Acute Malnutrition in ChildhoodNCT04872088
Integrated Research on Acute Malnutrition in Mali (IRAM-MALI)
A study testing Strengthened SBCC, Preventive nutritional supplement and Family MUAC in people with Acute Malnutrition in Childhood and Wasting, run by International Food Policy Research Institute at 1 site in Mali.
Trial summary
The IRAM MALI impact evaluation uses a cluster-randomized controlled study design to assess the impact of the package of integrated interventions aimed at reducing the longitudinal prevalence of wasting by reducing the incidence of child wasting, enhancing the recovery/cure rate from wasting treatment and reducing the… Read more about this study
- Who is it for?
- Ages 6 to 23 months
- Conditions the study is for
- Acute Malnutrition in Childhood, Wasting
- What is being tested?
- Strengthened SBCC, Preventive nutritional supplement and Family MUAC
- Type of treatment
- Lifestyle or therapy programme
- Could I receive a placebo?
- No, everyone receives an active treatment
- How many people
- 9,797 participants
- Where
- 1 siteMali
- Study dates
- 6 May 2021to 15 Oct 2022
- Phase
- Interventional
- Are there results?
- None posted in the registry
Key requirements
Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.
- Ages 6 to 23 months
- All sexes
- No healthy volunteers
- Child
Who may be able to join
- 6-6.9 months of age
- Singleton
- The mother must live in the study area from the time of inclusion.
- The consent of the mother or guardian
- The child is enrolled in CMAM treatment program.
- The child is between 6 and 23 months of age at inclusion
Show all 13Show fewer
- Child lives in one of the 45 health center catchment areas in the study area
- Cohort 3 (relapse cohort):
- Child has been successfully treated for wasting and MAM and has been discharged from CMAM treatment program for at least three months
- The child is between 9 and 17 months at time of measurement.
- The child is singleton.
- The mother must live in the study area from the time of inclusion.
- The consent of the mother or guardian
Who cannot join
- Congenital malformations that make anthropometric measurements impossible.
- Mother intends to leave the study area before January 2022.
- Cohort 2 (treatment cohort):
- Congenital malformations that make anthropometric measurements impossible.
- Mother intends to leave the study area before January 2022.
Trial locations and contacts
1 site in 1 country.
About this study
Official title: Impact Evaluation of Integrated Interventions to Reduce Child Wasting in Mali
The IRAM MALI impact evaluation uses a cluster-randomized controlled study design to assess the impact of the package of integrated interventions aimed at reducing the longitudinal prevalence of wasting by reducing the incidence of child wasting, enhancing the recovery/cure rate from wasting treatment and reducing the relapse rate determined three months after post-treatment recovery from wasting. These interventions include, among other things, strengthening of community care groups (NASGs); home visits with delivery of behavioral change communication about nutrition, health and hygiene (WASH) for young children; distribution of a preventive nutritional supplement; and improved coverage of wasting screening (family MUAC and community screening), management, adherence to treatment and prevention of relapse in the health district of Koutiala, Sikasso region, Mali, West Africa.
Read the detailed description
Progress in reducing the burden of child wasting is hampered by several factors. First, programmatic evidence on how to prevent wasting is limited. There is a growing body of evidence on the effectiveness of dietary supplements in preventing wasting, but little is known about the effectiveness of other strategies such as behavior change communication (BCC) (with or without supplements), cash transfers, or water, hygiene, and sanitation (WASH) interventions. Second, coverage of CMAM (Community based Management of Acute Malnutrition) treatment remains low in many settings. On the supply side, documented constraints include the complexity of current treatment procedures, which disproportionately affects resource-limited settings, and frequent shortages of treatment commodities. On the demand side, low participation in screening and low treatment uptake and adherence are key constraints to effective treatment.
Reducing the burden of wasting effectively requires coordination and integration of sequenced interventions and services along the continuum of care of child wasting including prevention, screening of cases, the timely and adequate treatment of wasted children, and the prevention of relapse of recovered children.
The overall objective of the study is to assess the impact of an integrated package covering the continuum of care of wasting on the longitudinal prevalence of child wasting.
The implementation of these interventions is led by World Vision Mali in collaboration with the health services of the Koutiala health district (Sikasso region, Mali) and UNICEF, and will take place at health center and community level, and includes i) a prevention component combining the strengthening of Nutrition Activity Support Groups (NASG) (who will conduct monthly home visits to deliver behavioral change communication, group counselling sessions and cooking demonstrations) and the distribution of Small-Quantity Lipid-based Nutrient Supplements (SQ-LNS) to children over 6 months of age; ii) a component related to strengthening screening and referral that will involve families (MUAC family approach) and screening by NASGs; iii) a treatment component that includes strengthening the national CMAM protocol currently in vigor in Mali and intensive follow-up of cases under treatment by NASGs to enhance adherence to treatment; and iv) a targetted prevention component through intensified follow-up visits by NASGs and the distribution of SQ-LNS to children who recovered from wasting.
The study, designed as a randomized controlled clustered trial, will allocate 45 health center catchment areas to an intervention (n=22) and comparison group (n=23) and will assess the impact of the integrated package of interventions in three different cohort samples
- the longitudinal prevalence of wasting in children between 6 and 14 months of age (cohort 1; n=1,620)
- the recovery rate of children 6-23 months of age enrolled in wasting, MAM and SAM treatment (cohort 2; census of all children enrolled in treatment programs between May and December 2021)
- the incidence of relapse in children aged 9-17 months discharged from wasting, MAM and SAM treatment after recovery (cohort 3; n=945), determined 3 months post-treatment.
