The effect of integrated prevention and treatment on child malnutrition and health in Mali: a cluster randomized intervention study (PROMIS-Mali)

Primary Investigator

  • Marie Ruel

Study Period

January 2015 - April 2017

Study Description

Globally, child undernutrition is the underlying cause for 3.1 million deaths of children younger than 5 years. 18.7 million children under five years of age suffer from severe acute malnutrition (SAM) and an additional 33 million children suffer from moderate acute malnutrition, and are at risk of developing SAM

In Sub-Saharan Africa, there is often poor integration between programs to treat child acute malnutrition and programs that focus on the prevention of acute and chronic undernutrition - resulting in many missed opportunities for using prevention platforms to screen and refer SAM children, or for using screening and referral platforms to provide prevention services.

This project will address two critical gaps related to the integration of preventive and treatment programs: 1) screening and treatment of MAM/SAM have not yet been systematically integrated into routine health-center visits or mainstreamed into community outreach programs; and 2) screening programs do not offer any preventive services for those children found not to be suffering from MAM/SAM at the time of screening; mothers of children identified as non-MAM/SAM case are usually sent home without receiving any health or nutrition inputs and as a result, may fail to come back for screening because they do not see any tangible benefit associated with their participation in the screening. This project will specifically address these gaps by assessing the effect of an integrated approach consisting of higher screening coverage and preventive Behavior Change Communication (BCC) + Small-Quantity Lipid-based Nutrient supplementation (SQ-LNS) on both prevention and treatment of child undernutrition.

Study Arms

  • Active Comparator: Behavioral: Child's health and nutrition topics
  • Experimental: PROMIS intervention

Primary Outcomes

  • Prevalence of acute child malnutrition defined by WHZ<-2 or MUAC <125mm or bilateral pitting edema in children 6-23 months of age
  • Screening coverage of acute child malnutrition (proportion of children monthly screened / total number of eligible children (aged 6-23 months)
  • ncidence of child acute malnutrition defined by WHZ<-2 or MUAC<125mm using the 2006 WHO growth reference will be used
  • Compliance to treatment of acute malnutrition (% of cases that complete treatment over total admitted)

Study Interventions

  • Behavior change communication (BCC)
  • Lipid-based nutrient supplements (LNS)

Research Gaps

  • Effectiveness

    How well do different food compositions and interventions prevent or treat undernutrition, when implemented "on the ground"?

  • Innovation

    What novel food-based products and programming methods effectively prevent and treat undernutrition?

Study Population