- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT05020847
Effectiveness of Alternative Diets During the Stabilization Phase on Children With Complicated SAM
The Underlying Causes Affecting the Response to Dietary Rehabilitation in Severely Acutely Malnourished Children at the Center Hôspitalier Universitaire Sourô Sanou, Bobo Dioulasso, Burkina Faso
Severe acute malnutrition (SAM) is a life threatening condition and is defined by 1) a weight-for-height Z-score more than three standard deviations (SD) below the median based on the 2006 World Health Organization (WHO) growth standards, 2) a mid-upper arm circumference (MUAC) of less than 115 mm or 3) by the presence of nutritional edema. Signs such as edema, mucocutaneous changes, hepatomegaly, lethargy, anorexia, anemia, severe immune deficiency and rapid progression to mortality characterize a state commonly coined as "complicated SAM". Kwashiorkor is one of the forms of complicated SAM commonly distinguished by the unmistakable presence of bipedal edema. SAM results in high mortality rates of up to half a million child deaths annually. Undernourished children are at higher risk of mortality ranging from three times more risk among children with moderate malnutrition to 10-times in SAM children compared to well-nourished children. Children with complicated SAM require inpatient treatment in specialized centers.
The "Rehabilitation and Nutritional Education Center" (CREN) is a specialized center in Burkina Faso receiving on average 10 SAM children per day. Recovery rate is lower than international standards; and adverse events and mortality remain strikingly high.
Our main objective is to assess the underlying risk factors affecting the effectiveness of the nutritional therapeutic treatment protocol for complicated SAM children under 5 years of age who have been referred to the CREN, at the Centre Hôspitalier Universitaire Souro, Bobo Dioulasso, Burkina Faso.
The specific objective is to assess the effectiveness of alternative dietary regimens during the stabilization phase on well-specified clinical and biochemical outcomes in children with complicated SAM. Dietary regimens differ by their carbohydrate profile and content, and by their different micronutrient composition including vitamin A, iron and zinc.
Study Overview
Status
Detailed Description
Severe acute malnutrition (SAM), defined as severe wasting [weight-to-height Z-score < -3 standard deviations (SD), based on the WHO Child Growth Standards] and / or the presence of nutritional edema, and / or mid-upper arm circumference (MUAC) <115 mm, is a condition that requires urgent attention and appropriate management to reduce mortality and promote recovery among children. Management of SAM children without complications is provided at the community level. Hospitalization in specialized care centers is necessary for SAM children with complications. SAM children with comorbidities have a greater risk of mortality and treatment failure. Our knowledge of the specific adequate nutritional needs of SAM is limited.
For the treatment of SAM in hospital, the WHO recommends the use of therapeutic milk low in protein 'F75' in the stabilization phase; and more protein-rich F100 or F75 combined with ready-to-use therapeutic foods (RUTF) in the transition phase. The WHO also recommends using as an alternative formula made of cereal flour, skimmed milk powder, oil, sugar, and a therapeutic vitamin and mineral complex (CMV), in case of shortage of the standard therapeutic milk F75 / F100 or in case of signs of intolerance (vomiting, diarrhea).
The Refeeding Center - Centre de Récupération et d'Education Nutritionnelle (CREN) of the Sourô Sanou University Hospital Center (CHUSS) in Burkina Faso specializes in the care of SAM children with complications. In 2018, out of 500 children aged 6-59 months admitted for SAM with complications, the CHUSS CREN registered 86.8% full recovery, 8.2% dropout and 5% death. Although the recovery rate is higher than international standards (greater than 75%), the mortality rate remains higher than the recommended 3% by international standards; in addition to the challenges that are faced locally in maintaining high standards of care. At the CREN, we observed that some SAM children with complications can have severe diarrhea and vomiting after taking F75 (first phase of the nutritional treatment). It was also observed that other SAM children with edema, whose edema resolved in the first phase of treatment under F75, redeveloped edema when they received RUTF (Plumpy Nut®) in the transition phase according to the WHO 2013 protocol.
The second objective of the study is to assess the risk factors affecting the response to dietary treatment in this center (the CREN, Burkina Faso) and to compare alternatives for treatment during the nutritional rehabilitation.
