compared to the integrated protocol. Recovery will be defined as mid upper arm circumference (MUAC) reaching ≥12.5 cm.

    Subjects will return to clinic every 2 weeks until MUAC of 12.5 cm is reached or until 12 weeks has elapsed. Follow-up recovery will then be measured at 1, 3, and 6 months.

Secondary Outcome Measures :
  1. Change in Growth rates [ Time Frame: 12 weeks, 1, 3, 6 months ]
    Subjects will return to clinic every 2 weeks until MUAC of 12.5 cm is reached or until 12 weeks has elapsed. Follow-up recovery will then be measured at 1, 3, and 6 months. At each clinic visit growth will be measured.

  2. Duration of treatment [ Time Frame: 12 weeks ]
    Subjects will return to clinic every 2 weeks until MUAC of 12.5 cm is reached or until 12 weeks has elapsed. Follow-up recovery will then be measured at 1, 3, and 6 months. Time to achieve MUAC of 12.5 cm will be documented.

  3. Cost estimates for participation [ Time Frame: 12 weeks ]
    Average cost of treatment will be measured per participant, this includes intervention costs and any medical costs needed by participants. The study costs no money to participants.

  4. Default reason [ Time Frame: 12 weeks ]
    If a child defaults, then the reason will be an outcome measure. Reasons to default include loss to follow-up (the child will be attempted to be contacted 3 times prior to being considered lost), death, or he/she enters into the inpatient clinic.

  5. Change in recovery status after 12 weeks [ Time Frame: 6 months ]
    Any changes in recovery will be measured at 1, 3, and 6 months at follow-up visits

Other Outcome Measures:
  1. Coverage [ Time Frame: 1 month ]
    Evaluation of Access and Coverage (SLEAQ Coverage) will be measured in the communities in Sierra Leone. This is a survey analysis of the coverage our treatment has in the regions we are serving in Sierra Leone. This will measure the effectiveness we have in treating malnutrition in the region not just within our patient population.

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Ages Eligible for Study:   6 Months to 59 Months   (Child)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No

Inclusion Criteria:

  • Children with MAM or non-complicated SAM aged 6-59 months.
  • Have an acceptable appetite.judged by giving the child 30 g of RUTF and asking the mother to feed this food to the child over 20 minutes. Children with SAM who are able to consume this RUTF will be eligible for the study. Children unable to consume the RUTF or presenting with IMCI warning signs (convulsions, altered mental status, respiratory distress) will be considered to have complicated SAM and will be referred for inpatient treatment.
  • Only the youngest child with malnutrition in each household will be enrolled; older siblings with MAM or SAM will be treated operationally using the same protocol.

Exclusion Criteria:

  • Children with obvious chronic debilitating illness like cerebral palsy or congenital abnormalities
  • Children having received treatment for MAM or SAM in the previous two months.

Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its identifier (NCT number): NCT01785680

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Sierra Leone
Project Peanut Butter Factory - 41D Wilkinson Road
Freetown, Sierra Leone
Sponsors and Collaborators
Washington University School of Medicine
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Principal Investigator: Mark Manary, MD Washington University School of Medicine

Additional Information:
Publications of Results:
Other Publications:

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Responsible Party: Washington University School of Medicine Identifier: NCT01785680     History of Changes
Other Study ID Numbers: 201211096
U01GH000647-01 ( U.S. NIH Grant/Contract )
First Posted: February 7, 2013    Key Record Dates
Last Update Posted: August 2, 2018
Last Verified: July 2018
Keywords provided by Washington University School of Medicine:
Additional relevant MeSH terms:
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Nutrition Disorders