MAM'Out project: evaluation of innovative approaches to prevent acute malnutritio

MAMOut 项目：评估预防急性营养不良的创新方法

• 批准号: 8449833
• 负责人: Patrick Kolsteren
• 金额: $ 57.5万
• 依托单位: ACTION AGAINST HUNGER
• 依托单位国家: 美国
• 财政年份: 2012
• 资助国家: 美国
• 起止时间: 2012-09-30 至 2014-09-29
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8449833
• 关键词: MAM; Out; project; evaluation; innovative

DESCRIPTION (provided by applicant): Project summary / abstract At international level, the WHO formulated guidelines for the treatment of severe acute malnutrition (or wasting) (WHO 1999, and more recently ACF 2011), and guidelines for moderate acute malnutrition (or wasting) are in the process of formulation. In contrast, surprisingly little is known on preventive schemes for acute malnutrition. In Haiti, Ruel et al (2008) found that targeting nutrition interventions to prevent children from becoming malnourished might be more effective than curative treatment to reduce child wasting. In addition, recent preventive trials in humanitarian settings focused on the use of food-based strategies, especially ready-to-use food (Isanaka, 2009; Hendricks, 2010; Parikh, 2010; Imbad, 2011). However, it is well known that the causes of under-nutrition are numerous and also relate to inadequate health and care practices, lack of food diversification, food insecurity... Therefore, the MAM'Out research project aims at assessing context-adapted sustainable preventive approaches, not based primarily on food supplementation. The objective is to provide an evidence base for these alternative approaches, in order that proven interventions be taken into account for scale-up at policy-making levels. More specifically, the MAM'Out project aims at evaluating two innovative approaches to prevent acute malnutrition, in terms of effectiveness and cost-effectiveness in the Tapoa province (East region of Burkina Faso, Africa). These preventive approaches have been identified as relevant to implement in this specific context.. Firstly, we propose to test a family development strategy (FD), a child-centered educational and home-based intervention aiming at mitigating the global family context of households vulnerable to under-nutrition. The objective is to counsel families with children under 2 to find the most advisable solutions to improve their living conditions and to acquire best possible behaviors to prevent acute malnutrition. Key messages will vary according to children age and will encompass issues with nutritional education, care practices, health, child development and hygiene. The second approach consists of a seasonal and multi-annual cash transfer (CT) program in the framework of a safety net, targeted to economically and nutritionally vulnerable households with children less than 2 years old. In order to fully adapt ths intervention to the Sahel households' context, a deeper analysis of the causes of under-nutrition will be made prior to the intervention. This will allow deciding whether it is relevant or not to condition CTs and which criteria is the most appropriate for CT conditioning. This study will be designed as a three-arm cluster randomized intervention trial, based on randomization of triple-matched rural villages of the Tapoa province. Two arms will receive the intervention and one will be a control arm. The main outcome will be the incidence of acute malnutrition (or wasting). Anthropometric measures (height, weight, edema and MUAC) will be measured at home, as well as indicators of diet diversity, hemoglobin, child development and morbidities. Questionnaires and 24-hour food recalls will also be analyzed, and a cost-effectiveness ratio will be calculated. This project is proposed by Action Contre la Faim - France, a non-governmental non-for- profit organization, and supported through a multi-annual formalized collaboration by two research institutions: Gent University (Belgium) and AgroParisTech University (France). The total length of the project is 3.5 years, with 2 years of direct interventions and measurements in the field. PUBLIC HEALTH RELEVANCE: Project narrative: The first aim of Millennium Development Goals is to eradicate extreme poverty and hunger. With 55 million of acute malnourished children in the world and effective but expensive treatment for Severe Acute Malnutrition, prevention of acute malnutrition is a worldwide major public health issue, especially in humanitarian contexts. Considering the paucity of data pertaining to non-food based strategies for the prevention of acute malnutrition, the proposed project will contribute to produce evidence on effective, context-adapted and reproducible approaches to prevent acute malnutrition.

说明(由申请人提供)：项目摘要/摘要在国际上，世卫组织制定了治疗严重急性营养不良(或消瘦)的指南(WHO 1999，最近的ACF 2011)，中度急性营养不良(或消瘦)的指南正在制定过程中。相比之下，令人惊讶的是，人们对急性营养不良的预防方案知之甚少。在海地，Ruel等人(2008)发现，有针对性的营养干预措施 防止儿童营养不良可能比治疗更有效，以减少儿童的浪费。此外，最近在人道主义环境中进行的预防性试验侧重于使用以食物为基础的战略，特别是即食食品(Isanaka，2009年；Hendricks，2010年；Parikh，2010年；Imbadd，2011年)。然而，众所周知，造成营养不良的原因很多，也与保健和护理做法不足、缺乏粮食多样化、粮食不安全……有关。因此，MAM‘OUT研究项目旨在评估适应具体情况的可持续预防方法，而不是主要基于食品补充。这样做的目的是为这些替代办法提供证据基础，以便在决策一级考虑到已证实的干预措施，以扩大其规模。更具体地说，MAM‘OUT项目旨在评估在塔波亚省(非洲布基纳法索东部地区)预防急性营养不良的两种创新方法的效果和成本效益。这些预防方法已被确定为与在这一特定背景下的实施有关。首先，我们建议测试家庭发展战略(FD)，这是一种以儿童为中心的教育和以家庭为基础的干预措施，旨在缓解易受营养不良影响的家庭的全球家庭环境。目标是建议2岁以下儿童的家庭找到最可取的解决方案，以改善他们的生活条件，并获得最好的 预防急性营养不良的可能行为。关键信息将根据儿童年龄的不同而有所不同，并将涵盖营养教育、护理实践、健康、儿童发展和卫生等问题。第二种办法是在安全网框架内实施季节性和多年现金转移(CT)方案，目标是有2岁以下儿童的经济和营养脆弱家庭。为了使这一干预措施完全适应萨赫勒家庭的情况，在干预之前将对营养不良的原因进行更深入的分析。这将允许决定是否与CT条件相关，以及哪些标准最适合CT条件。这项研究将被设计为一项三臂整群随机干预试验，基于塔波亚省三个匹配的农村村庄的随机分组。两个手臂将接受干预，其中一个将成为控制手臂。主要结果将是急性营养不良(或消瘦)的发生率。将在家里测量人体测量指标(身高、体重、水肿度和MUAC)，以及饮食多样性、血红蛋白、儿童发育和发病率的指标。还将分析调查问卷和24小时食品召回，并计算成本效益比。该项目由一个非政府非营利性组织--法国反饥饿行动提出，并通过两个研究机构的多年正式合作予以支持：比利时的金特大学和法国的农业技术大学。该项目的总长度为3.5年，其中包括2年的实地直接干预和测量。 公共卫生相关性：项目说明：千年发展目标的第一个目标是消除赤贫和饥饿。世界上有5500万急性营养不良儿童，严重急性营养不良的有效但昂贵的治疗，预防急性营养不良是一个世界性的重大公共卫生问题，特别是在人道主义情况下。考虑到缺乏关于预防急性营养不良的非粮食战略的数据，拟议的项目将有助于提供证据，说明预防急性营养不良的有效、适应具体情况和可重复使用的办法。