Problematic It was observed at the Refeeding Center (CREN) of the Sourô Sanou University Hospital (CHUSS) in Bobo Dioulasso, that SAM children with complications show during their treatment, signs of intolerance to F75 (diarrhea , vomiting). The pathophysiology of diarrhea in SAM involves several theories including that of lactose intolerance, and that of alteration of the intestinal microbiota.
The study aims to assess the effectiveness of diet regimens [standard F75, or alternative F75 + mineral vitamin complex (CMV), or alternative F75 without CMV] during the stabilization phase from both a clinical and biochemical aspects in children with complicated SAM. Diets differ in their profile and carbohydrate content, and in their different micronutrient compositions, including vitamin A, iron and zinc.
Our hypothesis is that the F75 alternative during the stabilization phase (the first phase) of complicated SAM children is associated with better compliance, less diarrhea and better outcomes than the recommended F75 formulation; and that children treated correctly with the F75 alternative containing CMV will perform better than the other two groups of children treated with F75 or the F75 alternative without CMV.
This will be an open, randomized controlled trial aimed at testing the effectiveness of three therapeutic diet regimens during the first phase of hospital management of children with complicated SAM admitted to CREN, Bobo Dioulasso.
After obtaining informed consent from parents / guardians for the inclusion of the child, the child will be randomized and will receive their assigned treatment. In accordance with the 2014 protocol for the management of SAM in Burkina Faso, an antibiotic will be given as part of the systematic treatment of complicated SAM, and other medical treatments depending on the associated complication. Deworming is provided also gratis, will be done only in children whose tests are positive for intestinal parasites and ONLY in the rehabilitation phase (the third phase of the treatment) as per the National Protocol for the management of complicated SAM. The dietetic treatment will be given by the nurses every 2 hours on the first day; then if tolerance is good, every 3 hours the following days. No family meals during phase 1. But the baby can breastfeed. The observance and tolerance of the treatment will be noted by the nurses: amount of milk taken, refusal, vomiting, diarrhea, presence of a nasogastric tube. The quantities will be given according to the weight of the child, the presence or not of edema, in accordance with the national protocol.
Study Type
Enrollment (Actual)
Phase
- Not Applicable
Contacts and Locations
Study Locations
-
-
Bobo Dioulasso
-
Bobo-Dioulasso, Bobo Dioulasso, Burkina Faso
- Centre Hospitalier Universitaire Souro
-
-
Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Description
Inclusion Criteria:
- Severe acute malnutrition defined as Weight-for-Height Z-score (WHZ) <- 3 SD AND / OR MUAC <115 mm AND / OR with edema
- With complications
- Who are admitted and treated in the refeeding center (CREN) of the CHUSS
- Aged between 6 and 59 Months
- Parental Signed informed consent form
Exclusion Criteria:
- Children younger than 6 months or older than 59 months of age
- Moderate Acute Malnutrition (MAM)
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Treatment
- Allocation: Randomized
- Interventional Model: Parallel Assignment
- Masking: None (Open Label)
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Active Comparator: Standard F75
At the admission, therapeutic food is given by the nurses every 2 hours on the first day; then if tolerance is good, every 3 hours the following days. No family meals during the stabilization phase. But the baby can breastfeed. A child will receive an antibiotic as per the national protocol, malaria treatment if diagnosed with malaria, Vitamin A if symptomatic eye damage, Folic acid in case of anemia, antifungal in case of candidiasis. |
F-75 contains 75 kcal and 0.9 g protein per 100 ml
|
Experimental: Alternative F75 with CMV
At the admission, therapeutic food is given by the nurses every 2 hours on the first day; then if tolerance is good, every 3 hours the following days. No family meals during the stabilization phase. But the baby can breastfeed. A child will receive an antibiotic as per the national protocol, malaria treatment if diagnosed with malaria, Vitamin A if symptomatic eye damage, Folic acid in case of anemia, antifungal in case of candidiasis. |
Alternative F75 With CMV contains cereal flour, oil, sugar, powdered milk with complex mineral-vitamin (CMV)
|
Experimental: Alternative F75 without CMV
At the admission, therapeutic food is given by the nurses every 2 hours on the first day; then if tolerance is good, every 3 hours the following days. No family meals during the stabilization phase. But the baby can breastfeed. A child will receive an antibiotic as per the national protocol, malaria treatment if diagnosed with malaria, Vitamin A if symptomatic eye damage, Folic acid in case of anemia, antifungal in case of candidiasis. |
Alternative F75 without CMV contains cereal flour, oil, sugar, powdered milk without complex mineral vitamin (CMV).
