Expanding Coverage of Severe Acute Malnutrition (SAM) Treatment in Kenya
R-SWITCH
Assessing the Impact, Implementation and Cost of Empowering Community Health Promoters to Improve Wasting Treatment Coverage in Turkana County Through Family-led MUAC Scale-up, Weight-for-age Screening, and Defaulters' Follow-up
1 other identifier
interventional
1,600
1 country
1
Brief Summary
Child wasting is a type of malnutrition which occurs when a child becomes too thin. This medical condition increases the risk of becoming sick or dying. A child with severe wasting needs to be seen in a medical consultation to check on health status and to receive some medicine and a medical food supplement for daily consumption until cured. Yet, only a small proportion of children suffering from severe wasting are presently receiving appropriate treatment. In Kenya, there is an opportunity to build on the existing network of community health promoters (CHPs) to increase the number of children with wasting who are identified and treated. In intervention areas, CHPs will be equipped with smartphones and an application which provides guidance on household members to visit and simple actions to take, related to health. CHPs will distribute color-coded mid-upper arm circumference tapes to households with young children and train caregivers on how to use it. After training, CHPs will send Short Message Services (SMS) to remind caregivers to regularly measure the arm circumference of the child. In addition, CHPs will receive a scale to measure the weight of children every month. Finally, wasted children registered in the treatment program who fail to attend a planned consultation will be flagged to their CHP through the phone application, and CHPs will conduct a specific home visit to investigate and help solve potential issues. The study will assess whether this community intervention (called SWITCH) allows to identify and treat more children suffering from severe wasting. Before the start of the intervention, the proportion of wasted children receiving treatment in 40 community units in Turkana South, Turkana East and Aroo will be assessed. After this survey, a computer will randomly select 20 community units where the intervention will be scaled up. The survey will be repeated after 2 years to assess if the proportion of severely wasted children receiving treatment is higher in the area where the intervention was scaled up compared to the area where it was not scaled up. In addition, after 1 year of implementation, the study will assess how the intervention was scaled up, what are the main challenges, and what are the overall perceptions on the intervention in the community among those who receive it and those who deliver it. Finally, costs of the various components of the intervention will be measured for all actors involved, including for caregivers.
Trial Health
Trial Health Score
Automated assessment based on enrollment pace, timeline, and geographic reach
participants targeted
Target at P75+ for not_applicable
Started Jun 2024
Typical duration for not_applicable
1 active site
Health score is calculated from publicly available data and should be used for screening purposes only.
Trial Relationships
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Study Timeline
Key milestones and dates
First Submitted
Initial submission to the registry
May 6, 2024
CompletedStudy Start
First participant enrolled
June 3, 2024
CompletedFirst Posted
Study publicly available on registry
June 4, 2024
CompletedPrimary Completion
Last participant's last visit for primary outcome
July 30, 2026
ExpectedStudy Completion
Last participant's last visit for all outcomes
July 30, 2027
March 27, 2026
March 1, 2026
2.2 years
May 6, 2024
March 25, 2026
Conditions
Keywords
Outcome Measures
Primary Outcomes (1)
Period prevalence of severe wasting (SAM) treatment coverage in children 6-59 months of age
defined as the proportion of children suffering from SAM or recovering from SAM who currently receive treatment. • SAM defined by weight-for-height Z-score (WHZ) \<-3 (relative to World Health Organization (WHO) 2006 reference) or MUAC \<115 mm or by the presence of bilateral edema. Children recovering from SAM through treatment will be considered to receive treatment for an initial SAM condition if they both attended an IMAM consultation in the previous 15 days (as reported by caregiver OR by a consultation card) AND either: * consumed RUTF at least once in the previous 3 days (as reported by the caregiver AND confirmed by observation of \>= 1 full or 2 empty RUTF sachets) OR * consumed RUSF at least once in the previous 3 days (as reported by the caregiver AND confirmed by observation by the enumerator of \>= 1 full or 2 empty RUSF sachets) AND child was previously enrolled for SAM treatment immediately prior to MAM treatment (as confirmed by treatment card OR reported by the mother
After 24 months of program implementation
Secondary Outcomes (22)
Point prevalence of SAM outpatient therapeutic program (OTP) treatment coverage in children 6-59 months of age
After 24 months of program implementation
Screening coverage of SAM
After 24 months of program implementation
Prevalence of SAM
After 24 months of program implementation
Prevalence of very low WHZ
After 24 months of program implementation
Prevalence of very low MUAC
After 24 months of program implementation
- +17 more secondary outcomes
Study Arms (2)
Standard of Care
NO INTERVENTION* Register-based household registration (census) by CHP every 12 months * Some family MUAC of variable and unknown coverage/frequency, national guidance developed. * Some passive screening using weight-for-height z-score at Health Facility and during outreach during Malezi bora (child health week every 6 months). * Monthly compilation by CHA (supervisors) of the list of defaulters and non-respondents for transmission to relevant community health promoter (CHP) during monthly in-person meeting.
