Tickell Kirkby D, Achieng Cathering, Masheti Mary, Anyango Maureen, Ndirangu Agnes, Diakhate Mareme M, Yoshioka Emily, Levin Carol, Rubin Means Arianna, Choo Esther M, Ronen Keshet, Unger Jennifer A, Richardson Barbra A, Singa Benson O, McGrath Christine J
Department of Global Health, University of Washington, Seattle, USA.
Centre for Clinical Research, Kenya Medical Research Institute, Nairobi, Kenya.
EClinicalMedicine. 2023 Sep 21;64:102218. doi: 10.1016/j.eclinm.2023.102218. eCollection 2023 Oct.
Effective methods of preventing and identifying childhood wasting are required to achieve global child health goals. Family mid-upper arm circumference (MUAC) programs train caregivers to screen their child for wasting with MUAC tapes. We assessed the effectiveness of a two-way short message service (SMS) platform (referred to as the Maternally Administered Malnutrition Monitoring System [MAMMS]) in western Kenya.
In this individual-level randomised controlled trial in two rural countries in western Kenya, children (aged 5-12 months) were randomly allocated (1:1) to receive either standard care (SOC) or MAMMS. Randomisation method was permuted-block randomisation with a block size of 10. Eligible participants were children attending maternal child health clinics in the two counties whom had a MUAC between 12.5 and 14.0 cm. The MAMMS group received two MUAC tapes and weekly SMS reminders to screen their child's MUAC. The SOC group received routine community health volunteer services and additional quarterly visits from the study team. The primary analysis used a cox proportional hazards model to compare SOC and MAMMS time-to-diagnosis of wasting (MUAC <12.5 cm) confirmed by a health professional during 6-months follow-up. Secondary outcomes were days from enrolment to treatment initiation among children with wasting, proportion of all children with wasting who were identified by the two approaches (treatment coverage), mean MUAC at treatment initiation, and duration of wasting treatment. This trial was registered on ClinicalTrials.gov, NCT03967015.
Between August 1, 2019 and January 31, 2022, 1200 children were enrolled, among whom the incidence of confirmed wasting was 37% lower in the MAMMS group (hazard ratio: 0.63, 95% CI: 0.42-0.94, p = 0.022). Among children with wasting, the median number of days-to-diagnosis was similar between study groups (MAMMS: 63 days [interquartile range (IQR): 23-92], SOC: 58 days [IQR: 22-94]). Treatment coverage in the MAMMS group was 83.3% (95% CI: 39.9-100.0) while coverage in the SOC group was 55.6% (95% CI: 22.3-88.9%, p = 0.300). Treatment duration and mean MUAC at treatment initiation were similar between groups.
Family MUAC supported by SMS was associated with a 37% reduction in wasting among young children. Empowering caregivers to monitor their child's nutritional status at home may prevent a substantial proportion of moderate wasting.
Thrasher Research Foundation and Pamela and Evan Fowler.
为实现全球儿童健康目标，需要有效的预防和识别儿童消瘦的方法。家庭中上臂围（MUAC）项目培训护理人员使用MUAC卷尺为孩子筛查消瘦情况。我们评估了双向短信服务（SMS）平台（称为孕产妇管理的营养不良监测系统 [MAMMS]）在肯尼亚西部的有效性。
在肯尼亚西部两个农村县进行的这项个体水平随机对照试验中，将儿童（5至12个月大）随机分配（1:1）接受标准护理（SOC）或MAMMS。随机化方法是采用10个区组大小的排列块随机化。符合条件的参与者是在这两个县的母婴健康诊所就诊、MUAC在12.5至14.0厘米之间的儿童。MAMMS组收到两条MUAC卷尺和每周短信提醒，以便为孩子筛查MUAC。SOC组接受常规社区健康志愿者服务以及研究团队每季度的额外访视。主要分析使用Cox比例风险模型比较SOC和MAMMS在6个月随访期间由卫生专业人员确诊的消瘦（MUAC<12.5厘米）的诊断时间。次要结局包括消瘦儿童从入组到开始治疗的天数、两种方法识别出的所有消瘦儿童的比例（治疗覆盖率）、开始治疗时的平均MUAC以及消瘦治疗的持续时间。该试验已在ClinicalTrials.gov上注册，注册号为NCT03967015。
在2019年8月1日至2022年1月31日期间，共招募了1200名儿童，其中MAMMS组确诊消瘦的发生率低37%（风险比：0.63，95%置信区间：0.42 - 0.94，p = 0.022）。在消瘦儿童中，研究组之间的诊断天数中位数相似（MAMMS组：63天[四分位间距（IQR）：23 - 92]，SOC组：58天[IQR：22 - 94]）。MAMMS组的治疗覆盖率为83.3%（95%置信区间：39.9 - 100.0），而SOC组的覆盖率为55.6%（95%置信区间：22.3 - 88.9%，p = 0.300）。两组之间的治疗持续时间和开始治疗时的平均MUAC相似。
短信支持的家庭MUAC与幼儿消瘦率降低37%相关。让护理人员有能力在家中监测孩子的营养状况可能会预防很大一部分中度消瘦。
思拉舍研究基金会以及帕梅拉和埃文·福勒。
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