INTEGRATED PROTOCOL FOR TREATMENT OF MAM AND SAM IN HUMANITARIAN EMERGENCIES

说明(由申请人提供)：项目摘要/摘要中度急性营养不良(MAM)和严重急性营养不良(SAM)是分别影响全世界5500万和2000万儿童的公共卫生状况，主要发生在更有可能发生人道主义紧急情况的发展中国家。患有MAM的儿童被定义为身高体重z分数(WHZ)在-3到-2之间的儿童。患有SAM的儿童被定义为有WHZ d-3和/或双侧水肿。通常，患有MAM的儿童会得到配给的食物，通常是混合面粉，对并发的疾病没有太多的关注，并且在50%的1年后恢复率很低。患有非复杂性SAM的儿童单独使用即食治疗食品(RUTF)进行治疗。研究的目的是在人道主义紧急情况下，将MAM和非复杂性SAM的门诊治疗操作与一个方案相结合，以提高恢复率和计划覆盖率，帮助缓解更多患病儿童的营养不良。研究方法包括使用一种食物(RUTF)同时治疗MAM和SAM。MAM和SAM的食品诊断和分发将在一个地点进行。中上臂围(MUAC)，对当地工作人员来说更简单，随着儿童的进步而稳步增加，将被用作 MAM和SAM的诊断和出院标准。随着儿童在该计划中的进步，RUTF比率将会降低。当儿童长到MUAC&GT；12.5厘米时，他们将退出该计划，他们将获得为期六周的微量营养素补充剂，添加到他们的常规饮食中。将利用塞拉利昂的10个地点--一个紧急情况后地点--进行初步研究，以制定综合治疗MAM和SAM的办法；总共将有1800名儿童参加。综合协议(五个站点)将与标准协议(五个站点)进行比较。一项促进母乳喂养的干预将通过使用关爱小组模式进行，这是一种同伴咨询系统。主要结果是恢复率、计划覆盖率和母乳摄入量。通过方案治愈出院率和复发率来评估其恢复情况。将进行为期六个月的随访，以确定复发。覆盖范围通过简化的LQAS(批次质量保证抽样)访问和覆盖评估(SLEAC)方法进行评估。母乳喂养咨询的有效性将通过用稳定同位素量化母乳摄入量来评估。将在乍得进行业务验证试验，以测试在人道主义紧急情况下综合治疗马萨诸塞州和南部非洲马萨诸塞州的方法。

DESCRIPTION (provided by applicant): Project Summary/Abstract Moderate acute malnutrition (MAM) and severe acute malnutrition (SAM) are public health conditions affecting 55 million and 20 million children worldwide, respectively, mostly in developing countries where humanitarian emergencies are more likely to occur. Children with MAM are defined as those with a weight-for-height z-score (WHZ) score between -3 and -2. Children with SAM are defined as having a WHZ d -3 and/or bilateral edema. Typically children with MAM receive food rations, often blended flours, without much attention to concurrent medical conditions and have low recovery rates after 1 year of < 50%. Children with non- complicated SAM are treated separately with ready-to-use therapeutic food (RUTF). The purpose of the research is to integrate the operation of outpatient treatment of MAM and non- complicated SAM with one protocol during humanitarian emergencies to improve the recovery rate and program coverage, helping to alleviate malnutrition in more sick children. The research approach involves the use of one food (RUTF) for treatment of both MAM and SAM. Diagnosis and distribution of food will be conducted at one location for both MAM and SAM. Mid-upper arm circumference (MUAC), which is simpler for local staff to use and steadily increases as children improve, will be used as both diagnosis and discharge criteria for MAM and SAM. As children progress through the program, the RUTF ration will be decreased. Children will be discharged from the program when they reach MUAC > 12.5 cm, and they will receive a six-week supply of a micronutrient-rich supplement to be added to their regular diet. Ten sites in Sierra Leone, a post-emergency location, will be used for a primary study to develop the approach to the integrated treatment of MAM and SAM; 1800 children in total will participate. The integrated protocol (five sites) will be compared to the standard protocol (five sites). An intervention to promote breastfeeding will be carried out by use of the Care Group model, a peer counseling system. Primary outcomes are recovery rate, program coverage, and breast milk intake. Recovery will be assessed by program cured discharge rate and by relapse rate. Follow-up will be conducted for six months to determine relapse. Coverage is assessed by the Simplified LQAS (Lot Quality Assurance Sampling) Evaluation of Access and Coverage (SLEAC) method. Effectiveness of breastfeeding counseling will be assessed by quantification of breast milk intake with stable isotopes. An operational validation trial will be carried out in Chad to test the integrated approach to treatment of MAM and SAM in a humanitarian emergency.