Tickell Kirkby D, Diakhate Mareme M, Goodman Jeanne L, Unger Jennifer A, Richardson Barbra A, Rubin Means Arianna, Ronen Keshet, Levin Carol, Choo Esther M, Achieng Catherine, Masheti Mary, Singa Benson O, McGrath Christine J
Global Health, University of Washington, Seattle, Washington, USA
Childhood Acute Illness and Nutrition Network, Nairobi, Kenya.
BMJ Open. 2020 Sep 22;10(9):e036660. doi: 10.1136/bmjopen-2019-036660.
Over 52 million children under 5 years of age become wasted each year, but only 17% of these children receive treatment. Novel methods to identify and deliver treatment to malnourished children are necessary to achieve the sustainable development goals target for child health. Mobile health (mHealth) programmes may provide an opportunity to rapidly identify malnourished children in the community and link them to care.
This randomised controlled trial will recruit 1200 children aged 6-12 months at routine vaccine appointments in Migori and Homa Bay Counties, Kenya. Caregiver-infant dyads will be randomised to either a maternally administered malnutrition monitoring system (MAMMS) or standard of care (SOC). Study staff will train all caregivers to measure their child's mid-upper arm circumference (MUAC). Caregivers in the MAMMS arm will be given two colour coded and graduated insertion MUAC tapes and be enrolled in a mHealth system that sends weekly short message service (SMS) messages prompting caregivers to measure and report their child's MUAC by SMS. Caregivers in the SOC arm will receive routine monitoring by community health volunteers coupled with a quarterly visit from study staff to ensure adequate screening coverage. The primary outcome is identification of childhood malnutrition, defined as MUAC <12.5 cm, in the MAMMS arm compared with the SOC arm. Secondary outcomes will assess the accuracy of maternal versus health worker MUAC measurements and determinants of acute malnutrition among children 6-18 months of age. Finally, we will explore the acceptability, fidelity and feasibility of implementing the MAMMS within existing nutrition programmes.
The study was approved by review boards at the University of Washington and the Kenya Medical Research Institute. A data and safety monitoring board has been convened, and the results of the trial will be published in peer-reviewed scientific journals, presented at appropriate conferences and to key stakeholders.
NCT03967015; Pre-results.
每年有超过5200万5岁以下儿童消瘦，但其中只有17%的儿童接受治疗。为实现儿童健康可持续发展目标，需要采用新方法来识别营养不良儿童并为其提供治疗。移动健康（mHealth）项目可能提供了一个在社区中快速识别营养不良儿童并将他们与医疗服务联系起来的机会。
这项随机对照试验将在肯尼亚米戈里县和霍马湾县的常规疫苗接种门诊招募1200名6至12个月大的儿童。母婴二元组将被随机分配到母亲管理的营养不良监测系统（MAMMS）组或标准护理（SOC）组。研究人员将培训所有照顾者测量其孩子的中上臂围（MUAC）。MAMMS组的照顾者将获得两条颜色编码且有刻度的插入式MUAC测量带，并加入一个移动健康系统，该系统每周发送短信提示照顾者通过短信测量并报告孩子的MUAC。SOC组的照顾者将接受社区卫生志愿者的常规监测，同时研究人员每季度进行一次访视，以确保有足够的筛查覆盖率。主要结局是比较MAMMS组与SOC组中被确定为儿童营养不良（定义为MUAC<12.5厘米）的情况。次要结局将评估母亲与卫生工作者测量MUAC的准确性以及6至18个月大儿童急性营养不良的决定因素。最后，我们将探讨在现有营养项目中实施MAMMS的可接受性、保真度和可行性。
该研究已获得华盛顿大学和肯尼亚医学研究所审查委员会的批准。已召集数据与安全监测委员会，试验结果将发表在同行评审的科学期刊上，在适当的会议上展示，并向主要利益相关者汇报。
NCT03967015；预结果。
