Journal Article > CommentaryFull Text
Lancet Child Adolesc Health. 23 March 2025; Online ahead of print; DOI:10.1016/S2352-4642(25)00062-8
Vonasek BJ, Marcy O, Armour J, Casenghi M, Cazes C, et al.
Lancet Child Adolesc Health. 23 March 2025; Online ahead of print; DOI:10.1016/S2352-4642(25)00062-8
Each day more than 500 children younger than 15 years die from tuberculosis. Considerable progress has been made to control tuberculosis, but the impact on reducing the burden of childhood tuberculosis lags behind that in adults. A key barrier to decreasing morbidity and mortality associated with childhood tuberculosis is the paucity of accurate and feasible diagnostic tools for this population. WHO estimates that 58% of children younger than 5 years with tuberculosis are never diagnosed or reported.
Conference Material > Poster
Cazes C, Alitanou R, Phelan KPQ, Hubert V, Kalenga Tshiala B, et al.
MSF Scientific Day International 2023. 7 June 2023; DOI:10.57740/y209-ga31
Conference Material > Poster
Cazes C, Sirna F, Phelan KPQ, Hubert V, Tshiala BK, et al.
MSF Scientific Days International 2022. 9 May 2022; DOI:10.57740/cbcx-vk63
Conference Material > Poster
Cazes C, Phelan KPQ, Hubert V, Boubacar H, Tshibangu G, et al.
MSF Scientific Days International 2021: Research. 18 May 2021
Conference Material > Video
Cazes C
MSF Scientific Days International 2021: Research. 19 May 2021
Conference Material > Abstract
Cazes C, Phelan KPQ, Hubert V, Boubacar H, Bozama LI, et al.
MSF Scientific Days International 2021: Research. 19 May 2021
INTRODUCTION
The Optimising MAlnutrition treatment (OptiMA) strategy aims to simplify current malnutrition treatment protocols for children with mid-upper arm circumference (MUAC)<125mm or oedema, by supplementing with one product—ready-to-use therapeutic food (RUTF), using gradually reducing doses as a child’s weight and MUAC increases.
METHODS
This non-inferiority, randomized controlled trial was conducted in Kasai province, Democratic Republic of Congo (DRC). It compared the OptiMA strategy with the effective standard DRC protocol, using increasing weight doses of RUTF for treating severe acute malnutrition (SAM) and ready to use supplementary food (RUSF) at fixed dose for moderate acute malnutrition. Children aged 6–59 months with MUAC<125mm or weight-for-height Z score<−3 or oedema, and without medical complications, were randomized to either OptiMA or the standard protocol, and followed up for six months. Primary outcome was a composite indicator at 6 months’ follow-up: child alive, not acutely malnourished per the study definition, and without any additional episode of acute malnutrition throughout the observation period. Non-inferiority was determined if the upper boundary of the 95% confidence interval (CI) for the difference between randomized arms in the proportion of children with favourable outcome was less than 10%, for both intention-to-treat (ITT) and per-protocol (PP) analyses. Superiority was determined if the upper boundary of the 95% CI for this difference was lower than 0%.
ETHICS
This study was approved by the National Congolese Health Ethics Committee and by the Ethics Evaluation Committee of Inserm, the French National Institute for Health and Medical Research. ClinicalTrials.gov number, NCT03751475.
RESULTS
Between July 2019 and July 2020, 981 children were enrolled. 896 children were included in ITT analysis, with 450 in the OptiMA arm and 446 standard; 792 were included in PP analysis. Over the entire follow-up, 450 (100%) children under OptiMA received RUTF treatment while under the standard protocol, 315 (71%) received RUTF or RUSF or both. ITT analysis found that 325 (72.2%) children had favourable outcome under OptiMA versus 282 (63.2%) in the standard arm (difference: -9.2%, 95%CI -15.9% to -2.0%). Under OptiMA, weight gain was greater (median weight gain, 1700g versus 1600g, p= 0.003), the nutritional treatment consumption lower (median of 64 of RUTF versus 102 sachets of RUTF/RUSF under standard; p= 0.018). Median time to recovery (i.e., MUAC>124mm without oedema for two consecutive visits) was lower under OptiMA than under standard: 5 weeks (95%CI 5–5) versus 9 weeks (95%CI 8–10), p<0.001. We did not observe a difference in hospitalization rates (10% OptiMA, 7% standard, p=0.228) or mortality rates (0.2% in both arms).
CONCLUSION
OptiMA led to better anthropometric status over a six-month period and expanded access to treatment, whilst the standard protocol partially addressed global acute malnutrition with higher consumption of nutritional products used in the trial. Our findings suggest it may be beneficial to address global acute malnutrition in one program using one product at a gradually adjusted dose.
