Increasing the Coverage of Severe Acute Malnutrition (SAM) Treatment in Ethiopia (R-SWITCH)

International Food Policy Research Institute

Status: Not yet enrolling

Conditions: Malnutrition, Child; Acute Malnutrition, Severe; Wasting

Treatments: Behavioral: R-SWITCH integrated intervention package

Study type: Interventional

Funder types: Other

Identifiers

NCT06380504

RSWITCH-Ethiopia

Details and patient eligibility

About

The R-SWITCH intervention aims to address the low coverage of treatment for severe wasting (SAM) by leveraging existing community groups to deliver an integrated package focused on prevention, screening, referral, and treatment of SAM. It includes behavior change communication on child nutrition and health, active screening, improved passive screening at health posts, and follow-up of referred cases and those enrolled in outpatient treatment programs (OTP). The primary objectives of the R-SWITCH studies are to assess the intervention's impact on OTP coverage, identify implementation barriers and facilitators, and evaluate its cost-efficiency and cost-effectiveness.

Full description

Despite the high mortality risk of severe wasting (also referred to as severe acute malnutrition or SAM), only a small proportion of children with severe wasting are currently identified and admitted to available outpatient treatment programs (OTP). In 2020, an estimated 4.9 million children with severe wasting received treatment, approximately a third of the total burden. Outside of humanitarian settings, this proportion is even lower (estimated to be around 15%). These figures highlight the urgent need to increase treatment coverage to meet the Sustainable Development Goals (SDG), which aim to reduce the prevalence of child wasting to less than 5% by 2025 and less than 3% by 2030. The continuum of care for SAM, from case identification, referral to treatment, and post-treatment follow-up, is hampered by several barriers including caregiver lack of awareness on the risks and treatment services of SAM, stigma related to SAM, poor accessibility to treatment, frequent stockouts of treatment inputs, and the overall workload faced by first-line health workers.

The R-SWITCH intervention will leverage existing community groups to deliver an integrated package aimed at preventing SAM through behavior change communication (BCC) on child nutrition and health, increasing wasting screening coverage through active screening, family-led MUAC and improved passive screening health posts, increasing treatment coverage through follow-up of earlier referred cases, cases enrolled in OTP, and children who completed OTP and recovered.

The primary objectives of the R-SWITCH studies are:

• To assess the impact of the R-SWITCH intervention on SAM OTP coverage
• To identify implementation barriers and facilitators
• To assess the cost-efficiency and cost-effectiveness of the intervention package and services

Enrollment: 1,080 estimated patients

Sex: All

Ages: 6 months to 5 years old

Volunteers: Accepts Healthy Volunteers

Inclusion criteria

• Child 6-59 months of age
• Suffering from SAM (defined as MUAC < 115mm or presence of bilateral pitting edema or Weight-for-Length Z-score <-3) OR currently enrolled in SAM OTP

Exclusion criteria

• Anthropometric malformation or being handicapped which hampers anthropometric measurements.

Trial design

Primary purpose: Health Services Research

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: None (Open label)

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1,080 participants in 2 patient groups

Standard of Care

No Intervention group

Description:

* Usual screening of wasting by health extension workers (HEW) using MUAC * Previous introduction of Family-led MUAC (not maintained) * Behavior Change Communication (BCC) offered by Health extension worker (low intensity) * Treatment of SAM at health post or health center * Follow-up of SAM OTP defaults through home visits by HEW (very low intensity)

R-SWITCH integrated intervention package

Experimental group

Description:

1. Monthly group meetings of AFD community groups 2. Introduction of weight-for-age Z-score \<-3 as an additional screening criterion 3. Promotion of Family-led MUAC screening and SAM awareness to fathers, community and religious leaders 4. Follow-up and counselling during home visits by AFD leaders 5. Strengthening communication between HEW and AFDs

Treatment:

Behavioral: R-SWITCH integrated intervention package