Improving the quality of care for children with acute malnutrition: Cluster Randomised Controlled Trial in West Nile Region, Uganda

Background and Significance
In low-income countries, especially in Sub-Saharan Africa, under-nutrition, is the main underlying cause of morbidity and mortality in children under 5 years. Malnutrition in children is highly prevalent in West Nile Region in Uganda,  an area currently affected by the humanitarian crisis of refugees from South Sudan. Baseline data suggest low quality of care (50% average cure rate vs 75% cured rate as for the international SPHERE standards). Lack of supportive supervision may be one of the reason explaining substandard outcomes.
 
Specific aims

The study has the following objectives: 1) evaluate the effectiveness of supportive supervision as an intervention to improve health outcomes of children with malnutrition;  2) Improve quality of care of nutritional services, staff knowledge and satisfaction, quality of data, and access to care; 3) evaluate the cost-efficacy of the intervention.   
 
Methods
This is a cluster randomised controlled trail (RCT) with health centers  as unit of randomisation. The main intervention will consist of supportive supervision (high frequency supervision specific to nutritional services), while the control will be standard care (no intervention). Complementary intervention will include: procurement of essential equipment; training and networking activities for staff; community engagement activities.  Outcomes of the study will include: health outcomes (recovered, non recovered, defaulters, transferred, died); process outcomes (satisfaction and knowledge of staff); cost outcomes (cost for the health system and for the families) and equity outcomes (access to care and health outcomes by wealth quintile).
 
Impact and Translational Implications
If the study will have positive results, it will benefit the health of children in the study area, and indirectly, their communities. The study will inform, with a robust design, about the efficacy and cost-efficacy of a quality improvement intervention for ameliorating the health of children suffering from malnutrition in Uganda. Currently no other study with RCT design explored the efficacy of supportive supervision as a quality improvement intervention at health center level. This study will therefore fill an important knowledge gap. Findings of the study will be useful to develop policies at local level, and in other countries with similar setting.
 
Collaborators
WHO Collaborating Centre for Maternal and Child Health,  Institute for Maternal and Child Health IRCCS Burlo Garofolo
CUAMM Doctors with Africa
Makerere University, School Of Public Health
 
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