INTEGRATED PROTOCOL FOR TREATMENT OF MAM AND SAM IN HUMANITARIAN EMERGENCIES

中度急性营养不良（MAM）和严重急性营养不良（SAM）是公共卫生状况，分别影响全世界5500万和2000万儿童，主要是在发展中国家，那里更容易发生人道主义紧急情况。患有MAM的儿童被定义为体重身高z评分（WHZ）在-3和-2之间的儿童。SAM儿童定义为WHZ d-3和/或双侧水肿。通常情况下，患有MAM的儿童接受食物配给，通常是混合面粉，没有太多关注并发的医疗条件，并且1年后的恢复率较低，<50%。患有非复杂性SAM的儿童单独使用即用型治疗食品（RUTF）治疗。该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协议相结合，以提高恢复率和计划覆盖率，帮助减轻更多患病儿童的营养不良。 研究方法涉及使用一种食物（RUTF）治疗MAM和SAM。MAM和SAM的诊断和食品分发将在一个地点进行。上臂中围（MUAC）对当地工作人员来说更容易使用，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通过该方案的进展，联阵的口粮将减少。当儿童达到MUAC > 12.5 cm时，他们将退出该计划，他们将获得六周的富含微量营养素的补充剂，添加到他们的常规饮食中。 塞拉利昂的10个地点是紧急情况后的地点，将用于初步研究，以制定MAM和SAM的综合治疗方法;总共将有1800名儿童参加。将综合方案（5个研究中心）与标准方案（5个研究中心）进行比较。将通过使用护理小组模式，即同伴咨询系统，开展促进母乳喂养的干预措施。主要结果是恢复率，计划覆盖率和母乳摄入量。将通过项目治愈出院率和复发率评估恢复情况。将进行六个月的随访以确定复发。覆盖率通过简化LQAS（批次质量保证抽样）访问和覆盖率评估（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定量母乳摄入来评估。将在乍得进行一项业务验证试验，以测试在人道主义紧急情况下处理地雷和反地雷行动的综合办法。 公共卫生相关性：为全世界数百万遭受严重和中度营养不良等重大全球健康问题的儿童提供的服务是分散的，特别是在人道主义紧急情况下。一个综合方案，使用相同的食物，相同的身体测量，和相同的网站，提出了简化和改善营养不良的治疗，并有助于全球健康知识库。一个综合方案有可能提高效率和成本效益，挽救世界各地更多儿童的生命。

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. PUBLIC HEALTH RELEVANCE: Project Narrative Services for the millions of children worldwide suffering from the major global health problems of severe and moderate malnutrition are fragmented, especially in humanitarian emergencies. An integrated program using the same food, the same body measurements, and the same site is proposed to streamline and improve the treatment of malnutrition and contribute to the global health knowledgebase. An integrated program has the potential to be more efficient and cost effective, saving the lives of more children worldwide.