CONFLICTS OF INTEREST
None declared.
The Optimising MAlnutrition treatment (OptiMA) strategy aims to simplify current malnutrition treatment protocols for children with mid-upper arm circumference (MUAC)<125mm or oedema, by supplementing with one product—ready-to-use therapeutic food (RUTF), using gradually reducing doses as a child’s weight and MUAC increases.
METHODS
This non-inferiority, randomized controlled trial was conducted in Kasai province, Democratic Republic of Congo (DRC). It compared the OptiMA strategy with the effective standard DRC protocol, using increasing weight doses of RUTF for treating severe acute malnutrition (SAM) and ready to use supplementary food (RUSF) at fixed dose for moderate acute malnutrition. Children aged 6–59 months with MUAC<125mm or weight-for-height Z score<−3 or oedema, and without medical complications, were randomized to either OptiMA or the standard protocol, and followed up for six months. Primary outcome was a composite indicator at 6 months’ follow-up: child alive, not acutely malnourished per the study definition, and without any additional episode of acute malnutrition throughout the observation period. Non-inferiority was determined if the upper boundary of the 95% confidence interval (CI) for the difference between randomized arms in the proportion of children with favourable outcome was less than 10%, for both intention-to-treat (ITT) and per-protocol (PP) analyses. Superiority was determined if the upper boundary of the 95% CI for this difference was lower than 0%.
ETHICS
This study was approved by the National Congolese Health Ethics Committee and by the Ethics Evaluation Committee of Inserm, the French National Institute for Health and Medical Research. ClinicalTrials.gov number, NCT03751475.
RESULTS
Between July 2019 and July 2020, 981 children were enrolled. 896 children were included in ITT analysis, with 450 in the OptiMA arm and 446 standard; 792 were included in PP analysis. Over the entire follow-up, 450 (100%) children under OptiMA received RUTF treatment while under the standard protocol, 315 (71%) received RUTF or RUSF or both. ITT analysis found that 325 (72.2%) children had favourable outcome under OptiMA versus 282 (63.2%) in the standard arm (difference: -9.2%, 95%CI -15.9% to -2.0%). Under OptiMA, weight gain was greater (median weight gain, 1700g versus 1600g, p= 0.003), the nutritional treatment consumption lower (median of 64 of RUTF versus 102 sachets of RUTF/RUSF under standard; p= 0.018). Median time to recovery (i.e., MUAC>124mm without oedema for two consecutive visits) was lower under OptiMA than under standard: 5 weeks (95%CI 5–5) versus 9 weeks (95%CI 8–10), p<0.001. We did not observe a difference in hospitalization rates (10% OptiMA, 7% standard, p=0.228) or mortality rates (0.2% in both arms).
CONCLUSION
OptiMA led to better anthropometric status over a six-month period and expanded access to treatment, whilst the standard protocol partially addressed global acute malnutrition with higher consumption of nutritional products used in the trial. Our findings suggest it may be beneficial to address global acute malnutrition in one program using one product at a gradually adjusted dose.
CONFLICTS OF INTEREST
None declared.
Conference Material > Poster
Cazes C, Phelan KPQ, Hubert V, Boubacar H, Tshibangu G, et al.
MSF Scientific Days International 2021: Research. 18 May 2021
Conference Material > Abstract
Daures M, Phelan KPQ, Issoufou M, Kouanda S, Sawadogo O, et al.
MSF Scientific Days International 2020: Research. 26 May 2020
INTRODUCTION
The Optimizing Treatment for Acute Malnutrition (OptiMA) strategy trains mothers to use mid-upper arm circumference (MUAC) bracelets for screening, and targets treatment to children with MUAC<125mm or oedema, with one product, ready-to-use therapeutic food (RUTF), at a gradually tapering dose, based on child weight and MUAC status. We aimed to determine incidence of relapse and associated factors among children who recovered under the OptiMA protocol.
METHODS
We conducted a prospective cohort study among all children who recovered from malnutrition under OptiMA at randomly selected health centers between April and November 2017. A one-stage clustered and stratified sampling design randomly selected 12 of the 54 health centers where the OptiMA strategy was implemented. Recovered children were then seen at home by community health workers every two weeks for three months. Relapse was defined as a child who initially recovered after OptiMA management but subsequently had a MUAC<125mm at any home visit. Overall incidence of relapse, and by MUAC category at admission and discharge, was calculated with 95% confidence intervals (CI). Multivariable survival analysis was run using a shared frailty model, using a random effect on health facilities to identify associated factors.
ETHICS
This study was approved by the Ethics Committee for Health Research, Burkina Faso.
