Project Details

Mothers Applying MUAC screening for Acute Malnutrition (MAMAN) Trial

Catherine Oldenburg, ScD, MPH

Summary

BACKGROUUND: Children with severe acute malnutrition (SAM) are at high risk of mortality, with approximately 9 times the risk of mortality compared to their well-nourished peers. Interventions for SAM typically focus on the acute phase of recovery in the weeks and months following admission to a nutritional program. However, recent evidence has demonstrated that relapse to SAM is a common outcome for children who have previously recovered, and that children who relapse have worse outcomes compared to those with new-onset SAM. Far fewer studies have considered interventions to prevent relapse in children who have recovered. Previous studies have demonstrated feasibility in training caregivers to screen for acute malnutrition using mid-upper arm circumference (MUAC) tapes. MUAC tapes are inexpensive and easy to use, as they are color coded (green, yellow, red) to allow for ready identification of acute malnutrition: yellow indicates moderate acute malnutrition (MAM), and red indicates SAM. Caregiver screening may be an inexpensive and easily scalable intervention if found to be effective for detection of moderate acute malnutrition or relapse. GAP: The results of this study will provide evidence of the effectiveness of caregiver screening for post-recovery detection of relapse among children recovered from an episode of SAM. It would provide critical evidence of a scalable and easily implementable intervention for relapse, an understudied condition. HYPOTHESIS: We hypothesize that caregiver screening will be effective for reducing time to detection of relapse and that children receiving caregiver screening will have better anthropometric measures at 12 months and faster time to detection of relapse among those who relapse. METHODS: 1:1:1 randomized controlled trial enrolling caregiver-child dyads into one of three arms: 1) caregiver screening with a MUAC tape and the usual follow-up schedule (monthly), 2) caregiver screening with a MUAC tape with a reduced follow-up schedule (at 3 months), or 3) standard of care (monthly clinic-based follow-up for 3 months post-recovery) and followed for 6 months. The primary endpoint for the trial will be time to detection of relapse, defined as MUAC < 12.5 cm and/or WHZ < -2. RESULTS: Pending. IMPACT: We anticipate that the results of this study will lead to inclusion of training in caregiver screening using standard MUAC tapes as part of routine discharge for children who have recovered from SAM. As MUAC tapes are inexpensive and easy to use, we anticipate this intervention could be rapidly scaled up if found to be effective.