- Conditions
- Acute Malnutrition in Childhood, Wasting
- Being tested
- Strengthened SBCC, Preventive nutritional supplement, Family MUAC, Active screening by NASGs, Intensified followup of children with wasting referred to and enrolled in CMAM treatment
- Medical subject headings
- Cachexia
What participants receive
What participants receive. In a randomised study each person is assigned to one group by chance.
Strengthened SBCCBehavioural
Social and Behavioral Change Communication related to prenatal, postnatal, IYCF practices as well as on the care of young children at several specific ages, hygiene, and health will be delivered during monthly home visits by pairs of NASG members.
Preventive nutritional supplementDietary supplement
Monthly delivery by NAGS pairs of a nutritional supplement: SQ-LNS, at a dose of 28 bags of 20g per month per beneficiary child. The nutritional supplement is limited to :
- [6-17]months old children diagnosed as non-wasted (MUAC>=125mm)
Family MUACBehavioural
MUAC screening of children 6 to 59 months of age by family members will be introduced. This will involve distributing Shakir MUAC tapes to all intervention households and training mothers/guardians, or any other family member expressing an interest, in the screening of wasting with the MUAC criterion.
The training will be carried out by the members of the NASGs and during each home visit, they will be able to ensure that the MUAC measurement technique is well mastered by the mother (or another member) and correct the technique if necessary. They will also explain the procedure to be followed if the child is diagnosed as wasted by a family.
Active screening by NASGsBehavioural
Monthly screening by the NASG members of the children they follow, using the MUAC.
Referral to the health center of [6-17] months old children screened as malnourished (result of MUAC orange or red), and follow-up on referral to confirm child was enrolled.
Intensified followup of children with wasting referred to and enrolled in CMAM treatmentBehavioural
NASG members will conduct biweekly follow-up visits in the households of children with wasting referred to and enrolled in CMAM treatment programs to ensure adherence to the outpatient treatment schedule.
Relapse preventionBehavioural
NASG members will conduct biweekly home visits to monitor the nutritional status of children aged 9 to 17 months who were discharged from CMAM treatment after recovery. NASGs members will provide additional counseling to prevent relapse and screen these children for wasting to detect possible relapse.
Cooking demonstrationsBehavioural
NASGs members will also be supported by the IRAM project in the organization of cooking demonstrations with nutrient-rich foods in the community, during which passive screening of children will be carried out.
| Study group | Role | What they receive |
|---|---|---|
| Control | No intervention | The control group will receive preventive (BCC on child health and nutrition) and screening services from existing unsupervised Nutrition Activity Support Groups (NASGs) without additional support from the IRAM project. Children with wasting are eligible to be enrolled in the existing national Community Management of Acute Malnutrition (CMAM) program. |
| Intervention | Experimental | The intervention group will receive the integrated package of interventions that will be delivered by the NASGs.
The NASG platform will be strengthened by the IRAM project by increasing their number proportional to the size of the population of the catchment area they serve and by regular formative supervision by NGO and health center staff.
The package of interventions includes:
* Social and Behavioral Change Communication by NASGs during home visits and group sessions
* Monthly delivery of preventive SQ-LNS to children 6-17 months of age
* Screening and referral of children 6-59 months of age through the introduction of the MUAC family approach (distribution MUAC tapes to families and offering formative supervision by NASGs to enhance measurement quality)
* Cooking demonstrations for complementary foods using nutrientdense foods in the community. Receives: Behavioral: Strengthened SBCC; Dietary Supplement: Preventive nutritional supplement; Behavioral: Family MUAC; Behavioral: Active screening by NASGs; Behavioral: Intensified followup of children with wasting referred to and enrolled in CMAM treatment; Behavioral: Relapse prevention; Behavioral: Cooking demonstrations |
What is being measured
The primary outcome is the main question the study is designed to answer.
The longitudinal prevalence of wasting in children enrolled at the age of 6 months followed monthly until the end of the study (Cohort 1).
This indicator is defined for each child as the number of visits during which nutritional wasting is observed divided by the total number of monthly visits made (by the interviewers).
Measured: Up to 7 months, from date of enrolment until the date of last documented progression or date of death from any cause, whichever came first
Recovery rate in children enrolled at [6-23] months of age for up to 3 months of treatment and followed through to discharge (Cohort 2)
This indicator is defined as the number children who recovered from wasting, MAM and SAM according to national program criteria (WHZ>-2 and MUAC>=125mm and absence of bilateral edema for two consecutive visits, within 12 weeks of enrollment in the CMAM program) divided by the total number of treatment results recorded.
Measured: Up to 3 months, from date of inclusion in CMAM program until the date of recovery or 12th week after inclusion in CMAM program or date of death from any cause, whichever came first
Prevalence of relapse after discharge from CMAM treatment (cohort 3).
This indicator is defined as the proportion of children (9-17 months of age) with WLZ-score <-2 or MUAC <125 mm or bilateral edema three months after discharge from a CMAM wasting and moderate wasting treatment program
Measured: Up to 4 months, at three months after discharge from CMAM treatment
Secondary outcomes (47)
Longitudinal prevalence of MAM (cohort 1)
defined as the number of months with MAM diagnosis divided by the total number of monthly visits made by the survey teams.
Measured: Up to 7 months, from date of enrolment until the date of last documented progression or date of death from any cause, whichever came first
Longitudinal prevalence of SAM (cohort 1)
defined by the number of months with SAM diagnosis divided by the total number of monthly visits made.
