Regular Growth Monitoring (RGM) of Young Children in Guinea-Bissau

Pilot Study to Assess the Benefits and Sustainability of Regular Growth Monitoring (RGM) of Young Children in Villages in Guinea-Bissau

Wasting (severe thinness) is a common and serious problem among young children in rural Guinea-Bissau. Community Health Agents (CHAs) can help prevent malnutrition by regularly measuring children's growth and advising families on nutritious local foods. However, this practice is not consistently implemented.

This pilot study will test whether implementing Regular Growth Monitoring (RGM) by CHAs every month is feasible and effective in reducing malnutrition among children aged 6 months to 5 years in two rural villages. Investigators will also compare three methods for measuring mid-upper arm circumference (MUAC), which is used to detect malnutrition: the standard WHO tape measure, a photograph of the arm, and a simple bracelet. The goal is to identify which method is easiest for CHAs to use reliably.

Baseline and final measurements will be taken in both villages. One village will receive the monthly RGM intervention first, followed by the second village. Families will also be asked about their experiences with the program through brief questionnaires.

Study Overview

• Status: Not yet recruiting
• Conditions: Severe Acute Malnutrition; Moderate Acute Malnutrition (MAM)
• Intervention / Treatment: Behavioral: Regular Growth Monitoring (RGM) by Community Health Agents

Detailed Description

Wasting is prevalent in rural Guinea-Bissau villages and adversely affects child health and cognitive development long-term. Prior work by this team of investigators suggests that regular feedback from Community Health Agents (CHAs) to caregivers, including recommendations of locally available nutritious recipes for at-risk children, may reduce the incidence of moderate acute malnutrition (MAM) and severe acute malnutrition (SAM). However, routine growth monitoring (RGM) has been largely unfeasible at the village level due to measurement complexity and limited training resources. Modern technology and artificial intelligence may help make this more scalable.

This is a proof-of-concept, sequential pilot study conducted in two villages in Guinea-Bissau with which the team has an established relationship. Baseline anthropometric measurements will be collected on all eligible children (aged 6 months to 5 years, without SAM at enrollment) in both villages. Children identified with SAM at baseline will be referred to the local malnutrition clinic and excluded from the study.

One village will begin the RGM intervention immediately after baseline data collection. The second village will begin the intervention after final data collection in the first village. Assignment order will be by PI decision rather than randomization, as required by the collaborating UCSF team members.

During the RGM period, CHAs will screen each child monthly using all three mid-upper arm circumference (MUAC) methods: (1) WHO tape measure (reference standard), (2) arm photograph, and (3) bracelet. Data will be entered into a secure REDCap database. Children meeting SAM criteria (by tape measure) will be referred to tertiary care; children with MAM will receive weekly CHA nutrition education on local recipes. Measurements collected at baseline and end-of-study include: weight, height, MUAC by all three methods, skinfold thicknesses (biceps and triceps), and family demographics.

After study completion, brief questionnaires will be administered to parents, CHAs, and Ministry of Health staff to assess perceived effects, acceptability, feasibility, and preferences among the monitoring methods. This study has been approved by both the Dartmouth College CPHS and the Ministry of Health in Guinea-Bissau.

• Study Type: Interventional
• Enrollment (Estimated): 400
• Phase: Not Applicable

Contacts and Locations

• Study Contact: Name: Rachel E. Silver, Ph.D., M.P.H.; Phone Number: 603-646-6482; Email: rachel.e.silver@dartmouth.edu
• Study Contact Backup: Name: Valerie Flaherman, M.D., M.P.H.; Phone Number: 415-502-6266; Email: valerie.flaherman@ucsf.edu

Study Locations

• Guinea-Bissau
  • Bissau Region
    • Bissau, Bissau Region, Guinea-Bissau, 1000
      • Two villages in rural Guinea-Bissau
      • Contact: Raimundo Co; Phone Number: 245-955-240-0808; Email: dimundorai@hotmail.com

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Child
• Accepts Healthy Volunteers: Yes

Description

Inclusion Criteria:

• Children aged 6 months to 5 years residing in one of the two selected villages in Guinea-Bissau
• Caregiver willing to enroll the child in the study (verbal consent provided)
• Caregiver can provide birth certificate or documentation of child's age
• Child does not have severe acute malnutrition (SAM) at the baseline assessment

Exclusion Criteria:

• Children diagnosed with severe acute malnutrition (SAM) at baseline (these children will be referred to the local malnutrition clinic)
• Children whose caregivers do not wish to participate

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Prevention
• Allocation: Non-Randomized
• Interventional Model: Sequential Assignment
• Masking: None (Open Label)

