Effectiveness of nutrition training for mid-level providers (MLPs) on feeding practices and nutrition status of HIV-positive children in Tanga, Tanzania
ISRCTN | ISRCTN65346364 |
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DOI | https://doi.org/10.1186/ISRCTN65346364 |
Secondary identifying numbers | N/A |
- Submission date
- 09/01/2013
- Registration date
- 15/02/2013
- Last edited
- 06/04/2017
- Recruitment status
- No longer recruiting
- Overall study status
- Completed
- Condition category
- Infections and Infestations
Plain English summary of protocol
Background and study aims
Tanzania is one of the countries devastated by dual burden of HIV/AIDS and child undernutrition. About 5.7 % of the general population in Tanzania is living with HIV/AIDS. Meanwhile, 47.8% of children suffer from stunting (reduction in growth rate), or a chronic form of undernutrition. Even under the treatment with antiretroviral therapy, undernutrition rates among HIV-positive children remains high. The country also suffers from a human resource for health crisis: it has a small number of qualified medical personnel. The doctor to patient ratio remains at 1:30,000. Therefore, less qualified health workers including mid-level providers (MLPs) are left to give health care to patients with high burden, especially in rural and suburban areas. These health workers are trained to treat only limited number of ailments and perform specific and less complex surgical procedures. They may not possess adequate skills to manage patients with complex health problems including HIV-positive children suffering from severe undernutrition. Previous studies have reported improvements on child undernutrition when the trained health providers give nutrition counseling to their caregivers. In Tanzania too, nutrition training for MLPs may improve their nutrition knowledge, counseling, and management skills of undernutrition among HIV-positive children. Successful transfer and translation of nutrition knowledge to caregivers through counseling and treatment may have a positive impact on HIV-positive childrens feeding practices and nutrition status. The aim of this study is therefore to examine the effectiveness of nutrition training of MLPs on feeding practices and nutrition status of HIV-positive children attending Care and Treatment Centers (CTCs) in Tanga, Tanzania.
Who can participate?
Mid-level providers working in CTC facilities for HIV/AIDS and pairs of mothers and their HIV-positive children attending such facilities in Tanga, Tanzania.
What does study involve?
Eight Care and Treatment Centers (CTCs) are randomly allocated to either the intervention or the control group. The nutrition training intervention is given to 16 MLPs in the intervention group. The training makes use of the specific local determinants of undernutrition. The trained MLPs provide the tailored nutrition counseling and nutrition follow up to caregivers of HIV-positive children attending the selected CTCs. The total of 400 pairs of caregivers and underfive children are assigned and followed up at the intervention group. Similar number and method are repeated for control group.
What are the possible benefits and risks of participating?
MLPs will have improved knowledge in nutrition, management of undernutrition, and counseling skills for caregivers of children at risk of undernutrition using a tailored approach. HIV-positive children with undernutrition will have better feeding patterns and nutrition status and may be sustained. There is no foreseen risk for participating in this study.
Where is the study run from?
The University of Tokyo, Japan in Collaboration with Dar es Salaam based Muhimbili University of Health and Allied Sciences and School of Public Health University of Massachusetts.
When is the study starting and how long is it expected to run for?
July 2013 to July 2014
Who is funding the study?
1. The University of Tokyo (Japan)
2. Muhimbili University of Health and Allied Sciences (Tanzania)
Who is the main contact?