Measured: Up to 7 months, from date of enrolment until the date of last documented progression or date of death from any cause, whichever came first
Incidence of Wasting, MAM and SAM (cohort 1)
defined as the number of new cases of wasting, MAM and SAM diagnosed during the monthly visits made by the survey teams.
Measured: Up to 7 months, from date of enrolment until the date of last documented progression or date of death from any cause, whichever came first
Hemoglobin concentration of children (cohort 1)
measured by hemocue reader (model 301)
Measured: Up to 7 months, from date of enrolment until the date of last documented progressio
Prevalence of anaemia (cohort 1)
defined as the proportion of children with a hemoglobin level below 11g/dl at the end of the study
Measured: Up to 7 months, from date of enrolment until the date of last documented progressio
Child weight (cohort 1)
Child weight measured by survey teams
Measured: Up to 7 months, from date of enrolment until the date of last documented progression or date of death from any cause, whichever came first
Child length (cohort 1)
Child length measured by survey teams
Measured: Up to 7 months, from date of enrolment until the date of last documented progression or date of death from any cause, whichever came first
Length-for-age Z-score (cohort 1)
Length-for-age Z-score relative to the 2006 WHO reference
Measured: Up to 7 months, from date of enrolment until the date of last documented progression or date of death from any cause, whichever came first
Prevalence of child stunting (cohort 1)
Proportion of children with Length-for-age Z-score (LAZ)<-2 (according to the 2006 WHO reference) at the end of the study
Measured: Up to 7 months, from date of enrolment until the date of last documented progression or date of death from any cause, whichever came first
Longitudinal wasting screening coverage (cohort 1)
defined as the proportion of children screened (using MUAC, WLZ or bilateral edema) in the month prior to the monthly visit by the interviewers. Two sub-outcomes will also be concerned:
- Coverage of screening performed by NASGs in the past month.
- Coverage of the family MUAC component, which is the screening performed by a family member in the past month.
Measured: Up to 7 months, from date of enrolment until the date of last documented progression or date of death from any cause, whichever came first
Referral rate of positive screenings (cohort 1)
defined as the proportion of children tested positive during the month (as reported by the mother) who were referred to the health center or Community health worker's site for treatment.
Measured: Up to 7 months, from date of enrolment until the date of last documented progression or date of death from any cause, whichever came first
Early Child development (cohort 1)
assessed via the Development Milestones Checklist-III score at the end of the study.
Measured: Up to 7 months, from date of enrolment until the date of last documented progression or date of death from any cause, whichever came first
Linear growth rate (cohort 1)
- The change in length per month
- The change in the LAZ per month
Measured: Up to 7 months, from date of enrolment until the date of last documented progression or date of death from any cause, whichever came first
Ponderal growth rate (cohort 1)
- Weight change per month
- The change in the WLZ per month
Measured: Up to 7 months, from date of enrolment until the date of last documented progression or date of death from any cause, whichever came first
MUAC growth rate (cohort 1)
change in MUAC per month
- Weight change per month
- The change in the WLZ index per month
- MUAC gain (change in MUAC per month)
Measured: Up to 7 months, from date of enrolment until the date of last documented progression or date of death from any cause, whichever came first
Longitudinal prevalence of child morbidity (cohort 1)
defined by the number of days with symptoms of acute respiratory infections, fever, diarrhea (three or more loose or liquid stools per day) and malaria divided by the total number of days observed/reported in the recall period
Measured: Up to 7 months, from date of enrolment until the date of last documented progression or date of death from any cause, whichever came first
Parental knowledge of nutrition, WASH, and health best practices (cohort 1)
expressed as cumulative total and domain-specific scores
Measured: Up to 7 months, from date of enrolment until the date of last documented progression or date of death from any cause, whichever came first
Longitudinal prevalence of Introduction of (semi) solid and soft complementary foods (cohort 1)
the proportion of children 6-8 months of age who consumed (semi) solid and soft complementary foods the day before the survey
Measured: Up to 7 months, from date of enrolment until the date of last documented progression or date of death from any cause, whichever came first
Longitudinal prevalence of minimum dietary diversity of infant and young children (cohort 1)
The proportion of children who consumed at least 5 of the 8 food groups (including breast milk) the day before the survey.
Measured: Up to 7 months, from date of enrolment until the date of last documented progression or date of death from any cause, whichever came first
Longitudinal prevalence of infant and young child minimum meal frequency (cohort 1)
defined as the proportion of children who had eaten the day before the survey: 2 meals for breastfed children 6-8 months, 3 meals for breastfed children 9-23 months, or 4 meals for non-breastfed children 6-23 monthsMinimum meal frequency for children, defined as the proportion of children who had eaten the day before the survey: 2 meals for breastfed children 6-8 months, 3 meals for breastfed children 9-23 months, or 4 meals for non-breastfed children 6-23 months.
Minimum acceptable diet, defined as the proportion of children with both minimal dietary diversity and minimal meal frequency on the day before the survey.
Consumption of iron-rich or iron-fortified foods in children.
Measured: Up to 7 months, from date of enrolment until the date of last documented progression or date of death from any cause, whichever came first
Longitudinal prevalence of infant and young child minimum acceptable diet (cohort 1)
defined as the proportion of children with both minimal dietary diversity and minimal meal frequency on the day before the survey.
