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

在国际层面，WHO制定了严重急性营养不良（或消瘦）的治疗指南（WHO 1999，最近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，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，针对性的营养干预措施， 防止儿童营养不良可能比治疗性治疗更有效地减少儿童消瘦。此外，最近在人道主义背景下进行的预防性试验侧重于使用基于食物的战略，特别是即食食品（Isanaka，2009年; Hendricks，2010年; Parikh，2010年; Imbad，2011年）。然而，众所周知，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环境的可持续预防方法，而不是主要基于食物补充。目的是为这些替代办法提供证据基础，以便在决策一级的推广工作中考虑到已被证明有效的干预措施。更具体地说，MAM'Out项目旨在评估塔波阿省（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。这些预防性办法已被确定为与这一具体情况相关。首先，我们建议测试家庭发展战略（FD），以儿童为中心的教育和家庭为基础的干预，旨在减轻全球家庭环境的家庭容易营养不良。目的是为有2岁以下子女的家庭提供咨询，以找到最明智的解决办法，改善他们的生活条件， 预防急性营养不良的可能行为。关键信息将因儿童年龄而异，并将包括营养教育、护理做法、健康、儿童发育和卫生等问题。第二种方法包括在安全网框架内实施的季节性和多年期现金转移方案，其目标是子女不满2岁的经济和营养脆弱家庭。为了使干预措施充分适应萨赫勒地区家庭的情况，在采取干预措施之前，将对营养不良的原因进行更深入的分析。这将允许决定它是否与条件CT相关，以及哪个标准最适合CT条件。本研究将被设计为一项三组随机干预试验，基于塔波阿省三组匹配农村村庄的随机化。两组接受干预，一组作为对照组，主要结果是急性营养不良（或消瘦）的发生率。将在家中测量人体测量指标（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。还将分析食品召回和24小时食品召回，并计算成本效益比。该项目由非政府非营利组织法国反饥饿行动提出，并得到两个研究机构的多年正式合作支持：根特大学（比利时）和巴黎农业技术大学（法国）。该项目的总长度为3.5年，其中两年是在实地进行直接干预和测量。

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.