Masamine Jimba
mjimba@m.u-tokyo.ac.jp
Contact information
Scientific
University of Tokyo
Graduate School of Medicine
Department of Community and Global Health
7-3-1 Hongo, Bunkyo-ku
Tokyo
113-0033
Japan
Phone | +81 (0)3 5841 3697 |
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mjimba@m.u-tokyo.ac.jp |
Study information
Study design | Cluster randomized control trial |
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Primary study design | Interventional |
Secondary study design | Cluster randomised trial |
Study setting(s) | Hospital |
Study type | Quality of life |
Participant information sheet | Not available in web format, please use the contact details to request a patient information sheet |
Scientific title | Effectiveness of nutrition training for mid-level providers (MLPs) on feeding practices and nutrition status of HIV-positive children in Tanga, Tanzania: a cluster randomized control trial |
Study objectives | Undernutrition among Human Immune-Deficiency Virus (HIV)-positive children can be controlled if qualified medical personnel counsel caregivers frequently. Such counseling may be beneficial if they focus on local determinants of undernutrition and specific feeding patterns of locally available foods. However, the number of qualified medical personnel is limited especially in Human Resource for Health (HRH) crisis country like Tanzania. Nutrition training of the available mid-level providers (MLPs) mostly found in rural and suburban areas can help to provide such nutrition counseling. Trained MLPs may improve their own nutrition knowledge, management skills of child undernutrition, nutrition monitoring, and counseling skills for mothers of HIV-positive children attending their centers. Counseled mothers will improve feeding practices of their children. This includes feeding frequency, quality and quantity of diet consumed, and dietary diversity. Secondarily, HIV-positive children may have improved nutrition status, anti-retroviral therapy (ART) profile including adherence, CD4 counts, viral load, and general welfare. |
Ethics approval(s) | 1. Research Ethics Committee of the Graduate School of Medicine of the University of Tokyo, ref: 1007-(1) 2. Research Ethics Committee of Muhimbili University of Health and Allied Sciences in Tanzania, 11/02/2013, ref: MU/DRP/AEC/Vol.XVI/88 |
Health condition(s) or problem(s) studied | Child nutrition/HIV/AIDS |
Intervention | In-service training will be conducted on prevention, diagnosing, and management of undernutrition based on the identified local determinants of undernutrition at the formative research. The training method will be adopted from the standard IMCI nutrition module and Nutrition Assessment and Counseling (NACs) modules. The trained MLPs will provide tailored nutrition counseling and management of undernutrition to HIV-positive children attending the CTCs intervention sites. After the completion of the study, a similar intervention will be made available for the control group after evaluation of results. The tailored nutrition counseling and management of undernutrition will be provided by MLPs when patients attend CTCs on a monthly basis. Such intervention will continue and be monitored for the entire study duration. |
Intervention type | Other |
Primary outcome measure | Feeding practices of HIV-positive children attending CTC in Tanga, Tanzania. This includes: 1. Feeding frequency 2. Dietary diversity 3. Quality, and quantity of diets fed to children Measured at baseline, and monthly for one year |
Secondary outcome measures | 1. Nutrition status (weight, height, and mid upper arm circumference) 2. ART profile (adherence, viral load, CD4 count, opportunistic infections) Measured at baseline, and monthly for one year |
Overall study start date | 01/07/2013 |
Completion date | 30/07/2014 |
Eligibility
Participant type(s) | Patient |
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Age group | Child |
Lower age limit | 6 Months |
Upper age limit | 14 Years |
Sex | Both |
Target number of participants | A total of 400 pairs of caregivers and their HIV-positive children attending CTC for intervention and 400 pairs for control group. |
Key inclusion criteria | Current inclusion criteria as of 16/07/2013: Children: 1. Aged 6 months to 14 years, either sex 2. Diagnosed of HIV / acquired immune deficiency syndrome (AIDS); registered at Care and Treatment Centers (CTC) for treatment or care Caregivers: Who takes care of the child on a routine basis MLP; classified as Assistant Medical Officers (AMO), Clinical Officers (CO), Nurse assistant Previous inclusion criteria: Children: 1. Aged 6 months to 5 years, either sex 2. Diagnosed of HIV / acquired immune deficiency syndrome (AIDS); registered at Care and Treatment Centers (CTC) for treatment or care Caregivers: Who takes care of the child on a routine basis MLP; classified as Assistant Medical Officers (AMO), Clinical Officers (CO), Nurse assistant |
Key exclusion criteria | 1. Children too sick to participate in the interview 2. Refusal to participate by caregiver 3. MLP who are not under formal WHO classification |
Date of first enrolment | 01/07/2013 |
Date of final enrolment | 30/07/2014 |
Locations
Countries of recruitment
- Japan
- Tanzania
Study participating centre
113-0033
Japan
Sponsor information
University/education
Department of Community and Global Health
Graduate School of Medicine
7-3-1 Hongo, Bunkyo-ku
Tokyo
113-0033
Japan
Phone | +81 (0)3 5841 3697 |
---|---|
mjimba@m.u-tokyo.ac.jp | |
Website | http://www.ich.m.u-tokyo.ac.jp/en/index.html |
https://ror.org/057zh3y96 |
Funders
Funder type
University/education
Government organisation / Local government
- Alternative name(s)
- The University of Tokyo, 東京大学憲, 도쿄대학, 东京大学设, Utokyo
- Location
- Japan
No information available
Results and Publications
Intention to publish date | |
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Individual participant data (IPD) Intention to share | No |
IPD sharing plan summary | Not provided at time of registration |
Publication and dissemination plan | Not provided at time of registration |
IPD sharing plan |
Study outputs
Output type | Details | Date created | Date added | Peer reviewed? | Patient-facing? |
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Protocol article | protocol | 25/10/2013 | Yes | No | |
Results article | results | 04/04/2017 | Yes | No |
Editorial Notes
06/04/2017: Publication reference added.