Imtiaz Hussain1, Atif Habib1, Shabina Ariff1, Gul Nawaz Khan1, Arjumand Rizvi1, Suhail Channar1, Abid Hussain1, Shahid Fazal2, Deepak Kumar1, Jose Luis Alvarez3, Saul Guerrero2, Angeline Grant2, Sajid Bashir Soofi4,5. 1. Department of Pediatric and Child Health, Associate Director Center of Excellence in Women and Child Health, Aga Khan University, Stadium Road, Karachi, 74800, Pakistan. 2. Action Against Hunger, Islamabad, Pakistan. 3. Action Against Hunger, London, UK. 4. Department of Pediatric and Child Health, Associate Director Center of Excellence in Women and Child Health, Aga Khan University, Stadium Road, Karachi, 74800, Pakistan. sajid.soofi@aku.edu. 5. Center of Excellence in Women and Child Health, Aga Khan University, Karachi, Pakistan. sajid.soofi@aku.edu.
Abstract
PURPOSE: We compared the impact of management of severe acute malnutrition (SAM) by lady health workers (LHWs) at a community level with the standard CMAM program provided at the health facility. METHODS: A two-arm cluster randomised controlled trial was conducted in a rural district in sindh Pakistan. The primary outcome was recovery from SAM and secondary outcomes were relapse, defaulter and mortality rate. RESULTS: A total of 829 children were recruited in the trial (430 in intervention and 399 in control groups). No significant difference was noted in recovery rate between the intervention and control groups (79.2% vs 85.6%, p = 0.276). Similarly, no significant differences were noted in relapse (p = 0.757), weight gain (p = 0.609), deaths (p = 0.775) and defaulter rate (p = 0.324) across the groups. Compliance of RUTF was significantly higher in the control group (93%) than in the intervention group (87%), p < 0.000. CONCLUSION: Our results showed no impact of SAM treatment on performance indicators of CMAM (recovery, relapse, death and default) between the standard CMAM programme performed at the health facility by the government and NGO staff and the programme performed at health house level by the LHWs in Pakistan. We recommend further robust trials in other settings to confirm our results.
RCT Entities:
PURPOSE: We compared the impact of management of severe acute malnutrition (SAM) by lady health workers (LHWs) at a community level with the standard CMAM program provided at the health facility. METHODS: A two-arm cluster randomised controlled trial was conducted in a rural district in sindh Pakistan. The primary outcome was recovery from SAM and secondary outcomes were relapse, defaulter and mortality rate. RESULTS: A total of 829 children were recruited in the trial (430 in intervention and 399 in control groups). No significant difference was noted in recovery rate between the intervention and control groups (79.2% vs 85.6%, p = 0.276). Similarly, no significant differences were noted in relapse (p = 0.757), weight gain (p = 0.609), deaths (p = 0.775) and defaulter rate (p = 0.324) across the groups. Compliance of RUTF was significantly higher in the control group (93%) than in the intervention group (87%), p < 0.000. CONCLUSION: Our results showed no impact of SAM treatment on performance indicators of CMAM (recovery, relapse, death and default) between the standard CMAM programme performed at the health facility by the government and NGO staff and the programme performed at health house level by the LHWs in Pakistan. We recommend further robust trials in other settings to confirm our results.
Entities:
Keywords:
Community-based management; Health facility management; LHWs; RUTF; Severe acute malnutrition
Authors: Zulfiqar A Bhutta; Zahid A Memon; Sajid Soofi; Muhammad Suhail Salat; Simon Cousens; Jose Martines Journal: Bull World Health Organ Date: 2008-06 Impact factor: 9.408