South Asia and child wasting – unravelling the conundrum

Published:

08 October 2020

Collaborators: London School of Hygiene and Tropical Medicine (LSHTM), Jimma University (Ethiopia), GOAL, and the Emergency Nutrition Network (ENN)

Donors: Eleanor Crook Foundation (ECF)

Overview of research

This four year research programme (2019-2023) will test the MAMI care pathway as a community based approach to care for nutritionally at risk infants under six months in a randomised control trial (RCT) within existing services in two sites in Ethiopia (Jimma Zone and Deder Woreda).

The ultimate goal of this research is to effect national (Ethiopian) and international policy guidance change to ensure access to community based care for at risk infants and their mothers. Central to this is generating high quality evidence on an intervention that is feasible, effective, scalable and sustainable. At the heart of this research are partnerships at sub-national, national and international levels to truly co-create an integrated intervention that has real potential for scale.

Formative research in Phase 1 (2020 to mid-2021) is now underway to collect quantitative data on caseload at facilities and qualitative research on perceptions of malnutrition amongst health workers and families. An updated MAMI Care Pathway will be piloted in preparation for Phase 2. Phase 1 also includes secondary data analysis on anthropometric data from Ethiopia to inform enrolment criteria, and consultation with international policy makers, programmers and researchers to inform plans, share developments and nurture cross-country learning. National and international stakeholder mapping to identify communication tools and influencers in collaboration with SDG2AdvocacyHub is being used to inform opportunities for strategic and practical engagement on MAMI.

The randomised control trial is planned for Phase 2 (mid-2021-2024) due to commence mid-2021. Primary outcomes (improved weight-for-age and MUAC) will be assessed at age 6 months. Secondary outcomes include breastfeeding status, and episodes of severe illness. Maternal benefits will also be explored, such as wellbeing / perceptions of social support. Infant follow up is planned to 18-24 months. In addition, cost and cost-effectiveness will be examined as a core component. A process evaluation accompanies the formative phase and RCT for real time, responsive research and to generate evidence on pathways to sustainable scale.

The COVID-19 pandemic impacted on our scheduled RCT that is now planned for mid 2021. We adapted timings and methodologies for Phase 1 research and have used the extended formative phase to undertake the feasibility study of the MAMI Care Pathway. Adaptation has been greatly facilitated by a dedicated frontline research team in Jimma University, regular remote team and 1: 1 meetings between partners, and a flexible, engaged funding partner (ECF).

Presentation to the Ethiopian Nutrition Leaders Network Annual Meeting, 23rd November 2020.

Stakeholder meeting

In follow up to key stakeholder meetings held in October 2019, the research team hosted two virtual (zoom) update meetings on 14^th December or 15^th December 2020, 1400 – 1630 Ethiopia time. The meeting on 14^th December focused on Jimma Zone and on the 15^th December focused on Deder Woreda. Key developments and plans were presented by the research team and discussed with all. Click the links for the meeting report and recordings of the meetings in Deder and Jimma.

Meet the team

Our team

The research partnership comprises a strong team of experienced researchers and practitioners at London School of Hygiene and Tropical Medicine (LSHTM) (overall lead & coordinator), Jimma University (academic lead, Ethiopia), GOAL (operational) and ENN (process evaluation and learning).

LSHTM

Marko Kerac, Principal investigator
Carlos Grijalva-Eternod, Co-investigator and Research Manager
Emma Beaumont, Statistician & Data Manager
Prof Elizabeth Allen, Professor of Medical Statistics

Jimma University

Melkamu Berhane, Principal investigator (Jimma and Deder)
Prof Tsinuel Girma, Senior Co-investigator
Prof Alemseged Abdissa, Senior Co-investigator
Mubarek Abera, Co-investigator
Bitiya Admassu, Co-investigator
Kiddus Yitbarek, Co-investigator
Nega Jibat, Co-investigator

GOAL

Hatty Barthorp, Research Advisor
Anley Haile, Research Lead
Abdulhakim Ali, Research focal point
Ritu Ranu, Co-investigator, MAMI Advisor

ENN

Marie McGrath, Co-investigator

Additional

Prof Jonathan Wells (UCL), Co-investigator/technical advisor
Dr Hannah Blencowe (LSHTM), Co-investigator/technical advisor
An in-country Technical Advisory Group provides advice and oversight and will be independent from the study investigator team.