Journal Article > CommentaryFull Text
Lancet Global Health. 3 February 2025; Online ahead of print; DOI:10.1016/S2214-109X(24)00509-6
Godard A, Phalkey R, Shepherd S, Rossi S, Tessema MT, et al.
Lancet Global Health. 3 February 2025; Online ahead of print; DOI:10.1016/S2214-109X(24)00509-6
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
Journal Article > ResearchFull Text
PLOS Med. 1 March 2016; Volume 13 (Issue 3); DOI:10.1371/journal.pmed.1001967
Sissoko D, Laouenan C, Folkesson E, M’Lebing A, Beavogui A, et al.
PLOS Med. 1 March 2016; Volume 13 (Issue 3); DOI:10.1371/journal.pmed.1001967
Ebola virus disease (EVD) is a highly lethal condition for which no specific treatment has proven efficacy. In September 2014, while the Ebola outbreak was at its peak, the World Health Organization released a short list of drugs suitable for EVD research. Favipiravir, an antiviral developed for the treatment of severe influenza, was one of these. In late 2014, the conditions for starting a randomized Ebola trial were not fulfilled for two reasons. One was the perception that, given the high number of patients presenting simultaneously and the very high mortality rate of the disease, it was ethically unacceptable to allocate patients from within the same family or village to receive or not receive an experimental drug, using a randomization process impossible to understand by very sick patients. The other was that, in the context of rumors and distrust of Ebola treatment centers, using a randomized design at the outset might lead even more patients to refuse to seek care. Therefore, we chose to conduct a multicenter non-randomized trial, in which all patients would receive favipiravir along with standardized care. The objectives of the trial were to test the feasibility and acceptability of an emergency trial in the context of a large Ebola outbreak, and to collect data on the safety and effectiveness of favipiravir in reducing mortality and viral load in patients with EVD. The trial was not aimed at directly informing future guidelines on Ebola treatment but at quickly gathering standardized preliminary data to optimize the design of future studies.
Journal Article > ResearchFull Text
PLOS Med. 11 September 2017; Volume 14 (Issue 9); DOI:10.1371/journal.pmed.1002387
Fabiansen C, Yameogo CW, Iuel-Brockdorf AS, Cichon B, Rytter MJH, et al.
PLOS Med. 11 September 2017; Volume 14 (Issue 9); DOI:10.1371/journal.pmed.1002387
Children with moderate acute malnutrition (MAM) are treated with lipid-based nutrient supplement (LNS) or corn-soy blend (CSB). We assessed the effectiveness of (a) matrix, i.e., LNS or CSB, (b) soy quality, i.e., soy isolate (SI) or dehulled soy (DS), and (c) percentage of total protein from dry skimmed milk, i.e., 0%, 20%, or 50%, in increasing fat-free tissue accretion.
Journal Article > ResearchFull Text
Sci Rep. 6 August 2020; Volume 10 (Issue 1); DOI:10.1038/s41598-020-69987-9
Fabiansen C, Cichon B, Yaméogo CW, Iuel-Brockdorf AS, Phelan KPQ, et al.
Sci Rep. 6 August 2020; Volume 10 (Issue 1); DOI:10.1038/s41598-020-69987-9
Children with moderate acute malnutrition (MAM) are treated based on low weight-for-length z-score (WLZ), low mid-upper arm circumference (MUAC) or both. This study aimed to assess associations of admission criteria and body composition (BC), to improve treatment of MAM. We undertook a cross-sectional study among 6-23 months old Burkinabe children with MAM. Fat-free (FFM) and fat mass (FM) were determined by deuterium dilution and expressed as FFM (FFMI) and FM index (FMI). Of 1,489 children, 439 (29.5%) were recruited by low MUAC only (MUAC-O), 734 (49.3%) by low WLZ and low MUAC (WLZ-MUAC) and 316 (21.2%) by low WLZ only (WLZ-O). Thus, 1,173 (78.8%) were recruited by low MUAC, with or without low WLZ (ALL-MUAC). After adjustments, WLZ-O had 89 g (95% confidence interval (CI) 5; 172) lower FFM compared to MUAC-O. Similarly, WLZ-O had 0.89 kg/m2 (95% CI 0.77; 1.01) lower FFMI compared to MUAC-O, whereas there was no difference for FMI. However, boys included by WLZ-O compared to MUAC-O had 0.21 kg/m2 (95% CI 0.05; 0.38) higher FMI. In contrast, girls included by WLZ-O had 0.17 (95% CI 0.01; 0.33) kg/m2 lower FMI compared to MUAC-O (interaction, p = 0.002). We found that different criteria for admission into MAM treatment programmes select children with differences in BC, especially FFMI.
Journal Article > ResearchFull Text
PLOS One. 26 November 2012; Volume 7 (Issue 11); e49320.; DOI:10.1371/journal.pone.0049320
Goossens S, Bekele Y, Yun O, Harczi G, Ouannes M, et al.