Results
Of 758 eligible children, 118 (15.6%) were lost to follow-up. 640 (84.5%) children were analysed, with a global incidence of relapse (MUAC<125mm at three months post-recovery) of 6.9% (95%CI 5.1-8.8), including 0.5% (95%CI 0.1-1.0) who relapsed with MUAC<115mm. Median time to relapse was 42 days (interquartile range 28.0-59.5). Most children (84.4%) relapsed with a MUAC of 120-124mm. Relapse was positively associated with low MUAC at discharge, adjusted hazard ratio (aHR) 2.75 (95%CI 1.11-6.83) for MUAC 126-128mm, and aHR 5.54 (95%CI 1.98-15.52) for MUAC=125mm, as compared to children with MUAC>=129mm. Relapse was also associated with having been hospitalised at any point during treatment, aHR 1.98 (95%CI 0.93-4.23).
CONCLUSIONS
Incidence of relapse following recovery under OptiMA was relatively low in this context, but the lack of a standard relapse definition does not allow comparison with other settings. The decrease in incidence of relapse among children with MUAC>=129mm at exit is in line with previous studies showing that MUAC>130mm at discharge reduced risk of mortality one year post-recovery. This finding challenges definition of the threshold for discharge under OptiMA, and standard protocols, of 125mm. Re-training caretakers at discharge to screen their children for relapse by MUAC at home could also be more effective at detecting early relapse, and less costly, than home visits by CHWs. One limitation to this study is the high percentage of children lost to follow up could impact on validity of the results. Further work is needed to define the most effective MUAC discharge threshold.
CONFLICTS OF INTEREST
KP serves on the Social Purposes Advisory Commission of Nutriset, a producer of lipid-based nutrient supplement products. Other authors declare no conflicts of interest.
The Optimizing Treatment for Acute Malnutrition (OptiMA) strategy trains mothers to use mid-upper arm circumference (MUAC) bracelets for screening, and targets treatment to children with MUAC<125mm or oedema, with one product, ready-to-use therapeutic food (RUTF), at a gradually tapering dose, based on child weight and MUAC status. We aimed to determine incidence of relapse and associated factors among children who recovered under the OptiMA protocol.
METHODS
We conducted a prospective cohort study among all children who recovered from malnutrition under OptiMA at randomly selected health centers between April and November 2017. A one-stage clustered and stratified sampling design randomly selected 12 of the 54 health centers where the OptiMA strategy was implemented. Recovered children were then seen at home by community health workers every two weeks for three months. Relapse was defined as a child who initially recovered after OptiMA management but subsequently had a MUAC<125mm at any home visit. Overall incidence of relapse, and by MUAC category at admission and discharge, was calculated with 95% confidence intervals (CI). Multivariable survival analysis was run using a shared frailty model, using a random effect on health facilities to identify associated factors.
ETHICS
This study was approved by the Ethics Committee for Health Research, Burkina Faso.
Results
Of 758 eligible children, 118 (15.6%) were lost to follow-up. 640 (84.5%) children were analysed, with a global incidence of relapse (MUAC<125mm at three months post-recovery) of 6.9% (95%CI 5.1-8.8), including 0.5% (95%CI 0.1-1.0) who relapsed with MUAC<115mm. Median time to relapse was 42 days (interquartile range 28.0-59.5). Most children (84.4%) relapsed with a MUAC of 120-124mm. Relapse was positively associated with low MUAC at discharge, adjusted hazard ratio (aHR) 2.75 (95%CI 1.11-6.83) for MUAC 126-128mm, and aHR 5.54 (95%CI 1.98-15.52) for MUAC=125mm, as compared to children with MUAC>=129mm. Relapse was also associated with having been hospitalised at any point during treatment, aHR 1.98 (95%CI 0.93-4.23).
CONCLUSIONS
Incidence of relapse following recovery under OptiMA was relatively low in this context, but the lack of a standard relapse definition does not allow comparison with other settings. The decrease in incidence of relapse among children with MUAC>=129mm at exit is in line with previous studies showing that MUAC>130mm at discharge reduced risk of mortality one year post-recovery. This finding challenges definition of the threshold for discharge under OptiMA, and standard protocols, of 125mm. Re-training caretakers at discharge to screen their children for relapse by MUAC at home could also be more effective at detecting early relapse, and less costly, than home visits by CHWs. One limitation to this study is the high percentage of children lost to follow up could impact on validity of the results. Further work is needed to define the most effective MUAC discharge threshold.
CONFLICTS OF INTEREST
KP serves on the Social Purposes Advisory Commission of Nutriset, a producer of lipid-based nutrient supplement products. Other authors declare no conflicts of interest.
Conference Material > Slide Presentation
Cazes C, Phelan KPQ, Hubert V, Boubacar H, Bozama LI, et al.
MSF Scientific Days International 2021: Research. 19 May 2021