Modelling an alternative nutrition protocol generalizable for outpatient (MANGO)

ISRCTN ISRCTN50039021
DOI https://doi.org/10.1186/ISRCTN50039021
Secondary identifying numbers N/A
Submission date
13/04/2016
Registration date
13/05/2016
Last edited
09/07/2024
Recruitment status
No longer recruiting
Overall study status
Completed
Condition category
Nutritional, Metabolic, Endocrine
Prospectively registered
Protocol
Statistical analysis plan
Results
Individual participant data

Plain English summary of protocol

Background and study aims
Severe acute malnutrition in children under 5 is defined by being too thin for a given height and/or having the left arm circumference less than a given threshold (i.e. measuring how fat or thin the arm is), and/or having swollen feet (malnutrition oedema). It affects 19 million children under five at any point in time, and is likely to result in death if left untreated. Children can be treated in the hospital as in inpatient (hospitalized, for example, due to medical complications) or as outpatients, coming once a week to the closest health centre for monitoring and to receive treatment that they take at home. A very effective ambulatory (outpatient) treatment has been in place for several years and involves giving each patient an antibiotic and a therapeutic food made of peanut paste, vegetable oil, powdered milk, sugar, vitamins and minerals. The amount given to each child is matched to their individual nutritional needs. The treatment does work, however the children do gain less weight than expected. There have been reports that this may be partly due to the therapeutic food being shared with the family and it being sold on the market. It is also possible that malnourished children in the process of recovery may need less therapeutic food than currently provided. This study will test out this theory by giving children treated as outpatients a lesser amount of the therapeutic food to see whether they still gain the weight. Other effects of the treatment from admission to discharge will also be measured, including duration of the treatment, the recovery, how many stick with the treatment, how many are admitted to hospital, death and relapse rates from the nutritional programme, the changes in anthropometry (weight, height, arm circumference, leg length), average energy intake after 4 weeks of treatment, micronutrient blood status changes (that is, levels of nutrients in the blood), hair changes, body fat and lean masses changes. The cost of treatment will also be calculated and compared with costs for children given the more standard amount of therapeutic food.

Who can participate?
Children aged 6 to 59 months, diagnosed with severe acute malnutrition, without malnutrition oedema, without medical complications and having passed successfully an appetite test.

What does the study involve?
The children are randomly allocated to one of two groups. Those in group 1 are given the standard amount of therapeutic food. Those in group 2 are given the reduced amount of therapeutic food. For the first two weeks of treatment, all children are given the same amount. From week three, however, children in group 2 are given a reduced amount until their discharge from care. All children are also given the same basic medical treatment for the management of severe acute malnutrition.

What are the possible benefits and risks of participating?
All children will benefit of getting treatment for malnutrition. However, children in both groups may not gain a lot of weight, if any at all. They may also suffer from fever, diarrhea, cough, etc. which are all danger signs that means they have to be referred to hospital for treatment under 24-hour care, as per standard protocol. For the reduced dosage group, referral will be considered towards returning to a standard dosage, or to hospital, depending of the clinical assessment.

Where is the study run from?
The study will be run in 10 health centres of Fada N’Gourma district, located in the Eastern Region of Burkina Faso.

When is the study starting and how long is it expected to run for?
September 2015 to December 2017

Who is funding the study?
1. Children's Investment Fund Foundation (CIFF)
2. European Commission's Humanitarian aid and Civil Protection Department (ECHO)
3. Humanitarian Innovation Fund (HIF)

Who is the main contact?
Mrs Cécile Salpéteur (public)
csalpeteur@actioncontrelafaim.org

Contact information

Mrs Cécile Salpéteur
Public

Action contre la Faim France
14/16 Boulevard de Douaumont
CS 80060
Paris
75854
France

Phone +33 1 70 84 73 49
Email csalpeteur@actioncontrelafaim.org

Study information

Study designRandomized controlled non-inferiority trial using individual randomization to allocate patients to either the intervention arm or control arm.
Primary study designInterventional
Secondary study designRandomised controlled trial
Study setting(s)GP practice
Study typeTreatment
Participant information sheet Not available in web format, please use the contact details below to request a patient information sheet
Scientific titleModelling an Alternative Nutrition Protocol Generalizable for Outpatient (MANGO) - effectiveness of an optimized dosage of RUTF for the treatment of severe acute malnutrition: a randomized controlled, non-inferiority trial in Burkina Faso
Study acronymMANGO Project
Study objectivesThe proposed study hypothesizes that a reduced dose of RUTF starting at the third week of treatment among severely acutely malnourished children would result in equal weight gain and recovery from malnutrition as when children are receiving a full dose of RUTF throughout the treatment period. This hypothesis is based on the assumption that the full dose of RUTF is not consumed entirely by the malnourished child but shared with other family members or even sold. This assumption is based on various field observations and backed up by program data indicating a slower recovery than expected when considering the energy provided by the RUTF.
Ethics approval(s)Ethical Committee on Health research of the Ministry of Health of Burkina Faso, 02/12/2015, ref: 2015-12-01
Health condition(s) or problem(s) studiedNon-complicated severe acute malnutrition among children 6-59 months.
InterventionThe intervention tested is restricted to the nutritional treatment of malnourished children involving ready-to use therapeutic foods (RUTFs). The nutritional treatment protocol will be different between the 2 study groups. For the first 2 weeks of treatment, both the intervention and the control arm receive a standard dose of RUTF as per national protocol. However, from the third week onwards the intervention arm will receive a reduced dose while the control arm will continue on the full dose of RUTF. This will continue until discharge. The basic medical treatment of the children will be the same between the 2 groups and will follow the recommendations for the management of severe acute malnutrition as per the national protocol. The nutritional treatment scheme for the 2 groups is described below.

