title: The impact of integrated prevention and treatment on child malnutrition and health: the PROMIS project, a randomized control trial in Burkina Faso and Mali.
abstract: Evidence suggests that both preventive and curative nutrition interventions are needed to tackle child acute malnutrition (AM) in developing countries. In addition to reducing the incidence of AM, providing preventive interventions may also help increase attendance (and coverage) of AM screening, a major constraint in the community-based management of child acute malnutrition (CMAM) model. There is a paucity of evidence-based strategies to deliver integrated preventive and curative interventions effectively and affordably at scale. The aim of the Innovative Approaches for the Prevention of Childhood Malnutrition (PROMIS) study is to assess the feasibility, quality of implementation, effectiveness and cost-effectiveness of an integrated child malnutrition prevention and treatment intervention package implemented through a community-based platform in Mali and a facility-based platform in Burkina Faso.
  
  
  
  The PROMIS intervention entails a comprehensive preventive package offered on a monthly basis to caregivers of children, while children are screened for acute malnutrition (AM). The package consists of behavior change communication on essential nutrition and hygiene actions, and monthly preventive doses of small quantity lipid-based nutrient supplements (SQ-LNS) for children aged 6 to 23.9 months. Positive AM cases are referred to treatment services offered by first-line health services according to the CMAM model. The PROMIS intervention will be evaluated using a mixed methods approach. The impact study encompasses two types of study design: i) repeated cross-sectional surveys conducted at baseline and at endline after 24 months of program implementation and ii) a longitudinal study with a monthly follow-up for 18 months. Primary study impact measures include the incidence and endpoint prevalence of AM, AM screening coverage and treatment compliance. A process evaluation will assess the feasibility and quality of implementation of the intervention guided by country specific program impact pathways (PIPs). Cost-effectiveness analysis will assess the economic feasibility of the intervention.
  
  
  
  The PROMIS study assesses the effectiveness of an innovative model to integrate prevention and treatment interventions for greater and more sustainable impacts on the incidence and prevalence of AM using a rigorous, theory-based randomized control trial approach. This type of programmatic research is urgently needed to help program implementers, policy makers, and investors prioritize, select and scale-up the best program models to prevent and treat AM and achieve the World Health Assembly goal of reducing childhood wasting to less than 5% globally by the year 2025.
  
  
  
  Clinicaltrials.gov NCT02323815 (registered on December 18, 2014) and NCT02245152 (registered on September 16, 2014).
authors.affiliation: International Food Policy Research Institute, 2033 K Street, NW, Washington, DC, 20006, USA. L.Huybregts@cgiar.org.
authors.forename: Lieven
authors.identifier: 0000-0002-3068-2853
authors.initials: L
authors.lastname: Huybregts
authors.affiliation: International Food Policy Research Institute, 2033 K Street, NW, Washington, DC, 20006, USA.
authors.forename: Elodie
authors.initials: E
authors.lastname: Becquey
authors.affiliation: International Food Policy Research Institute, 2033 K Street, NW, Washington, DC, 20006, USA.
authors.forename: Amanda
authors.initials: A
authors.lastname: Zongrone
authors.affiliation: International Food Policy Research Institute, 2033 K Street, NW, Washington, DC, 20006, USA.
authors.forename: Agnes
authors.initials: A
authors.lastname: Le Port
authors.affiliation: Helen Keller International Burkina Faso country office, Ouagadougou, Burkina Faso.
authors.forename: Regina
authors.initials: R
authors.lastname: Khassanova
authors.affiliation: Helen Keller International Mali country office, Bamako, Mali.
authors.forename: Lazare
authors.initials: L
authors.lastname: Coulibaly
authors.affiliation: International Food Policy Research Institute, 2033 K Street, NW, Washington, DC, 20006, USA.
authors.forename: Jef L
authors.initials: JL
authors.lastname: Leroy
authors.affiliation: International Food Policy Research Institute, 2033 K Street, NW, Washington, DC, 20006, USA.
authors.forename: Rahul
authors.initials: R
authors.lastname: Rawat
authors.affiliation: International Food Policy Research Institute, 2033 K Street, NW, Washington, DC, 20006, USA.
authors.forename: Marie T
authors.initials: MT
authors.lastname: Ruel
mesh_terms: D002050:Burkina Faso / Q000453:epidemiology; D002648:Child; D015362:Child Nutrition Disorders / Q000453:epidemiology / Q000517:prevention & control*; D002675:Child, Preschool; D003362:Cost-Benefit Analysis; D003430:Cross-Sectional Studies; D003906:Developing Countries; D019587:Dietary Supplements; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D006266:Health Education / Q000379:methods*; D006284:Health Plan Implementation / Q000379:methods; D006801:Humans; D006920:Hygiene; D015994:Incidence; D007223:Infant; D008137:Longitudinal Studies; D008297:Male; D008302:Mali / Q000453:epidemiology; D008403:Mass Screening / Q000379:methods*; D009752:Nutritional Status; D010043:Outcome and Process Assessment, Health Care / Q000379:methods*; D010349:Patient Compliance; D015995:Prevalence; D015397:Program Evaluation / Q000379:methods*
keywords: Behavior change communication; Child malnutrition; Prevention; Research protocol; Small quantity lipid-based nutrient supplement