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: 8541633
• 负责人: Patrick Kolsteren
• 金额: $ 30万
• 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/8541633
• 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.

描述（由申请人提供）： 项目摘要/摘要 在国际层面，世界卫生组织制定了治疗严重急性营养不良（或消瘦）的指南（WHO 1999，以及最近的 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计划知之甚少。在海地，Ruel 等人（2008 年）发现，针对营养干预措施 预防儿童营养不良可能比减少儿童消瘦的治疗更有效。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基于食品的策略，特别是即用食品（Isanaka，2009；Hendricks，2010；Parikh，2010；Imbad，2011）。然而，众所周知，造成营养不良的原因有很多，还与健康和护理措施不足、缺乏食物多样化、粮食不安全有关……因此，MAM'Out 研究项目旨在评估因地制宜的可持续预防方法，而不是主要基于食物补充剂。目的是为这些替代方法提供证据基础，以便在政策制定层面扩大规模时考虑经过验证的干预措施。更具体地说，MAM'Out 项目旨在评估塔波亚省（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有效性和成本效益。这些预防措施已被确定为在这一特定背景下实施的相关措施。首先，我们建议测试家庭发展战略（FD），这是一项以儿童为中心的教育和以家庭为基础的干预措施，旨在减轻全球家庭环境中易受营养不良影响的家庭环境。目的是为有 2 岁以下儿童的家庭提供咨询，以找到最明智的解决方案来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而有所不同，并将涵盖营养教育、护理实践、健康、儿童发育和卫生等问题。第二种方法包括安全网框架内的季节性和多年期现金转移（CT）计划，针对有 2 岁以下儿童的经济和营养弱势家庭。为了使干预措施充分适应萨赫勒家庭的情况，在干预之前将深入分析营养不良的原因。这将允许决定是否与调节 CT 相关以及哪种标准最适合 CT 调节。这项研究将被设计为一项三臂整群随机干预试验，基于塔波亚省三重匹配农村的随机化。两只手臂将接受干预，一只手臂将作为控制臂。主要结果是急性营养不良（或消瘦）的发生率。人体测量指标（身高、体重、水肿和 MUAC）以及饮食多样性、血红蛋白、儿童发育和发病率指标将在家中进行测量。还将对问卷调查和 24 小时食品召回进行分析，并计算成本效益比。该项目由法国非政府非营利组织 Action Contre la Faim 提出，并通过两个研究机构：根特大学（比利时）和农业巴黎科技大学（法国）的多年正式合作提供支持。项目总工期为3.5年，其中2年为现场直接干预和测量。