%0 Journal Article
%T Impact on child acute malnutrition of integrating a preventive nutrition package into facility-based screening for acute malnutrition during well-baby consultation: A cluster-randomized controlled trial in Burkina Faso
%A Agnes Le Port
%A Amanda Zongrone
%A Elodie Becquey
%A Jef L. Leroy
%A Lieven Huybregts
%A Mariama Tour谷
%A Marie T. Ruel
%A Rahul Rawat
%J -
%D 2019
%R 10.1371/journal.pmed.1002877
%X Background Community management of acute malnutrition (CMAM) is a highly efficacious approach for treating acute malnutrition (AM) in children who would otherwise be at significantly increased risk of mortality. In program settings, however, CMAM＊s effectiveness is limited because of low screening coverage of AM, in part because of the lack of perceived benefits for caregivers. In Burkina Faso, monthly screening for AM of children <2 years of age is conducted during well-baby consultations (consultation du nourrisson sain [CNS]) at health centers. We hypothesized that the integration of a preventive package including age-appropriate behavior change communication (BCC) on nutrition, health, and hygiene practices and a monthly supply of small-quantity lipid-based nutrient supplements (SQ-LNSs) to the monthly screening would increase AM screening and treatment coverage and decrease the incidence and prevalence of AM.   Methods and findings We used a cluster-randomized controlled trial and allocated 16 health centers to the intervention group and 16 to a comparison group. Both groups had access to standard CMAM and CNS services; caregivers in the intervention group also received age-appropriate monthly BCC and SQ-LNS for children >6 months of age. We used two study designs: (1) a repeated cross-sectional study of children 0每17 months old (n = 2,318 and 2,317 at baseline and endline 2 years later) to assess impacts on AM screening coverage, treatment coverage, and prevalence; (2) a longitudinal study of 2,113 children enrolled soon after birth and followed up monthly for 18 months to assess impacts on AM screening coverage, treatment coverage, and incidence. Data were analyzed as intent to treat. Level of significance for primary outcomes was 汐 = 0.016 after adjustment for multiple testing. Children＊s average age was 8.8 ㊣ 4.9 months in the intervention group and 8.9 ㊣ 5.0 months in the comparison group at baseline and, respectively, 0.66 ㊣ 0.32 and 0.67 ㊣ 0.33 months at enrollment in the longitudinal study. Relative to the comparison group, the intervention group had significantly higher monthly AM screening coverage (cross-sectional study: +18 percentage points [pp], 95% CI 10每26, P < 0.001; longitudinal study: +23 pp, 95% CI 17每29, P < 0.001). There were no impacts on either AM treatment coverage (cross-sectional study: +8.0 pp, 95% CI 0.09每16, P = 0.047; longitudinal study: +7.7 pp, 95% CI ˋ1.2 to 17, P = 0.090), AM incidence (longitudinal study: incidence rate ratio = 0.98, 95% CI 0.75每1.3, P = 0.88), or AM prevalence (cross-sectional study: ˋ0.46 pp,
%K Child health
%K Longitudinal studies
%K Health screening
%K Cross-sectional studies
%K Malnutrition
%K Nutrition
%K Children
%K Hygiene
%U https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1002877