Measured: Up to 7 months, from date of enrolment until the date of last documented progression or date of death from any cause, whichever came first
Longitudinal prevalence of continuous breastfeeding (cohort 1)
defined as the proportion of children breastfed during the study
Measured: Up to 7 months, from date of enrolment until the date of last documented progression or date of death from any cause, whichever came first
Longitudinal prevalence of infant and young child consumption of iron-rich or iron-fortified foods (cohort 1)
defined as the proportion of children who consumed flesh foods or iron-fortied foods the day before the survey
Measured: Up to 7 months, from date of enrolment until the date of last documented progression or date of death from any cause, whichever came first
Vaccination coverage (cohort 1)
Proportion of children with complete vaccination for their age
Measured: Up to 7 months, from date of enrolment until the date of last documented progression or date of death from any cause, whichever came first
Adoption of practices recommended by NASGs (cohort 1)
related to WASH, treated net use, family planning, deworming, vitamin A, childbirth registration, use of iodized salt, and consumption of SQ-LNS
Measured: Up to 7 months, from date of enrolment until the date of last documented progression or date of death from any cause, whichever came first
Weight-for-length Z-score and MUAC at enrollment in CMAM (cohort 2)
weight-for-length Z-score (relative to the 2006 WHO reference) and MUAC(mm)
Measured: Up to 7 months, at the date of inclusion in CMAM program
Duration of CMAM treatment (cohort 2)
defined as the number of days spent on treatment (enrollment and discharge) in children 6-23 months of age at enrollment, according to health registers
Measured: Up to 3 months, from date of inclusion in CMAM program until the date of recovery or 12th week after inclusion in CMAM program or date of death from any cause, whichever came first
Treatment adherence (cohort 2)
defined as the proportion of cases enrolled for treatment who received timely treatment from dedicated services (health center or Community Health Worker) until recovery
Measured: Up to 3 months, from date of inclusion in CMAM program until the date of recovery or 12th week after inclusion in CMAM program or date of death from any cause, whichever came first
Treatment outcomes (drop-out, death, transfer, non-response rates) (cohort 2)
Among cases of wasting, MAM and SAM enrolledin CMAM treatment
Measured: Up to 3 months, from date of inclusion in CMAM program until the date of recovery or 12th week after inclusion in CMAM program or date of death from any cause, whichever came firs
Longitudinal prevalence of childhood morbidity (cohort 2)
defined by the number of days with symptoms of acute respiratory infections, fever, diarrhea (three or more loose or liquid stools per day) and malaria divided by the total number of days observed/reported in the recall period
Measured: Up to 3 months, from date of inclusion in CMAM program until the date of recovery or 12th week after inclusion in CMAM program or date of death from any cause, whichever came first
Mid-Upper Arm Circumference of children (cohort 3)
measured using Shakir MUAC tape by survey teams
Measured: Up to 4 months, at three months after discharge from CMAM treatment
Child weight (cohort 3)
Weight measured by survey teams
Measured: Up to 4 months, at three months after discharge from CMAM treatment
Child length(cohort 3)
Length measured by survey teams
Measured: Up to 4 months, at three months after discharge from CMAM treatment
Weight-for-length Z-score (cohort 3)
Weight-for-length Z-score relative to the 2006 WHO reference
Measured: Up to 4 months, at three months after discharge from CMAM treatment
Length-for-age Z-score (cohort 3)
Length-for-age Z-score relative to the 2006 WHO reference
Measured: Up to 4 months, at three months after discharge from CMAM treatment
Child Stunting (cohort 3)
defined as the proportion of children with Length-for-age Z-score <-2 (relative to the 2006 WHO reference)
Measured: Up to 4 months, at three months after discharge from CMAM treatment
Wasting screening coverage (cohort 3)
defined as the proportion of children screened (using MUAC, WLZ-score or bilateral edema) in the month prior to the interviewer's visit. Two sub-outcomes will also be concerned:
- Coverage of screening performed by NASGs in past month.
- Coverage of the MUAC family component, which is the screening performed by a family member in past month.
Measured: Up to 4 months, at three months after discharge from CMAM treatment
Prevalence of readmission (cohort 3)
Prevalence of children readmitted to CMAM treatment within three months after discharge from CMAM treatment from MAS and MAM treatment programs.
Measured: Up to 4 months, at three months after discharge from CMAM treatment
Prevalence of anemia (cohort 3)
defined as the proportion of children with a hemoglobin level below 11g/dl
Measured: Up to 4 months, at three months after discharge from CMAM treatment
Hemoglobin concentration of children (cohort 3)
measured by hemocue reader (model 301) by survey teams
Measured: Up to 4 months, at three months after discharge from CMAM treatment
Longitudinal prevalence of childhood morbidity (cohort 3)
defined by the number of days with symptoms of acute respiratory infections, fever, diarrhea (three or more loose or liquid stools per day) and malaria divided by the total number of days observed/reported in the recall period
Measured: Up to 4 months, at three months after discharge from CMAM treatment
Prevalence of minimum dietary diversity of infant and young children (cohort 3)
The proportion of children who consumed at least 5 of the 8 food groups (including breast milk) the day before the survey.
Measured: Up to 4 months, at three months after discharge from CMAM treatment
Prevalence of infant and young child minimum meal frequency (cohort 3)
defined as the proportion of children who had eaten the day before the survey: 2 meals for breastfed children 6-8 months, 3 meals for breastfed children 9-23 months, or 4 meals for non-breastfed children 6-23 monthsMinimum meal frequency for children, defined as the proportion of children who had eaten the day before the survey: 2 meals for breastfed children 6-8 months, 3 meals for breastfed children 9-23 months, or 4 meals for non-breastfed children 6-23 months.
Minimum acceptable diet, defined as the proportion of children with both minimal dietary diversity and minimal meal frequency on the day before the survey.