SWITCH intervention package
EXPERIMENTAL* Addition of digital monitoring \& supervision by CHA * Digitized registration of households by CHPs every 6 months * Digital reminders to CHP to conduct home visit if a child has never been visited in 3 mo. * Digital reminder for timely training to family MUAC of all family members through home visit by CHP when child turns 6 months of age. * Platform for 2-ways messaging: biweekly SMS reminders to caregivers through the CHP's app; feedback by caregiver * Community level screening based on weight and weight-for-age (WAZ) led by CHP every other month (aligned with Community Action Days), * Digital calculation of WAZ. * CHP and Growth Monitoring and Promotion refer to health facility if WAZ\<-3 to check on WHZ eligibility * At the end of every wasting treatment consultation, compilation of the list of defaulters and non-respondents, for immediate transmission by CHA to relevant CHP through digital task of an instruction for immediate follow-up.
Interventions
* Addition of digital monitoring \& supervision by CHA * Digitized registration of households by CHPs every 6 months * Digital reminders to CHP to conduct home visit if a child has never been visited in 3 mo. * Digital reminder for timely training to family MUAC of all family members through home visit by CHP when child turns 6 months of age. * Platform for 2-ways messaging: biweekly SMS reminders to caregivers through the CHP's app; feedback by caregiver * Community level screening based on weight and weight-for-age (WAZ) led by CHP every other month (aligned with Community Action Days), * Digital calculation of WAZ. * CHP and Growth Monitoring and Promotion refer to health facility if WAZ\<-3 to check on WHZ eligibility * At the end of every wasting treatment consultation, compilation of the list of defaulters and non-respondents, for immediate transmission by CHA to relevant CHP through digital task of an instruction for immediate follow-up.
Eligibility Criteria
You may qualify if:
- Household in a village of the study area covered by a CHP (although the child may or may not be registered by a CHP) AND
- Child is 6-59.9 months of age AND
- Caregiver consents to be part of the study AND
- any of the following:
- WHZ \< -3 (relative to WHO 2006 reference) OR
- MUAC \<115 mm OR
- Presence of bilateral edema OR
- receiving treatment as follow-up for an initial SAM condition on the way to full recovery
You may not qualify if:
- Congenital malformation that makes anthropometric measurements impossible.
- Length is below 54 cm or height is above 120cm.
Contact the study team to confirm eligibility.
Sponsors & Collaborators
- International Food Policy Research Institutelead
- UNICEFcollaborator
- Kenyatta Universitycollaborator
Study Sites (1)
Turkana South and Turkana East and Aroo
Lodwar, Kenya
MeSH Terms
Conditions
Condition Hierarchy (Ancestors)
Study Officials
- PRINCIPAL INVESTIGATOR
Elodie Becquey, PhD
International Food Policy Research Institute
- PRINCIPAL INVESTIGATOR
Sophie Ochola, PhD
Kenyatta University
Central Study Contacts
Study Design
- Study Type
- interventional
- Phase
- not applicable
- Allocation
- RANDOMIZED
- Masking
- NONE
- Masking Details
- Evaluator teams will be blinded from intervention allocation
- Purpose
- HEALTH SERVICES RESEARCH
- Intervention Model
- PARALLEL
- Sponsor Type
- OTHER
- Responsible Party
- SPONSOR
Study Record Dates
First Submitted
May 6, 2024
First Posted
June 4, 2024
Study Start
June 3, 2024
Primary Completion (Estimated)
July 30, 2026
Study Completion (Estimated)
July 30, 2027
Last Updated
March 27, 2026
Record last verified: 2026-03
Data Sharing
- IPD Sharing
- Will share
- Shared Documents
- STUDY PROTOCOL, SAP
- Time Frame
- At the time of publication of scientific articles presenting primary results.
All data will be carefully anonymized and de-identified so that the privacy of participants and research subjects is fully protected. Databases will be anonymized using identification codes. No names, GPS coordinates, dates of birth or other identifying data will be stored in the databases. At the time of publication of scientific articles presenting primary results, the fully anonymized databases (quantitative data) will become a public good and will be made available to the scientific community, government, and partners.