{
  "abstract": "Introduction Patient-centred task-shifting models may be a promising strategy in the community-based management of severe acute malnutrition (SAM) to alleviate pressure on health systems and increase access to treatment in low-resource settings. The engagement of caregivers in clinical and anthropometric surveillance has not been evaluated.Objectives We examined the effect of caregiver training on their knowledge and confidence in at-home clinical and anthropometric surveillance of children with uncomplicated SAM in Sokoto, Nigeria.Methods We used data from a cross-over cluster-randomised trial (n clusters=10) comparing a monthly follow-up schedule with caregiver training to standard weekly follow-up for the outpatient management of children 6–59 months with uncomplicated SAM. Caregivers in the monthly follow-up group received a one-time training on at-home clinical surveillance and mid-upper arm circumference (MUAC) measurement. Intention-to-treat analyses assessed mean differences in knowledge and confidence scores within the monthly follow-up group and between groups at enrolment, post-training, programme discharge and 3 months post-discharge. Accuracy of MUAC measurement and classification was compared in the monthly follow-up group to study staff at enrolment post-training, programme discharge and 3 months post-discharge.Results Of 3945 enrolled children, 96% were followed to programme discharge and 91% to 3 months post-discharge. Caregivers’ knowledge and confidence scores in clinical surveillance increased significantly in the monthly follow-up group post-training and remained elevated at programme discharge and 3 months post-discharge, compared with pretraining. Agreement in MUAC classification between caregiver and study staff was high (>92% agreement at all time points). Caregivers’ knowledge and confidence scores in clinical surveillance were significantly greater in the monthly follow-up group compared with the weekly follow-up group at all time points.Discussion These findings confirm caregiver training increases knowledge and confidence in at-home clinical and anthropometric surveillance in the management of children with uncomplicated SAM, encouraging the continued consideration for task-shifting models in the community-based management of SAM in similar settings.Trial registration number NCT03140904.",
  "authors": [
    {
      "affiliations": [
        "Department of Global Health and Population, Harvard T H Chan School of Public Health, Boston, Massachusetts, USA",
        "Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research Bangladesh, Dhaka, Bangladesh"
      ],
      "name": "Nazia Binte Ali"
    },
    {
      "affiliations": [
        "Biology, University of Florida, Gainesville, Florida, USA"
      ],
      "name": "Matt DT Hitchings"
    },
    {
      "affiliations": [
        "Epicentre Niger, Niamey, Niger"
      ],
      "name": "Fatou Berthé"
    },
    {
      "affiliations": [
        "Operations, Médecins Sans Frontières Operational Centre Amsterdam, Amsterdam, The Netherlands"
      ],
      "name": "Philip Aruna"
    },
    {
      "affiliations": [
        "Epicentre Niger, Niamey, Niger"
      ],
      "name": "Ibrahim Shehu"
    },
    {
      "affiliations": [
        "UNICEF West and Central Regional Office, Dakar, Senegal"
      ],
      "name": "Siméon Nanama"
    },
    {
      "affiliations": [
        "UNICEF West and Central Regional Office, Dakar, Senegal"
      ],
      "name": "Chizoba Steve-Edemba"
    },
    {
      "affiliations": [
        "Epicentre, Paris, France"
      ],
      "name": "Rebecca F Grais"
    },
    {
      "affiliations": [
        "Department of Global Health and Population, Harvard T H Chan School of Public Health, Boston, Massachusetts, USA",
        "Department of Nutrition, Harvard T H Chan School of Public Health, Boston, Massachusetts, USA"
      ],
      "name": "Sheila Isanaka"
    }
  ],
  "title": "Effect of caregiver training on knowledge and confidence of at-home clinical and anthropometric surveillance of children with uncomplicated severe acute malnutrition: analysis of a cross-over cluster randomised trial in Sokoto, Nigeria",
  "uid": "6919334b-2d0d-552f-922a-53d20e7ec319"
}