Consumption of iron-rich or iron-fortified foods in children.
Measured: Up to 4 months, at three months after discharge from CMAM treatment
Prevalence of infant and young child minimum acceptable diet (cohort 3)
defined as the proportion of children with both minimal dietary diversity and minimal meal frequency on the day before the survey.
Measured: Up to 4 months, at three months after discharge from CMAM treatment
Prevalence of infant and young child consumption of iron-rich or iron-fortified foods (cohort 3)
defined as the proportion of children who consumed flesh foods or iron-fortied foods the day before the survey
Measured: Up to 4 months, at three months after discharge from CMAM treatment
Prevalence of continuous breastfeeding (cohort 1)
defined as the proportion of children breastfed during the study
Measured: Up to 4 months, at three months after discharge from CMAM treatment
Adoption of practices recommended by NASGs (cohort 3)
related to WASH, treated net use, family planning, deworming, vitamin A, childbirth registration, use of iodized salt, and consumption of SQ-LNS
Measured: Up to 4 months, at three months after discharge from CMAM treatment
Timeline
From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.
- First posted4 May 2021
- Study start6 May 2021
- Primary completion15 Jul 2022
- Study completion15 Oct 2022
Resources
- Official record on ClinicalTrials.govThe registry entry this page is built from, with its full change history.
- Publications (1)Papers the sponsor has linked to this study.
- Other trials for Acute Malnutrition in ChildhoodStudies of the same condition, open and under way.
- What the trial phases meanHow a treatment moves from first tests in people to approval.
More details
For doctors and researchers: how the study is designed, who runs it, and its registry IDs.
Study design
- Study type
- Interventional
- Phase
- Phase N/A
- Primary purpose
- Other
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Model description
- Non-blinded cluster randomized controlled trial
- Masking
- None (open label)
- Enrolment
- 9,797 participants (actual)
Sponsor and investigators
- Lead sponsor
- International Food Policy Research Institute
- Sponsor type
- University, hospital or other
- Collaborators
- UNICEF, World Vision, AFRICSante
- Responsible party
- Sponsor
- Investigators
- Lieven Huybregts, PHD, Principal investigator, IFPRIElodie Becquey, PHD, Principal investigator, IFPRIJef Leroy, Principal investigator, IFPRI
IDs, dates and publications
- ClinicalTrials.gov ID
- NCT04872088
- Sponsor's protocol ID
- IRAM-MALI
- Status last verified
- Feb 2022
- First submitted
- 29 Apr 2021
- Last updated
- 28 Oct 2022
- Results posted
- No
- Data monitoring committee
- No
- FDA-regulated drug
- No
- FDA-regulated device
- No
- Individual data sharing
- Yes: In accordance with IFPRI's policy on research data management and open access, at the time of publication of scientific articles presenting results, the fully anonymized databases will become a public good and will be made available to the scientific community, government, and partners.
Publications
Huybregts L, Diop L, Fall T, Barba FM, Brander RL, Toure M, Ouedraogo M, Hien A, Becquey E. The impact of a continuum of care intervention from prevention to treatment on child wasting compared with usual community group activities: a cluster-randomized controlled trial in Mali. Am J Clin Nutr. 2026 Jun;123(6):101294. doi: 10.1016/j.ajcnut.2026.101294. Epub 2026 Mar 25.
PubMed 41895698
Study at a glance
From the registry record, last updated by the sponsor on 28 Oct 2022. Recruitment status is as the sponsor reported it: confirm with the study team.
- Official title
- Impact Evaluation of Integrated Interventions to Reduce Child Wasting in Mali
- ClinicalTrials.gov ID
- NCT04872088
- Acronym / sponsor ID
- IRAM-MALI
- Conditions
- Acute Malnutrition in Childhood, Wasting
- Study type
- Interventional
- Recruitment status
- Completed
- Enrolment
- 9,797 participants (actual)
- Lead sponsor
- International Food Policy Research InstituteUniversity, hospital or other
- Collaborators
- UNICEF, World Vision, AFRICSante
- Study start
- 6 May 2021 (actual)
- Primary completion
- 15 Jul 2022 (actual)
- Study completion
- 15 Oct 2022 (actual)
- First posted
- 4 May 2021 (actual)
- Results
- Not posted in the source record
Clinical summary
The research question as the sponsor registered it. This describes what the study plans to test, not what it found.
The IRAM MALI impact evaluation uses a cluster-randomized controlled study design to assess the impact of the package of integrated interventions aimed at reducing the longitudinal prevalence of wasting by reducing the incidence of child wasting, enhancing the recovery/cure rate from wasting treatment and reducing the relapse rate determined three months after post-treatment recovery from wasting. These interventions include, among other things, strengthening of community care groups (NASGs); home visits with delivery of behavioral change communication about nutrition, health and hygiene (WASH) for young children; distribution of a preventive nutritional supplement; and improved coverage of wasting screening (family MUAC and community screening), management, adherence to treatment and prevention of relapse in the health district of Koutiala, Sikasso region, Mali, West Africa.
Detailed description
Progress in reducing the burden of child wasting is hampered by several factors. First, programmatic evidence on how to prevent wasting is limited. There is a growing body of evidence on the effectiveness of dietary supplements in preventing wasting, but little is known about the effectiveness of other strategies such as behavior change communication (BCC) (with or without supplements), cash transfers, or water, hygiene, and sanitation (WASH) interventions. Second, coverage of CMAM (Community based Management of Acute Malnutrition) treatment remains low in many settings. On the supply side, documented constraints include the complexity of current treatment procedures, which disproportionately affects resource-limited settings, and frequent shortages of treatment commodities. On the demand side, low participation in screening and low treatment uptake and adherence are key constraints to effective treatment.