PLOS One. 26 November 2012; Volume 7 (Issue 11); e49320.; DOI:10.1371/journal.pone.0049320
BACKGROUND
In therapeutic feeding programs (TFP), mid-upper arm circumference (MUAC) shows advantages over weight-for-height Z score (WHZ) and is recommended by the World Health Organization (WHO) as an independent criterion for screening children 6-59 months old. Here we report outcomes and treatment response from a TFP using MUAC ≤118 mm or oedema as sole admission criteria for severe acute malnutrition (SAM).
METHODS
Patient data from September 2007 to March 2009 for children admitted by MUAC ≤118 mm or oedema to a Médecins Sans Frontières (MSF) TFP in Burkina Faso were retrospectively analyzed. Analysis included anthropometric measurements at admission and discharge, program outcomes and treatment response.
RESULTS
Of 24,792 patient outcomes analyzed, nearly half (48.8%; n = 12,090) were admitted with MUAC 116-118 mm. Most patients (88.7%; n = 21,983) were 6-24 months old. At admission, 52.7% (n = 5,041) of those with MUAC 116-118 mm had a WHZ <-3 SD. At discharge, 89.1% (n = 22,094) recovered (15% weight gain or oedema resolution), 7.9% (n = 1,961) defaulted, 1.5% (n = 384) failed to respond to treatment, and 1.0% (n = 260) died. Average weight gain was 5.4 g/kg/day, and average MUAC gain was 0.42 mm/day. Patients with MUAC ≤114 mm at admission had higher average daily weight and MUAC gains at discharge compared to those admitted with MUAC 116-118 mm, but those in the latter category required longer lengths of stay to achieve recovery (P<0.001).
CONCLUSION
This analysis suggests that MUAC ≤118 mm as TFP admission criterion is a useful alternative to WHZ. Regarding treatment response, rates of weight and MUAC gain were acceptable. Applying 15% weight gain as discharge criterion resulted in longer lengths of stay for less malnourished children. Since MUAC gain parallels weight gain, it may be feasible to use MUAC as both an admission and discharge criterion.
In therapeutic feeding programs (TFP), mid-upper arm circumference (MUAC) shows advantages over weight-for-height Z score (WHZ) and is recommended by the World Health Organization (WHO) as an independent criterion for screening children 6-59 months old. Here we report outcomes and treatment response from a TFP using MUAC ≤118 mm or oedema as sole admission criteria for severe acute malnutrition (SAM).
METHODS
Patient data from September 2007 to March 2009 for children admitted by MUAC ≤118 mm or oedema to a Médecins Sans Frontières (MSF) TFP in Burkina Faso were retrospectively analyzed. Analysis included anthropometric measurements at admission and discharge, program outcomes and treatment response.
RESULTS
Of 24,792 patient outcomes analyzed, nearly half (48.8%; n = 12,090) were admitted with MUAC 116-118 mm. Most patients (88.7%; n = 21,983) were 6-24 months old. At admission, 52.7% (n = 5,041) of those with MUAC 116-118 mm had a WHZ <-3 SD. At discharge, 89.1% (n = 22,094) recovered (15% weight gain or oedema resolution), 7.9% (n = 1,961) defaulted, 1.5% (n = 384) failed to respond to treatment, and 1.0% (n = 260) died. Average weight gain was 5.4 g/kg/day, and average MUAC gain was 0.42 mm/day. Patients with MUAC ≤114 mm at admission had higher average daily weight and MUAC gains at discharge compared to those admitted with MUAC 116-118 mm, but those in the latter category required longer lengths of stay to achieve recovery (P<0.001).
CONCLUSION
This analysis suggests that MUAC ≤118 mm as TFP admission criterion is a useful alternative to WHZ. Regarding treatment response, rates of weight and MUAC gain were acceptable. Applying 15% weight gain as discharge criterion resulted in longer lengths of stay for less malnourished children. Since MUAC gain parallels weight gain, it may be feasible to use MUAC as both an admission and discharge criterion.
Journal Article > ResearchAbstract
Appetite. 4 August 2012; Volume 59 (Issue 3); DOI:10.1016/j.appet.2012.07.019
Cohuet S, Marquer C, Shepherd S, Captier V, Langendorf C, et al.
Appetite. 4 August 2012; Volume 59 (Issue 3); DOI:10.1016/j.appet.2012.07.019
Few studies have looked at consumption of Ready-to-Use-Supplementary-Foods (RUSFs) during a nutritional emergency. Here, we describe the use and acceptability of RUSF within households in four districts of the region of Maradi, Niger during large scale preventive distributions with RUSF in 2010 targeted at children 6-35months of age. Our study comprised both quantitative and qualitative components to collect detailed information and to allow in-depth interviews. We performed a cross-sectional survey in 16 villages between two monthly distributions of RUSF (October-November 2010). All households with at least one child who received RUSF were included and a total of 1842 caregivers were interviewed using a structured questionnaire. Focus groups and individual interviews of 128 caregivers were conducted in eight of the selected villages. On average, 24.7% of households reported any sharing of RUSF within the household. Sharing practices outside the household remained rare. Most of the sharing reported occurred among children under 5years of age living in the household. On average, 91% of caregivers in all districts rated the child's appreciation of the products as good or very good. Program planning may need to explicitly accounting for the sharing of products among children under 5 within household.
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.