SAM Photo Diagnosis App Project

Plain English Summary

Background and study aims
Action against Hunger (ACH) is an international humanitarian organization that fights against the causes and effects of hunger. We save lives of malnourished children and guarantee families access to safe water, food, training and basic health care. The SAM Photo Diagnosis App® project has developed an innovative easy-to-use smartphone tool which can quick and accurately diagnose nutritional status in children aged 6-59 months by means of a photo (body shape analysis). Our innovation responds to the need to improve screening, diagnosis and management of malnutrition, providing a unique opportunity to address it at scale at community level.
Despite significant progress over recent decades, maternal and child undernutrition remains a significant problem throughout the developing world, with 45% of deaths of children younger than five years old attributed to malnutrition. Acute malnutrition (wasting) in children is the life-threatening result of hunger and/or disease. Children suffering from acute malnutrition face an increased risk of morbidity and mortality, and therefore require urgent treatment to survive. In 2016, over 52 million children under five years of age suffered from acute malnutrition, with almost 17 million of these children experiencing the most severe form. Only 3.2 million children were successfully diagnosed and treated in 2016, leaving over 80% of children in need but unable to access treatment. It is important that health centres are equipped with the tools and expertise they need to be able to diagnose and manage cases of acute malnutrition. By the same token, it’s important that caretakers are also empowered to continue the treatment and regularly monitor the condition until the child is fully recovered.
Historically, two methods of anthropological measurement have been used for the diagnosis of moderate and severe acute malnutrition – weight-for-height (WHZ) and mid-upper arm circumference (MUAC). While these techniques provide an accurate diagnosis of acute malnutrition, there are still significant operational challenges for their use at scale. We have demonstrated that image-based techniques can be applied as an alternative diagnosis approach.
This project reinforces decentralization and sustainability of community management of malnutrition by empowering caretakers to diagnose and monitor the nutrition status of their children. It also presents a great opportunity for governments and local health systems to revolutionize nutrition assessments and improve the impact and coverage of nutrition programs.

Who can participate?
Children aged 6-59 months with severe acute malnutrition

What does the study involve?
Phase 1 is the pilot phase. This phase is complete and involved developing an innovative smartphone tool which could quick and accurately diagnose nutritional status, by analysing the child’s body shape registered in photos taken by the device. The development of the algorithm required taking photographs of a sample of well-nourished children in Spain and well-nourished and malnourished children in Senegal. The sample was composed of 107 Spanish children, 154 Senegalese well-nourished children and 142 Senegalese children with severe acute malnutrition. Overall, the Phase 1 project collected over 2,060 images across the sample of children in the study. These images captured the full body photos in different views and allowed the study of both the whole body and split body regions. These images provided the information needed to generate the templates used for diagnosis.
Phase 2 involves adapting the technology to the users. Here the aim is to reinforce both dimensions of the App as a research and diagnostic tool. At conception, it was recognised that a second phase of the project would be needed to further develop the tool and expand its use to different contexts and explore further use of the tool at scale. Thus, as both the programming of the App and the first preliminary results were being generated, new research questions and concerns were arising and opening-up potential future App functionality and usability paths to be developed.
Phase 3 will be a scaling up phase and is currently under development.

What are the possible benefits and risks of participating?
Both Spanish and Senegalese children receive a personalised report (written for Spanish children and both written and/or oral for Senegalese children) regarding their nutritional status, as well as important information related to health and nutrition care practices. All malnutrition diagnosis (both under and overnutrition) are reported directly to the families, informing them of next steps. In Senegal, when a MAM or SAM child is identified, they are immediately referred to the health system. All participants families are informed of the associated technology that was going to be created and the important role they were carrying out for that population in risk or suffering malnutrition by allowing their children to participate. They are also informed that such technology would be available for free in the near future for everyone who wishes to use it.
However, the possible risk is that children do not always wish to participate, even if their parents do, especially babies. Children may get tired during the sampling process.

Where is the study run from?
Action Against Hunger (Spain)

When is the study starting and how long is it expected to run for?
November 2015 to December 2021

Who is funding the study?
1. Children's Investment Fund Foundation (UK)
2. World Food Programme (Italy)
3. Grand Challenges Canada (GCC, Canada)
4. Agencia Española de Cooperación (AECID, Spain)

Who is the main contact?
Laura Medialdea Marcos, Principal Researcher
lmedialdea@accioncontraelhambre.org

Contact information

Study information

Eligibility

Locations

Countries of recruitment

• Guatemala
• Senegal
• Spain

Study participating centres

Sponsor information

Children's Investment Fund Foundation
Charity

7 Clifford Street
London
W1S 2FT
United Kingdom

Website	https://ciff.org/
"ROR"	https://ror.org/00jfgrn87

Funders

Funder type

Charity

Results and Publications

Study outputs

Additional files

ISRCTN71157571_PIS_18Oct2018_FRENCH.pdf

Uploaded 02/04/2019

ISRCTN71157571_PIS_18Oct2018_SPANISH.pdf

Uploaded 02/04/2019

Editorial Notes

09/09/2020: Internal review.
07/09/2020: The following changes have been made:
1. The overall trial end date has been changed from 30/06/2020 to 31/12/2021 and the plain English summary updated accordingly.
2. The intervention has been changed.
3. The primary outcome measures have been changed.
4. The condition has been changed from "Acute and chronic malnutrition in children" to "Acute and chronic malnutrition in children aged 6-59 months".
5. The participant inclusion criteria have been changed.
6. The target number of participants has been changed from "Minimum 450. 2 countries (150 Spain, 300 Senegal), nutritional status (normalweight: 150 Spanish, 150 Senegalese; SAM: 150 Senegalese), 2 sexes (50% each group), 2 age groups (50% each group)" to "Phase I: n= 450. 2 countries (150 Spain, 300 Senegal), nutritional status (normalweight: 150 Spanish, 150 Senegalese; SAM: 150 Senegalese). Phase II: n=1800 (1200 Senegal, 600 Guatemala), Senegal= 4 nutritional conditions decribed by WHO (25% each), Guatemala= wasting (presence/absence) + stunting (presence/absence) equally distributed. Phases I & II: 2 sexes (50% each group), 2 age groups (50% each group)".
7. The participant exclusion criteria have been changed.
8. The recruitment end date has been changed from 20/05/2017 to 31/12/2020.
9. The total target enrolment has been changed from 450 to 2250.
10. The total final enrolment number of 258 has been deleted, as this onlyreferred to phase I of the study.
11. Guatemala has been added to the countries of recruitment.
12. Grand Challenges Canada and Agencia Española de Cooperación (AECID) have been added as funders and the plain English summary updated accordingly.
13. The publication and dissemination plan has been updated.
14. The intention to publish date has been changed from 01/01/2019 to 31/12/2020.
09/07/2019: The following changes were made to the trial record:
1. Publication reference added.
2. The total final enrolment was added.
02/04/2019: The participant information sheet has been uploaded.