evidence-based blog of Filippo Dibari

Posts Tagged ‘community based management’

Comparison of the effectiveness of a milk-free soy-maize-sorghum-based ready-to-use therapeutic food to standard ready-to-use therapeutic food with 25% milk in nutrition management of severely acutely malnourished Zambian children: an equivalence non-blinded cluster randomised controlled trial

In Under-nutrition on July 7, 2013 at 12:33 pm

by Irena AH, Bahwere P, Owino VO, Diop EI, Bachmann MO, Mbwili-Muleya C, Dibari F, Sadler K, Collins S.

Matern Child Nutr. 2013 Jun 18.

Abstract

Community-based Management of Acute Malnutrition using ready-to-use therapeutic food (RUTF) has revolutionised the treatment of severe acute malnutrition (SAM). However, 25% milk content in standard peanut-based RUTF (P-RUTF) makes it too expensive. The effectiveness of milk-free RUTF has not been reported hitherto.

This non-blinded, parallel group, cluster randomised, controlled, equivalence trial that compares the effectiveness of a milk-free soy-maize-sorghum-based RUTF (SMS-RUTF) with P-RUTF in treatment of children with SAM, closes the gap. A statistician randomly assigned health centres (HC) either to the SMS-RUTF (n = 12; 824 enrolled) or P-RUTF (n = 12; 1103 enrolled) arms. All SAM children admitted at the participating HCs were enrolled. All the outcomes were measured at individual level. Recovery rate was the primary outcome.

The recovery rates for SMS-RUTF and P-RUTF were 53.3% and 60.8% for the intention-to-treat (ITT) analysis and 77.9% and 81.8% for per protocol (PP) analyses, respectively. The corresponding adjusted risk difference (ARD) and 95% confidence interval, were -7.6% (-14.9, 0.6%) and -3.5% (-9,6., 2.7%) for ITT (P = 0.034) and PP analyses (P = 0.257), respectively. An unanticipated interaction (interaction P < 0.001 for ITT analyses and 0.0683 for PP analyses) between the study arm and age group was observed. The ARDs were -10.0 (-17.7 to -2.3)% for ITT (P = 0.013) and -4.7 (-10.0 to 0.7) for PP (P = 0.083) analyses for the <24 months age group and 2.1 (-10.3,14.6)% for ITT (P = 0.726) and -0.6 (-16.1, 14.5) for PP (P = 0.939) for the ≥24 months age group.

In conclusion, the study did not confirm our hypothesis of equivalence between SMS-RUTF and P-RUTF in SAM management.

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Semi-Quantitative Evaluation of Access and Coverage (SQUEAC)/ Simplified Lot Quality Assurance Sampling Evaluation of Access and Coverage (SLEAC) Technical Reference (2012)

In Under-nutrition on May 26, 2013 at 9:07 am

from FANTA web site.

FANTA, in collaboration with Valid International, Action Against Hunger, Concern Worldwide, Tufts University, and Brixton Health, has developed a technical reference guide for two new low-resource coverage assessment methods for evaluating access and coverage of Community-Based Management of Acute Malnutrition (CMAM) and other selective feeding programs.

The first method—Semi-Quantitative Evaluation of Access and Coverage (SQUEAC)—combines routine program monitoring data, an array of qualitative information, and small-sample quantitative surveys. This combination is used to identify key issues affecting timely presentation at a clinic program uptake and provides an estimate of the level of program coverage achieved. SQUEAC can be used in real time, allowing the collected data to be of immediate practical use to adjust program design and implementation.

The second method—Simplified Lot Quality Assurance Sampling Evaluation of Access and Coverage (SLEAC)—is a small-sample quantitative method. The keys features of SLEAC are simplicity, low cost, and versatility. SLEAC can be used to map and estimate coverage over large areas.

The report is available for download in whole or parts. If you have difficulty downloading the PDFs, please send an email to fantamail@fhi360.org with your mailing address and we can send you the files via CD-rom.

PDF icon Download the report [7.09 mb]

Finally! Everything, really everything, about treatment of undernutrition (CMAM). In just-one-click-away, comprehensive, interactive, open-access, website.

In Under-nutrition on July 10, 2012 at 10:42 am

A new electronic forum improves the management of acute malnutrition. Worldwide.

In this area of humanitarian intervention, CMAM is the acronym mostly used: Community-based Management of Acute Malnutrition.

The CMAM forum not only hosts e-discussions about this topic, but also collects all the key documents endorsed by the WHO, other UN agencies, national and international NGOs. Otherwise scattered around, in their web sites.

World experts in this field (Andre’ Briend, and Mark Myatt among them) support this forum. Therefore, the target consists of practitioners rather than the general public.

The main focus list of the e-forum includes:

  • malnutrition and HIV/AIDS
  • malnutrition and infants, children, adolescents and adults, whose specificities are treated separately
  • malnutrition and health systems in the individual countries
  • evidence for action aiming policy-making, advocacy, support in the area of malnutrition treatment
  • product development for malnutrition rehabilitation
  • current research and existing evidences about most of the topics mentioned above
The web site has important tools:
  • you are interested in CMAM in a specific country? Visit the country section of the CMAM web forum
  • you wish to receive notices about meetings, conferences, trainings? You want to ask questions, learn how to calculate case loads, or simply follow up other people’s questions? Create your website account (for free)
  • you are interested in the latest evidence-based documents or the current state of research? Visit the related section of the forum
  • you can also contribute sharing, with the other forum members, the lessons learnt from your community-based feeding programme

This important forum was conceived thanks to the effort of many organizations. However, the realization was led by Valid International and Action Against Hunger.

If you find the CMAM forum interesting, do not hesitate to re-blog this post, or forward the link of the forum to relevant people.

If you have some constructive criticism or ideas to improve this new important tool, I encourage you to contact its coordinators: Nicky Dent and Rebecca Brown (contacts): I promise that they will be extremely happy to hear from you…

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