Reducing the burden of wasting effectively requires coordination and integration of sequenced interventions and services along the continuum of care of child wasting including prevention, screening of cases, the timely and adequate treatment of wasted children, and the prevention of relapse of recovered children.
The overall objective of the study is to assess the impact of an integrated package covering the continuum of care of wasting on the longitudinal prevalence of child wasting.
The implementation of these interventions is led by World Vision Mali in collaboration with the health services of the Koutiala health district (Sikasso region, Mali) and UNICEF, and will take place at health center and community level, and includes i) a prevention component combining the strengthening of Nutrition Activity Support Groups (NASG) (who will conduct monthly home visits to deliver behavioral change communication, group counselling sessions and cooking demonstrations) and the distribution of Small-Quantity Lipid-based Nutrient Supplements (SQ-LNS) to children over 6 months of age; ii) a component related to strengthening screening and referral that will involve families (MUAC family approach) and screening by NASGs; iii) a treatment component that includes strengthening the national CMAM protocol currently in vigor in Mali and intensive follow-up of cases under treatment by NASGs to enhance adherence to treatment; and iv) a targetted prevention component through intensified follow-up visits by NASGs and the distribution of SQ-LNS to children who recovered from wasting.
The study, designed as a randomized controlled clustered trial, will allocate 45 health center catchment areas to an intervention (n=22) and comparison group (n=23) and will assess the impact of the integrated package of interventions in three different cohort samples
- the longitudinal prevalence of wasting in children between 6 and 14 months of age (cohort 1; n=1,620)
- the recovery rate of children 6-23 months of age enrolled in wasting, MAM and SAM treatment (cohort 2; census of all children enrolled in treatment programs between May and December 2021)
- the incidence of relapse in children aged 9-17 months discharged from wasting, MAM and SAM treatment after recovery (cohort 3; n=945), determined 3 months post-treatment.
Study design
- Primary purpose
- Other
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Masking
- None (open label)
- Number of arms
- 2
- Model description
- Non-blinded cluster randomized controlled trial
| Arm | Type | Receives |
|---|---|---|
| Control | No intervention | –The control group will receive preventive (BCC on child health and nutrition) and screening services from existing unsupervised Nutrition Activity Support Groups (NASGs) without additional support from the IRAM project. Children with wasting are eligible to be enrolled in the existing national Community Management of Acute Malnutrition (CMAM) program. |
| Intervention | Experimental | Behavioral: Strengthened SBCC, Dietary Supplement: Preventive nutritional supplement, Behavioral: Family MUAC, Behavioral: Active screening by NASGs, Behavioral: Intensified followup of children with wasting referred to and enrolled in CMAM treatment, Behavioral: Relapse prevention, Behavioral: Cooking demonstrationsThe intervention group will receive the integrated package of interventions that will be delivered by the NASGs. The NASG platform will be strengthened by the IRAM project by increasing their number proportional to the size of the population of the catchment area they serve and by regular formative supervision by NGO and health center staff. The package of interventions includes: * Social and Behavioral Change Communication by NASGs during home visits and group sessions * Monthly delivery of preventive SQ-LNS to children 6-17 months of age * Screening and referral of children 6-59 months of age through the introduction of the MUAC family approach (distribution MUAC tapes to families and offering formative supervision by NASGs to enhance measurement quality) * Cooking demonstrations for complementary foods using nutrientdense foods in the community. |
Who may qualify
- Ages
- 6 to 23 months
- Sex
- All
- Healthy volunteers
- Not accepted
- Age groups
- Child
Key inclusion criteria (13 listed)
- 6-6.9 months of age
- Singleton
- The mother must live in the study area from the time of inclusion.
- The consent of the mother or guardian
- The child is enrolled in CMAM treatment program.
Key exclusion criteria (5 listed)
- Congenital malformations that make anthropometric measurements impossible.
- Mother intends to leave the study area before January 2022.
- Congenital malformations that make anthropometric measurements impossible.
- Mother intends to leave the study area before January 2022.
Eligibility is decided by the study team after screening; this overview does not establish that a patient qualifies. Full inclusion and exclusion criteria.
Interventions
| Intervention | Type | Arms |
|---|---|---|
| Strengthened SBCCSocial and Behavioral Change Communication related to prenatal, postnatal, IYCF practices as well as on the care of young children at several specific ages, hygiene, and health will be delivered during monthly home visits by pairs of NASG members. | Behavioural | Intervention |
| Preventive nutritional supplementMonthly delivery by NAGS pairs of a nutritional supplement: SQ-LNS, at a dose of 28 bags of 20g per month per beneficiary child. The nutritional supplement is limited to : - [6-17]months old children diagnosed as non-wasted (MUAC>=125mm) | Dietary supplement | Intervention |
| Family MUACMUAC screening of children 6 to 59 months of age by family members will be introduced. This will involve distributing Shakir MUAC tapes to all intervention households and training mothers/guardians, or any other family member expressing an interest, in the screening of wasting with the MUAC criterion. The training will be carried out by the members of the NASGs and during each home visit, they will be able to ensure that the MUAC measurement technique is well mastered by the mother (or another member) and correct the technique if necessary. They will also explain the procedure to be followed if the child is diagnosed as wasted by a family. | Behavioural | Intervention |
| Active screening by NASGsMonthly screening by the NASG members of the children they follow, using the MUAC. Referral to the health center of [6-17] months old children screened as malnourished (result of MUAC orange or red), and follow-up on referral to confirm child was enrolled. | Behavioural | Intervention |
| Intensified followup of children with wasting referred to and enrolled in CMAM treatmentNASG members will conduct biweekly follow-up visits in the households of children with wasting referred to and enrolled in CMAM treatment programs to ensure adherence to the outpatient treatment schedule. | Behavioural | Intervention |
| Relapse preventionNASG members will conduct biweekly home visits to monitor the nutritional status of children aged 9 to 17 months who were discharged from CMAM treatment after recovery. NASGs members will provide additional counseling to prevent relapse and screen these children for wasting to detect possible relapse. | Behavioural | Intervention |
| Cooking demonstrationsNASGs members will also be supported by the IRAM project in the organization of cooking demonstrations with nutrient-rich foods in the community, during which passive screening of children will be carried out. | Behavioural | Intervention |
Primary outcome
The longitudinal prevalence of wasting in children enrolled at the age of 6 months followed monthly until the end of the study (Cohort 1).