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Village #1 (initial start); Children aged 6 months to 5 years in the first village who do not have SAM at baseline. This village receives the monthly Regular Growth Monitoring (RGM) intervention immediately after baseline data collection. CHAs perform monthly MUAC screening using three methods; at-risk children are referred or receive caregiver nutrition education.	Behavioral: Regular Growth Monitoring (RGM) by Community Health Agents; Monthly malnutrition screening by Community Health Agents (CHAs) using three MUAC methods: (1) WHO standard tape measure, (2) arm photograph for remote review, and (3) a solid bracelet device. The tape measure is the reference standard. Children identified with SAM are referred to a tertiary malnutrition clinic; children with MAM have their caregivers provided with weekly education on using local nutritious recipes to support recovery. Data are entered into REDCap and reviewed remotely by the US research team.
Active Comparator: Village #2 (delayed start); Children aged 6 months to 5 years in the second village who do not have SAM at baseline. This village serves as a comparison group during the first village's RGM period, then receives the same RGM intervention subsequently.	Behavioral: Regular Growth Monitoring (RGM) by Community Health Agents; Monthly malnutrition screening by Community Health Agents (CHAs) using three MUAC methods: (1) WHO standard tape measure, (2) arm photograph for remote review, and (3) a solid bracelet device. The tape measure is the reference standard. Children identified with SAM are referred to a tertiary malnutrition clinic; children with MAM have their caregivers provided with weekly education on using local nutritious recipes to support recovery. Data are entered into REDCap and reviewed remotely by the US research team.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Prevalence of severe acute malnutrition (SAM)	Proportion of enrolled children meeting SAM criteria (by WHO tape measure MUAC) at study completion, compared between early-start and delayed-start villages.	Baseline to study completion (~4 months)

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Prevalence of moderate acute malnutrition (MAM)	Proportion of enrolled children meeting MAM criteria (by WHO tape measure MUAC) at study completion, compared between early-start and delayed-start villages.	Baseline to study completion (~4 months)
Weight-for-length z-score	Change in weight-for-length z-score between baseline and final assessment, compared between early-start and delayed-start villages	Baseline to study completion (~4 months)
Weight-for-age z-score	Change in weight-for-age z-score between baseline and final assessment, compared between early-start and delayed-start villages.	Baseline to study completion (~4 months)
Length-for-age z-score	Change in length-for-age z-score between baseline and final assessment, compared between early-start and delayed-start villages	Baseline and study completion (~4 months)

Other Outcome Measures

Outcome Measure	Measure Description	Time Frame
Agreement of new RGM methods vs. reference standard	Accuracy of the arm photograph and bracelet for detecting MAM and SAM relative to the WHO tape measure MUAC.	Assessed at each study visit (monthly from baseline to 4 months follow-up)
Acceptability and feasibility of RGM methods	Perceived acceptability and feasibility of the three MUAC monitoring methods among parents, CHAs, and Ministry of Health staff, collected via brief structured questionnaires.	N/A, data collected at study completion (4 month visit)

Collaborators and Investigators

• Sponsor: Trustees of Dartmouth College
• Collaborators: University of California, San Francisco
• Investigators: Principal Investigator: Susan B. Roberts, Ph.D., Dartmouth College

Study record dates

Study Major Dates

• Study Start (Estimated): May 2, 2026
• Primary Completion (Estimated): December 1, 2026
• Study Completion (Estimated): December 1, 2026

Study Registration Dates

• First Submitted: April 30, 2026
• First Submitted That Met QC Criteria: May 7, 2026
• First Posted (Actual): May 13, 2026

Study Record Updates

• Last Update Posted (Actual): May 13, 2026
• Last Update Submitted That Met QC Criteria: May 7, 2026
• Last Verified: April 1, 2026

More Information

Terms related to this study

• Keywords: Guinea-Bissau; Wasting; Mid-upper arm circumference; Childhood malnutrition; Growth monitoring
• Additional Relevant MeSH Terms: Nutrition Disorders; Body Weight; Body Weight Changes; Malnutrition; Weight Loss; Thinness; Pathological Conditions, Signs and Symptoms; Nutritional and Metabolic Diseases; Signs and Symptoms; Severe Acute Malnutrition; Cachexia
• Other Study ID Numbers: 33690

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: YES
• IPD Plan Description: Deidentified participant data will be stored and made publicly available at an appropriate repository following publication of the primary manuscript. Participant names stored locally in Guinea-Bissau will be retained for 3 years after study completion and then destroyed. The US team will not have access to identifiable participant information.
• IPD Sharing Time Frame: Following publication of the primary manuscript.
• IPD Sharing Access Criteria: Publicly available deidentified dataset; access details to be determined at time of publication.
• IPD Sharing Supporting Information Type: STUDY_PROTOCOL; SAP

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No