Ration scheme

Normal dose RUTF:
Week 1 to discharge
Weight (kg) Sachets/wk Kcal/kg/d
3.0-3.4 8 168-190
3.5-4.9 10 183-204
5.0-6.9 15 155-214
7.0-9.9 20 144-204
10.0-14.9 30 144-214

Optimised dose RUTF:
Week 1-2 Week 3 to discharge
Weight (kg) Sachets/wk Kcal/kg/d Sachets/wk Kcal/kg/d
3.0-3.4 8 168-190 7 147-167
3.5-4.9 10 183-204 7 102-143
5.0-6.9 15 155-214 7 72-100
7.0-9.9 20 144-204 14 101-143
10.0-14.9 30 144-214 14 67-100
Intervention typeOther
Primary outcome measureChildrens rate of weight gain (g/kg/d) during treatment, measured at admission, upon weekly visits, and at discharge.
Secondary outcome measures1. Duration of treatment (days) until recovery
2. Recovery rate, defaulter rate, mortality rate and transfer to hospital rate, measured monthly
3. Growth velocity and change in anthropometry (weight for height, height for age, weight for age, Mid Upper Arm Circumference), measured on a weekly basis from admission to discharge, and with monthly follow-up measurements during 4 months
4. Relapse rate 4 months after discharge
5. Cost-effectiveness ratio of the intervention to rehabilitate one child
6. Average energy intake (kcal/d) of the child during treatment week number 4
7. Level of vitamin A, iron and inflammation markers in the blood, measured at admission and discharge dates
8. Body composition status at admission and discharge, measuring bio-impedancemetry
9. Level of leptin in the blood, measured at admission, and discharge
10. Catabolism markers in hair, measured at admission, and last follow-up 4 months after discharge
Overall study start date01/01/2015
Completion date01/02/2019

Eligibility

Participant type(s)Patient
Age groupChild
Lower age limit6 Months
Upper age limit59 Months
SexBoth
Target number of participants750 severely acute malnourished children, with 375 in each arm
Total final enrolment801
Key inclusion criteria1. Children aged 6 to 59 months
2. Diagnosed with uncomplicated SAM and eligible for CMAM treatment, defined as WHZ <-3 and/or MUAC <115mm
3. No pitting bilateral oedema
4. No medical complications
5. Passed a standardized appetite test
Key exclusion criteria1. Severe anaemia defined as haemoglobin concentration < 4g/dl
2. Plans to leave the catchment area within the next 6 months
3. Known peanut and/or milk allergy
4. Treatment for SAM already received within the last 6 months, including re-admissions after defaulting, relapses, and medical transfers
5. Malformations or handicap which may affect food intake such as cleft palate, cerebral palsy or Down’s syndrome
Date of first enrolment17/10/2016
Date of final enrolment20/07/2018

Locations

Countries of recruitment

  • Burkina Faso

Study participating centre

Health centres located in Health district of Fada N’Gourma, East of Burkina Faso
N/A
Burkina Faso

Sponsor information

ACF France
Other

c/o Mrs Myriam Aït Aïssa, Research Senior Advisor
14/16 Boulevard Douaumont
CS 80060
Paris
75854
France

Phone +33 1 70 84 70 70
Email maitaissa@actioncontrelafaim.org
Website http://www.actioncontrelafaim.org/
ROR logo "ROR" https://ror.org/035j0tq82

Funders

Funder type

Charity

Children's Investment Fund Foundation (CIFF)

No information available

European Commission's Humanitarian aid and Civil Protection Department (ECHO)

No information available

Humanitarian Innovation Fund (HIF)

No information available

Results and Publications

Intention to publish date01/06/2019
Individual participant data (IPD) Intention to shareYes
IPD sharing plan summaryAvailable on request
Publication and dissemination planThe results of this trial will be published in peer-reviewed scientific journals and presented at international conferences and at a national level from 2018 onwards.
IPD sharing planThe datasets generated during and/or analysed during the current study are/will be available upon request from Cécile Salpéteur (csalpeteur@actioncontrelafaim.org)

Study outputs

Output type Details Date created Date added Peer reviewed? Patient-facing?
Results article results 27/08/2019 16/12/2019 Yes No
Results article results 01/11/2020 12/02/2021 Yes No
Results article results 01/11/2020 12/02/2021 Yes No
Results article results 11/02/2021 12/02/2021 Yes No
Results article 23/02/2021 11/08/2021 Yes No
Results article 01/06/2021 11/08/2021 Yes No
Protocol (other) 02/09/2022 No No
Statistical Analysis Plan 02/09/2022 No No
Other publications predictors of time to recovery and non-response 31/05/2022 09/07/2024 Yes No
Other publications sub-study vitamin B12 status 08/08/2023 09/07/2024 Yes No

Editorial Notes

09/07/2024: Publication references added.
02/09/2022: Protocol and statistical analysis plan added.
11/08/2021: Publication references added, contact details updated.
12/02/2021: Publication references added.
16/12/2019: The following changes were made to the trial record:
1. Publication reference added.
2. The total final enrolment was added.
3. The address of Suvi Kangas was updated.
4. The plain English summary was updated to reflect these changes.
10/09/2018: The following changes have been made:
1. The recruitment end date has been changed from 31/07/2018 to 20/07/2018.
2. The overall trial end date has been changed from 30/04/2018 to 01/02/2019.
3. The intention to publish date has been changed from 31/01/2019 to 01/06/2019.
20/03/2017: Overall trial dates changed from 01/09/2015 - 31/12/2017 to 01/01/2015 - 30/4/2018. Recruitment dates changed from 01/06/2016 - 31/05/2017 to 17/10/2016 - 31/01/2018. Updated contact email. Intention to publish date was changed from 30/06/2018 to 31/01/2019.