Time frame: Up to 7 months, from date of enrolment until the date of last documented progression or date of death from any cause, whichever came first
This indicator is defined for each child as the number of visits during which nutritional wasting is observed divided by the total number of monthly visits made (by the interviewers).
Recovery rate in children enrolled at [6-23] months of age for up to 3 months of treatment and followed through to discharge (Cohort 2)
Time frame: Up to 3 months, from date of inclusion in CMAM program until the date of recovery or 12th week after inclusion in CMAM program or date of death from any cause, whichever came first
This indicator is defined as the number children who recovered from wasting, MAM and SAM according to national program criteria (WHZ>-2 and MUAC>=125mm and absence of bilateral edema for two consecutive visits, within 12 weeks of enrollment in the CMAM program) divided by the total number of treatment results recorded.
Prevalence of relapse after discharge from CMAM treatment (cohort 3).
Time frame: Up to 4 months, at three months after discharge from CMAM treatment
This indicator is defined as the proportion of children (9-17 months of age) with WLZ-score <-2 or MUAC <125 mm or bilateral edema three months after discharge from a CMAM wasting and moderate wasting treatment program
47 secondary outcomes
Longitudinal prevalence of MAM (cohort 1)
Time frame: Up to 7 months, from date of enrolment until the date of last documented progression or date of death from any cause, whichever came first
Longitudinal prevalence of SAM (cohort 1)
Time frame: Up to 7 months, from date of enrolment until the date of last documented progression or date of death from any cause, whichever came first
Incidence of Wasting, MAM and SAM (cohort 1)
Time frame: Up to 7 months, from date of enrolment until the date of last documented progression or date of death from any cause, whichever came first
Hemoglobin concentration of children (cohort 1)
Time frame: Up to 7 months, from date of enrolment until the date of last documented progressio
Prevalence of anaemia (cohort 1)
Time frame: Up to 7 months, from date of enrolment until the date of last documented progressio
Child weight (cohort 1)
Time frame: Up to 7 months, from date of enrolment until the date of last documented progression or date of death from any cause, whichever came first
Child length (cohort 1)
Time frame: Up to 7 months, from date of enrolment until the date of last documented progression or date of death from any cause, whichever came first
Length-for-age Z-score (cohort 1)
Time frame: Up to 7 months, from date of enrolment until the date of last documented progression or date of death from any cause, whichever came first
Prevalence of child stunting (cohort 1)
Time frame: Up to 7 months, from date of enrolment until the date of last documented progression or date of death from any cause, whichever came first
Longitudinal wasting screening coverage (cohort 1)
Time frame: Up to 7 months, from date of enrolment until the date of last documented progression or date of death from any cause, whichever came first
Referral rate of positive screenings (cohort 1)
Time frame: Up to 7 months, from date of enrolment until the date of last documented progression or date of death from any cause, whichever came first
Early Child development (cohort 1)
Time frame: Up to 7 months, from date of enrolment until the date of last documented progression or date of death from any cause, whichever came first
Linear growth rate (cohort 1)
Time frame: Up to 7 months, from date of enrolment until the date of last documented progression or date of death from any cause, whichever came first
Ponderal growth rate (cohort 1)
Time frame: Up to 7 months, from date of enrolment until the date of last documented progression or date of death from any cause, whichever came first
MUAC growth rate (cohort 1)
Time frame: Up to 7 months, from date of enrolment until the date of last documented progression or date of death from any cause, whichever came first
Longitudinal prevalence of child morbidity (cohort 1)
Time frame: Up to 7 months, from date of enrolment until the date of last documented progression or date of death from any cause, whichever came first
Parental knowledge of nutrition, WASH, and health best practices (cohort 1)
Time frame: Up to 7 months, from date of enrolment until the date of last documented progression or date of death from any cause, whichever came first
Longitudinal prevalence of Introduction of (semi) solid and soft complementary foods (cohort 1)
Time frame: Up to 7 months, from date of enrolment until the date of last documented progression or date of death from any cause, whichever came first
Longitudinal prevalence of minimum dietary diversity of infant and young children (cohort 1)
Time frame: Up to 7 months, from date of enrolment until the date of last documented progression or date of death from any cause, whichever came first
Longitudinal prevalence of infant and young child minimum meal frequency (cohort 1)
Time frame: Up to 7 months, from date of enrolment until the date of last documented progression or date of death from any cause, whichever came first
Longitudinal prevalence of infant and young child minimum acceptable diet (cohort 1)
Time frame: Up to 7 months, from date of enrolment until the date of last documented progression or date of death from any cause, whichever came first
Longitudinal prevalence of continuous breastfeeding (cohort 1)
Time frame: Up to 7 months, from date of enrolment until the date of last documented progression or date of death from any cause, whichever came first
Longitudinal prevalence of infant and young child consumption of iron-rich or iron-fortified foods (cohort 1)
Time frame: Up to 7 months, from date of enrolment until the date of last documented progression or date of death from any cause, whichever came first
Vaccination coverage (cohort 1)
