Improved Breastfeeding Support to Treat Acute Malnutrition amongst Infants under 6 months (IBAMI)

改善母乳喂养支持以治疗 6 个月以下婴儿的急性营养不良 (IBAMI)

• 批准号: MR/N021940/1
• 负责人: MARTHA MWANGOME
• 金额: $ 12.16万
• 依托单位: ARCH - KWTRP
• 依托单位国家: 英国
• 项目类别: Research Grant
• 财政年份: 2016
• 资助国家: 英国
• 起止时间: 2016 至 无数据
• 项目状态: 已结题
• 来源: https://gtr.ukri.org/projects?ref=MR%2FN021940%2F1
• 关键词: Improved; Breastfeeding; Support; Treat; Acute

For the first time, in 2013, the WHO guidelines for treating children with Severe Acute Malnutrition (SAM) included guidance on how to diagnose and treat SAM in infants aged below 6 months. The treatment guidelines for infants under 6 months focused on inpatient treatment and recommended that admitted infants with SAM be supported to re-establish exclusive breastfeeding before they can be discharged. The recommendation was based mainly on programmatic reports and a few studies that had shown that lactation failure is common among infants with SAM, and that re-establishing breastfeeding among infants being treated for SAM is possible using re-lactation techniques such as supplementary suckling. However, since none of the studies followed infants up after discharge, we still do not know i) if exclusive breastfeeding was retained after discharge; ii) if retaining exclusive breastfeeding after discharge is sufficient for nutritional recovery and iii) if additional breastfeeding support offered to mothers of discharged infants would be beneficial. The proposed study is aimed at generating important information to develop a trial to establish the effectiveness of home-based breastfeeding support to mothers of infants discharged from SAM treatment on survival and growth. The main aim of the proposed study is to i) establish the breastfeeding retention rate among infants under 6 months discharged from SAM treatment within the current strategies that are without a specific post discharge breastfeeding support; and ii) establish whether among infants retaining exclusive breastfeeding, breastmilk alone is sufficient for nutritional recovery. This information will form the baseline data from where any success of any applied intervention will be measured. Hence the findings from this study will strengthen the calculations of the sample size required to show an improvement in the outcomes due to an intervention.In addition, the study will provide insight on the acceptability and sustainability of using peer breastfeeding supporters commonly used to encourage breastfeeding in preterm neonates for infants with SAM. It will also provide information on the optimal trial follow-up strategy that could be applied successfully for this group of participants.Apart from providing information for trial development, the study findings will by themselves provide data to previously identified research gap. Within the 2013 updated WHO guidelines on management of SAM in children, http://apps.who.int/iris/bitstream/10665/95584/1/9789241506328_eng.pdf (page 66) the question of how breastfeeding is most effectively established is raised. Our study intends to optimize the WHO inpatient treatment guidelines and will in the process develop a step-by-step re-lactation protocol that would be applicable for resource poor settings. Recently, using the well developed and highly recommended Child Health and Nutrition Research Initiative (CHNRI) methodology, researchers, developmental partners and other stakeholders including UN agencies identified that research into the components of a package care for outpatient care as one of the top research priorities for infants with SAM (Angood, McGrath et al. 2015). Findings from the proposed study will provide baseline information useful in designing and testing a package for outpatient care.

2013年，世卫组织治疗严重急性营养不良(SAM)儿童指南首次包括如何诊断和治疗6个月以下婴儿严重急性营养不良(SAM)的指南。针对6个月以下婴儿的治疗指南侧重于住院治疗，并建议入院的SAM婴儿在出院前应得到支持，以重新建立纯母乳喂养。该建议主要基于程序性报告和一些研究，这些研究表明，哺乳失败在患有SAM的婴儿中很常见，在接受SAM治疗的婴儿中，使用再哺乳技术，如补充哺乳，重新建立母乳喂养是可能的。然而，由于没有一项研究在婴儿出院后进行跟踪调查，我们仍然不知道：i)出院后是否保留纯母乳喂养；ii)出院后保留纯母乳喂养是否足以恢复营养；iii)为出院婴儿的母亲提供额外的母乳喂养支持是否有益。这项拟议的研究旨在产生重要的信息，以开发一项试验，以确定对接受SAM治疗出院的婴儿的母亲提供家庭母乳喂养支持对存活和生长的有效性。拟议研究的主要目的是：i)在目前的策略下，在没有特定的出院后母乳喂养支持的情况下，确定接受SAM治疗后出院的6个月以下婴儿的母乳喂养率；以及ii)确定在保留纯母乳喂养的婴儿中，单靠母乳是否足以恢复营养。这些信息将构成衡量任何应用干预是否成功的基准数据。因此，这项研究的结果将加强所需样本量的计算，以显示由于干预而改善的结果。此外，这项研究还将深入了解使用同伴母乳喂养支持者的可接受性和可持续性，这些支持者通常用于鼓励患有SAM的早产儿进行母乳喂养。它还将提供可成功应用于这一组参与者的最佳试验后续战略的信息。除了为试验发展提供信息外，研究结果本身也将为先前确定的研究差距提供数据。在2013年世卫组织关于儿童SAM管理的最新指南中，http://apps.who.int/iris/bitstream/10665/95584/1/9789241506328_eng.pdf(第66页)提出了如何最有效地建立母乳喂养的问题。我们的研究旨在优化世卫组织住院治疗指南，并将在此过程中制定一项适用于资源匮乏环境的循序渐进的再哺乳方案。最近，研究人员、发展伙伴和包括联合国机构在内的其他利益攸关方使用成熟的和高度推荐的儿童健康和营养研究倡议(CHNRI)方法，确定对SAM婴儿门诊护理一揽子护理的组成部分进行研究是SAM婴儿的首要研究重点之一(AnGood，McGrath等人。2015年)。这项拟议研究的结果将提供有助于设计和测试门诊护理一揽子方案的基线信息。

项目成果

A review of methods to detect cases of severely malnourished infants less than 6 months for their admission into therapeutic care

检测 6 个月以下严重营养不良婴儿并接受治疗护理的方法综述

• 发表时间: 2017
• 作者: Lelijveld, N

The Handbook of Famine, Starvation and Nutrient Deprivation: From Biology to Policy

饥荒、饥饿和营养匮乏手册：从生物学到政策

• 发表时间: 2017
• 作者: Briend A

Diagnostic criteria for severe acute malnutrition among infants aged under 6 mo.

• DOI: 10.3945/ajcn.116.149815
• 发表时间: 2017-06
• 期刊: The American journal of clinical nutrition
• 作者: Mwangome M;Ngari M;Fegan G;Mturi N;Shebe M;Bauni E;Berkley JA
• 通讯作者: Berkley JA

A growth reference for mid upper arm circumference for age among school age children and adolescents, and validation for mortality: growth curve construction and longitudinal cohort study.

• DOI: 10.1136/bmj.j3423
• 发表时间: 2017-08-03
• 期刊: BMJ (Clinical research ed.)
• 作者: Mramba L;Ngari M;Mwangome M;Muchai L;Bauni E;Walker AS;Gibb DM;Fegan G;Berkley JA
• 通讯作者: Berkley JA

Call to action for equitable access to human milk for vulnerable infants.

• DOI: 10.1016/s2214-109x(19)30402-4
• 发表时间: 2019-11
• 期刊: The Lancet. Global health
• 作者: Israel-Ballard K;Cohen J;Mansen K;Parker M;Engmann C;Kelley M;Oxford-PATH Human Milk Working Group
• 通讯作者: Oxford-PATH Human Milk Working Group