Effectiveness of nutrition training for mid-level providers (MLPs) on feeding practices and nutrition status of HIV-positive children in Tanga, Tanzania

ISRCTN ISRCTN65346364
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
Prospectively registered
Protocol
Statistical analysis plan
Results
Individual participant data

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 children’s 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

Prof Masamine Jimba
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
Email mjimba@m.u-tokyo.ac.jp

Study information

Study designCluster randomized control trial
Primary study designInterventional
Secondary study designCluster randomised trial
Study setting(s)Hospital
Study typeQuality of life
Participant information sheet Not available in web format, please use the contact details to request a patient information sheet
Scientific titleEffectiveness 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 objectivesUndernutrition 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) studiedChild nutrition/HIV/AIDS
InterventionIn-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 typeOther
Primary outcome measureFeeding 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 measures1. 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 date01/07/2013
Completion date30/07/2014

Eligibility

Participant type(s)Patient
Age groupChild
Lower age limit6 Months
Upper age limit14 Years
SexBoth
Target number of participantsA total of 400 pairs of caregivers and their HIV-positive children attending CTC for intervention and 400 pairs for control group.
Key inclusion criteriaCurrent 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 criteria1. 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 enrolment01/07/2013
Date of final enrolment30/07/2014

Locations

Countries of recruitment

  • Japan
  • Tanzania

Study participating centre

University of Tokyo
Tokyo
113-0033
Japan

Sponsor information

University of Tokyo (Japan)
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
Email mjimba@m.u-tokyo.ac.jp
Website http://www.ich.m.u-tokyo.ac.jp/en/index.html
ROR logo "ROR" https://ror.org/057zh3y96

Funders

Funder type

University/education

University of Tokyo
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
School of Public Health and Social Sciences of Muhimbili University of Health and Allied Sciences (Tanzania)

No information available

Results and Publications

Intention to publish date
Individual participant data (IPD) Intention to shareNo
IPD sharing plan summaryNot provided at time of registration
Publication and dissemination planNot provided at time of registration
IPD sharing plan

Study outputs

Output type Details Date created Date added Peer reviewed? Patient-facing?
Protocol article protocol 25/10/2013 Yes No
Results article results 04/04/2017 Yes No

Editorial Notes

06/04/2017: Publication reference added.