Time frame: Up to 7 months, from date of enrolment until the date of last documented progression or date of death from any cause, whichever came first
Adoption of practices recommended by NASGs (cohort 1)
Time frame: Up to 7 months, from date of enrolment until the date of last documented progression or date of death from any cause, whichever came first
Weight-for-length Z-score and MUAC at enrollment in CMAM (cohort 2)
Time frame: Up to 7 months, at the date of inclusion in CMAM program
Duration of CMAM treatment (cohort 2)
Time frame: Up to 3 months, from date of inclusion in CMAM program until the date of recovery or 12th week after inclusion in CMAM program or date of death from any cause, whichever came first
Treatment adherence (cohort 2)
Time frame: Up to 3 months, from date of inclusion in CMAM program until the date of recovery or 12th week after inclusion in CMAM program or date of death from any cause, whichever came first
Treatment outcomes (drop-out, death, transfer, non-response rates) (cohort 2)
Time frame: Up to 3 months, from date of inclusion in CMAM program until the date of recovery or 12th week after inclusion in CMAM program or date of death from any cause, whichever came firs
Longitudinal prevalence of childhood morbidity (cohort 2)
Time frame: Up to 3 months, from date of inclusion in CMAM program until the date of recovery or 12th week after inclusion in CMAM program or date of death from any cause, whichever came first
Mid-Upper Arm Circumference of children (cohort 3)
Time frame: Up to 4 months, at three months after discharge from CMAM treatment
Child weight (cohort 3)
Time frame: Up to 4 months, at three months after discharge from CMAM treatment
Child length(cohort 3)
Time frame: Up to 4 months, at three months after discharge from CMAM treatment
Weight-for-length Z-score (cohort 3)
Time frame: Up to 4 months, at three months after discharge from CMAM treatment
Length-for-age Z-score (cohort 3)
Time frame: Up to 4 months, at three months after discharge from CMAM treatment
Child Stunting (cohort 3)
Time frame: Up to 4 months, at three months after discharge from CMAM treatment
Wasting screening coverage (cohort 3)
Time frame: Up to 4 months, at three months after discharge from CMAM treatment
Prevalence of readmission (cohort 3)
Time frame: Up to 4 months, at three months after discharge from CMAM treatment
Prevalence of anemia (cohort 3)
Time frame: Up to 4 months, at three months after discharge from CMAM treatment
Hemoglobin concentration of children (cohort 3)
Time frame: Up to 4 months, at three months after discharge from CMAM treatment
Results and safety
The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.
Research links
- Official record on ClinicalTrials.govLast updated by the sponsor 28 Oct 2022.
- Derived from this study: PubMed 41895698Huybregts L, Diop L, Fall T, Barba FM, Brander RL, Toure M, Ouedraogo M, Hien A, Becquey E. The impact of a continuum of care intervention from prevention to treatment on child wasting compared with usual community group activities: a cluster-randomized controlled trial in Mali. Am J Clin Nutr. 2026 Jun;123(6):101294. doi: 10.1016/j.ajcnut.2026.101294. Epub 2026 Mar 25.
- Individual participant dataSharing planned: Yes. In accordance with IFPRI's policy on research data management and open access, at the time of publication of scientific articles presenting results, the fully anonymized databases will become a public good and will be made available to the scientific community, government, and partners.
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Referral and contact
AzTrials does not enrol participants or take referrals. Contact the study team or a site listed below; they decide who can take part. This study is not recruiting at the moment.
Lieven Huybregts, PHD principal investigator
IFPRI
Elodie Becquey, PHD principal investigator
IFPRI
Jef Leroy principal investigator
IFPRI
1 site in 1 country: see every site and its status.
Questions about this trial
What is this clinical trial studying?
A study testing Strengthened SBCC, Preventive nutritional supplement and Family MUAC in people with Acute Malnutrition in Childhood and Wasting, run by International Food Policy Research Institute at 1 site in Mali.
The full registered description is in the About this study section and the official record.
Who may be eligible to take part?
The sponsor lists 13 inclusion and 5 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.
Is this clinical trial currently recruiting?
The record says: finished, as of the sponsor's last update on 28 Oct 2022. Status can change between updates, so confirm with the study contact before making plans.
Where is the study taking place?
The record lists 1 site in Mali. Whether a site is taking part right now should be confirmed with that site. See every site.
What are the possible benefits and risks?
They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.
Are results available for this study?
The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.
How can a doctor refer a patient or contact the research team?
The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.
What does the primary outcome measure?
The longitudinal prevalence of wasting in children enrolled at the age of 6 months followed monthly until the end of the study (Cohort 1). (time frame: Up to 7 months, from date of enrolment until the date of last documented progression or date of death from any cause, whichever came first). The study lists 3 primary outcomes in all. It is what the study was designed to measure, not a finding.
Where can I read the original study information?
On the ClinicalTrials.gov record for NCT04872088, which also lists 1 linked publication.
Does a listing mean the treatment is approved or proven to work?
No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.
How often is this information updated?
AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 28 Oct 2022.