Effect of caregiver training on knowledge and confidence of at-home clinical and anthropometric surveillance of children with uncomplicated severe acute malnutrition
Analysis of a cross-over cluster randomised trial in Sokoto, Nigeria
Bibliographic Data
INTRODUCTION: Patient-centred task-shifting models may be a promising strategy in the community-based management of severe acute malnutrition (SAM) to alleviate pressure on health systems and increase access to treatment in low-resource settings. The engagement of caregivers in clinical and anthropometric surveillance has not been evaluated. OBJECTIVES: We examined the effect of caregiver training on their knowledge and confidence in at-home clinical and anthropometric surveillance of children with uncomplicated SAM in Sokoto, Nigeria. METHODS: We used data from a cross-over cluster-randomised trial (n clusters=10) comparing a monthly follow-up schedule with caregiver training to standard weekly follow-up for the outpatient management of children 6-59 months with uncomplicated SAM. Caregivers in the monthly follow-up group received a one-time training on at-home clinical surveillance and mid-upper arm circumference (MUAC) measurement. Intention-to-treat analyses assessed mean differences in knowledge and confidence scores within the monthly follow-up group and between groups at enrolment, post-training, programme discharge and 3 months post-discharge. Accuracy of MUAC measurement and classification was compared in the monthly follow-up group to study staff at enrolment post-training, programme discharge and 3 months post-discharge. RESULTS: Of 3945 enrolled children, 96% were followed to programme discharge and 91% to 3 months post-discharge. Caregivers' knowledge and confidence scores in clinical surveillance increased significantly in the monthly follow-up group post-training and remained elevated at programme discharge and 3 months post-discharge, compared with pretraining. Agreement in MUAC classification between caregiver and study staff was high (>92% agreement at all time points). Caregivers' knowledge and confidence scores in clinical surveillance were significantly greater in the monthly follow-up group compared with the weekly follow-up group at all time points. DISCUSSION: These findings confirm caregiver training increases knowledge and confidence in at-home clinical and anthropometric surveillance in the management of children with uncomplicated SAM, encouraging the continued consideration for task-shifting models in the community-based management of SAM in similar settings. TRIAL REGISTRATION NUMBER: NCT03140904
Anthropometry · Clinical trial · Cluster randomised controlled trial · Confidence interval · Randomized controlled trial · Child Nutrition and Water Access · Global Maternal and Child Health · Health Education and Validation
Management of severe acute malnutrition in children
Community Health Workers in Low-, Middle-, and High-Income Countries
Involving men to improve maternal and newborn health
Strategies for improving health care seeking for maternal and newborn illnesses in low- and middle-income countries
Feasibility of engaging caregivers in at‐home surveillance of children with uncomplicated severe acute malnutrition
Burden and risk factors for relapse following successful treatment of uncomplicated severe acute malnutrition in young children
Barriers to access for severe acute malnutrition treatment services in Pakistan and Ethiopia
Determinants of coverage in Community‐based Therapeutic Care programmes
| Citation velocity | historical |
|---|---|
| Highly cited | No |