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Recovery rate of children
Time Frame: Three to Five days
|
Number of children treated and admitted to the transition phase
|
Three to Five days
|
Daily weight gain
Time Frame: Three to Five days
|
Average daily weight gain in the stabilization phase in Grams
|
Three to Five days
|
Number of days during the first phase of treatment
Time Frame: Three to Five days
|
Average number of days spent in the stabilization phase in Day
|
Three to Five days
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
% of intake of the therapeutic regimen
Time Frame: Three to Five days
|
Daily intake of the administered dietary treatment
|
Three to Five days
|
Anorexia
Time Frame: Three to Five days
|
Serious severe event that occurs at anytime during the treatment
|
Three to Five days
|
Mortality
Time Frame: Three to Five days
|
Serious severe event that occurs at anytime during the treatment
|
Three to Five days
|
Diarrhea
Time Frame: Three to Five days
|
Serious severe event that occurs at anytime during the treatment
|
Three to Five days
|
Vomiting
Time Frame: Three to Five days
|
Serious severe event that occurs at anytime during the treatment
|
Three to Five days
|
Other Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
HIV/AIDS
Time Frame: Three to Five days
|
Detection of HIV/AIDS using polymerase chain reaction (PCR) in infants and children younger than 18 months or retroviral serology test in older children.
|
Three to Five days
|
Hepatitis infection
Time Frame: Three to Five days
|
Blood test of hepatitis using the enzyme-linked immunosorbent assay (ELISA)
|
Three to Five days
|
Tuberculosis infection
Time Frame: Three to Five days
|
Test of tuberculosis via search for Koch's Bacillus in gastric/spit tubing and molecular testing of stools using polymerase chain reaction (PCR)
|
Three to Five days
|
Collaborators and Investigators
Sponsor
Collaborators
Investigators
- Principal Investigator: Stefaan De Henauw, Md. PhD, University of Ghent
- Principal Investigator: Souheila Abbeddou, MSc. PhD, University of Ghent
- Principal Investigator: Jerome Some, Md. PhD, Institut de Recherche en Sciences de la Sante, Burkina Faso
- Principal Investigator: Bintou Sanogo, MSc. Md., Centre Hospitalier Universitaire Souro, Bobo Dioulasso, Burkina Faso.
Publications and helpful links
General Publications
- Bartz S, Mody A, Hornik C, Bain J, Muehlbauer M, Kiyimba T, Kiboneka E, Stevens R, Bartlett J, St Peter JV, Newgard CB, Freemark M. Severe acute malnutrition in childhood: hormonal and metabolic status at presentation, response to treatment, and predictors of mortality. J Clin Endocrinol Metab. 2014 Jun;99(6):2128-37. doi: 10.1210/jc.2013-4018. Epub 2014 Feb 27.
- Deen JL, Funk M, Guevara VC, Saloojee H, Doe JY, Palmer A, Weber MW. Implementation of WHO guidelines on management of severe malnutrition in hospitals in Africa. Bull World Health Organ. 2003;81(4):237-43. Epub 2003 May 16.
- Gopalan C. Kwashiorkor and marasmus: evolution and distinguishing features. 1968. Natl Med J India. 1992 May-Jun;5(3):145-51. No abstract available.
- Nguefack F, Adjahoung CA, Keugoung B, Kamgaing N, Dongmo R. [Hospital management of severe acute malnutrition in children with F-75 and F-100 alternative local preparations: results and challenges]. Pan Afr Med J. 2015 Aug 31;21:329. doi: 10.11604/pamj.2015.21.329.6632. eCollection 2015. French.
