Research Projects

Severe acute malnutrition

Operational experience on the use of mid upper arm circumference for the admission, monitoring and discharge of children under treatment for uncomplicated severe acute malnutrition in Madaoua, Niger

 
The non-randomized intervention study will provide evidence for the simplification of international nutritional protocols using mid upper arm circumference alone (MUAC) vs. the standard protocol using both weight-for-height and MUAC for the admission, monitoring and discharge of children with uncomplicated severe acute malnutrition. A total of 6,100 infants aged 6-59 months will be included over 12 months at two treatment sites in Madaoua, Niger. Program outcomes, including recovery, default, hospitalization and death, as well as coverage, the risk of relapse at 3 months will be evaluated.
 
Médecins Sans Frontières (MSF)-Spain research grant

Development of an incidence correction factor to improve estimates of the burden of severe wasting

 
Routine survey, program, and surveillance or cohort data can be used to generate updated and country-specific severe acute malnutrition (SAM) incidence correction factors. Country-specific incidence correction factors to improve estimation of the SAM burden and program planning will be generated. In collaboration with UNICEF, a global call for data to collect survey, program, surveillance or cohort data for analysis will be launched among key stakeholders in the global nutrition community. The country-specific incidence correction factors generated will provide evidence on if, how, and the extent to which the incidence correction factor for SAM varies between countries in order to improve global guidance and program planning tools.
 
Funder: Bill and Melinda Gates Foundation

Evaluation of non-routine use of antibiotic in the outpatient treatment of severely malnourished children without complications in an operational context

 
There is ongoing discussion amongst operational partners regarding the outpatient feeding protocol that uses ready-to-use therapeutic foods (RUTF), as early guidance was based on historical data from inpatient settings where therapeutic milks were used. Historical weight gain data from inpatient settings may not represent weight gain achieved in outpatient settings today, given the difference in presence of complications and type of therapeutic foods used. Therapeutic feeding protocols that provide an excess of energy and nutrients risk overfeeding children and wasting limited resources, while providing too little energy and nutrients can jeopardize weight gain and recovery.
 
Médecins Sans Frontières-France research grant

Assessing the risk of hospital-acquired infection and multi-drug resistance among hospitalized severe acutely malnourished children

 
The goal of this descriptive study is to collect information on the risk of health-care acquired infection in MSF-supported inpatient nutritional treatment centers. Information on key clinical indicators will be collected regularly from the time of admission to discharge. As part of active surveillance for bacterial transmission and colonization, including multi-drug resistant organisms, all children will undergo blood draw and nasal and rectal swabs at the time of admission, suspected infection, and discharge. Data will provide an estimate of HCAI incidence under routine circumstances and inform sample size calculations if further interventional study is warranted.
 
Médecins Sans Frontières-France research grant

Reducing the frequency of follow up and task sharing in the treatment of uncomplicated severe acute malnutrition: an evaluation of monthly visits and home-based surveillance for access-limited and high-burden settings

This is a cluster randomized study to evaluate one of two schedules of treatment: (1) standard weekly visits or (2) monthly visits with support for home-based surveillance in the outpatient treatment of uncomplicated severe acute malnutrition in Nigeria. Distribution of the therapeutic feeding rations, as well as medical and anthropometric surveillance of children being treated for uncomplicated severe acute malnutrition, will take place on a weekly or monthly basis until discharge according to the random assignment of the site. Caregivers in the monthly visit group will receive additional instruction at admission regarding home-based surveillance. Routine program data on the child’s anthropometric and clinical status at scheduled follow-up visits will be collected. All children will receive additional visits within the first two weeks of treatment and 2 months post-discharge to assess the child’s anthropometric status.

Children’s Investment Foundation Fund

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Nutrition and infectious disease

Randomized, double-blind, placebo-controlled phase III clinical trial to assess the efficacy and safety of a pentavalent rotavirus vaccine (BRV-PV) against severe rotavirus gastroenteritis among infants in NigerRandomized, double-blind, placebo-controlled phase III clinical trial to assess the efficacy and safety of a pentavalent rotavirus vaccine (BRV-PV) against severe rotavirus gastroenteritis among infants in Niger

 
The study is as a double-blind, placebo-controlled randomized phase III event-driven trial with two parallel groups of infants in Madarounfa, Niger to assess the efficacy, safety and immunogenicity of BRV-PV, a pentavalent rotavirus vaccine. A total of 7,770 infants aged 6-8 weeks will be individually randomized in a 1:1 ratio using permuted blocks of random sizes to receive three doses BRV-PV or placebo. Episodes of gastroenteritis will be identified through facility- and home-based surveillance until 2 years of age.
 
Médecins Sans Frontières-Switzerland research grant

Linkages between maternal nutrition and child health

Randomized trial of prenatal nutritional supplementation to improve infant immune response to oral vaccines in Niger

 
In recognition of the need to identify potential boosters of immunogenicity in developing countries where oral vaccine efficacy is low, I nested a sub-study of 1320 infants to assess the vaccine immunogenicity within the randomized trial phase III trial designed to evaluate the safety and efficacy and safety an oral rotavirus vaccine. The immunogenicity sub-study was designed as a cluster randomized trial of 3 prenatal nutrient supplements to test the hypothesis that prenatal supplementation with a lipid-based supplement (LNS) improves infant immune response to three doses of vaccine, compared to multiple micronutrients (MMN) and iron-folic acid (IFA), among healthy infants in Niger. 53 villages were randomized in a 1:1:1 ratio to receive daily LNS, MMN, or IFA. A total of 1000 pregnant women per arm received the assigned supplement at home on a weekly basis from the time of pregnancy identification until delivery. All 3000 women provided biological samples (blood, urine, stool, vaginal swab and breast milk) for laboratory analysis of micronutrient and infection status. Additional blood, urine, and stool samples were collected from the 1320 infants.
 
Médecins Sans Frontières-Switzerland research grant

Formative study to assess the acceptability and utilization of preferred fortified balanced energy-protein supplements in Southern Nepal

 
This formative study aims to a) identify preferred product types for the provision of fortified balanced energy-protein (BEP) supplements and 2) assess the 8-week acceptability and at-home consumption of up to 2 supplements among pregnant women in southern Nepal. As recommended in the 2016 WHO antenatal care guidelines, pregnant women in undernourished populations should receive fortified BEP supplements to reduce the risk of stillbirth and small-for-gestational-age birth. However, the guidelines recognize that acceptable supplement forms and delivery channels must be determined for different contexts. This study will therefore assess the acceptability and utilization practices related to the use of selected BEP supplements in southern Nepal.
Role: Co-Investigator
 
Funder: Bill and Melinda Gates Foundation

Designing and testing the impact of a nutritious food supplement during pregnancy for enhancing birth outcomes in Burkina Faso

 
This formative study aims to a) identify preferred product types for the provision of fortified balanced energy-protein (BEP) supplements and 2) assess the 8-week acceptability and at-home consumption of up to 2 supplements among pregnant women (PW) in Burkina Faso. As recommended in the 2016 WHO antenatal care guidelines, pregnant women in undernourished populations should receive fortified BEP supplements to reduce the risk of stillbirth and small-for-gestational-age birth. However, the guidelines recognize that acceptable supplement forms and delivery channels must be determined for different contexts. This study will therefore assess the acceptability and utilization practices related to the use of selected BEP supplements in Burkina Faso.
Role: Co-Investigator
 
Funder: Bill and Melinda Gates Foundation