- Singh K, Badgaiyan N, Ranjan A, Dixit HO, Kaushik A, Kushwaha KP, Aguayo VM. Management of children with severe acute malnutrition: experience of Nutrition Rehabilitation Centers in Uttar Pradesh, India. Indian Pediatr. 2014 Jan;51(1):21-5. doi: 10.1007/s13312-014-0328-9. Epub 2013 Jul 5.
Helpful Links
- World Health Organization (2013) WHO guideline: updates on the management of severe acute malnutrition in infants and children.
- Enquête Nutritionnelle Nationale SMART 2016 au Burkina Faso. 2016 ; 47p
- Ministère de la Sante au Burkina Faso. Protocol National : Prise en charge intégrée de la malnutrition aigüe (PCIMA). 2014
Study record dates
Study Major Dates
Study Start (Actual)
Primary Completion (Actual)
Study Completion (Actual)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (Actual)
Study Record Updates
Last Update Posted (Actual)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Keywords
Additional Relevant MeSH Terms
Other Study ID Numbers
- BC-09443-A
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
IPD Plan Description
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
Studies a U.S. FDA-regulated device product
This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.
Clinical Trials on Severe Acute Malnutrition
-
Society for Applied StudiesWorld Health Organization; Christian Medical College, Vellore, India; ArthCompletedUncomplicated Severe Acute MalnutritionIndia
-
University of California, San FranciscoEunice Kennedy Shriver National Institute of Child Health and Human Development... and other collaboratorsCompletedUncomplicated Severe Acute MalnutritionBurkina Faso
-
International Centre for Diarrhoeal Disease Research...UNICEF; NutrisetCompletedSevere Acute Malnutrition in ChildhoodBangladesh
-
International Centre for Diarrhoeal Disease Research...UNICEFNot yet recruitingMalnutrition SevereBangladesh
-
UNICEFSave the ChildrenCompletedSevere MalnutritionCongo, The Democratic Republic of the
-
Aga Khan UniversityAction Contre la FaimCompletedEvaluation of the Effectiveness and Impact of Community Case Management of Severe Acute MalnutritionSevere MalnutritionPakistan
-
Action Against Hunger USAUniversity of Washington; Ethiopian Public Health InstituteNot yet recruitingModerate Acute Malnutrition | Severe Acute Malnutrition
-
Microbiome Health Research InstituteUniversity of Cape TownTerminatedModerate Acute Malnutrition | Severe Acute MalnutritionSouth Africa
-
University of OxfordLondon School of Hygiene and Tropical Medicine; University College, London; KEMRI-Wellcome... and other collaboratorsUnknownAntibiotic Resistance | Malnutrition Severe | Antibiotic ToxicityKenya, Uganda
-
Victor M. AguayoGandhi Medical College, Bhopal; Bundelkhand Medical College, Sagar, Madhya... and other collaboratorsCompletedSevere MalnutritionIndia
Clinical Trials on Standard F75
-
University of OxfordThe Hospital for Sick Children; KEMRI-Wellcome Trust Collaborative Research... and other collaboratorsCompletedMalnutrition | Metabolic Disturbance | DiarrhoeaKenya, Malawi
-
University GhentInstitut de Recherche en Sciences de la Sante, Burkina Faso; Centre Muraz; University...CompletedSevere Acute Malnutrition | Kwashiorkor | Marasmus | Nutritional EdemaBurkina Faso
-
University GhentInstitut de Recherche en Sciences de la Sante, Burkina Faso; Centre Muraz; University...CompletedSevere Acute Malnutrition | Kwashiorkor | Nutritional EdemaBurkina Faso
-
Indonesia UniversityPT. Nutricia Medical NutritionCompletedSevere Acute MalnutritionIndonesia
-
University of PennsylvaniaRestaurant AssociatesActive, not recruitingObesity | Weight Gain | Food Preferences | Food SelectionUnited States
-
HealthpointCompleted
-
Neuroscience Trials AustraliaNational Institute for Health Research, United Kingdom; Northern Ireland Chest... and other collaboratorsCompleted
-
University of MichiganEnrolling by invitationDepression | Anxiety | Sleep Disturbance | AddictionUnited States
-
Micro Medical Solution, Inc.RecruitingPeripheral Arterial DiseaseUnited States
-
Institute of Cardiology, Warsaw, PolandUnknownCardiac RehabilitationPoland