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Cluster-Randomized trial of the Implementation of the Responses to Illness Severity Quantification System (RISQ) in children with acute Malnutrition Six to Fifty-nine months of age in Ngouri, Chad (CRIMSON)
A cluster randomised control trial comparing implementation of the RISQ System with usual care in an ALIMA-run nutrition treatment program.
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Principal Investigators: Dr. Christopher Parshuram and Dr Youssouf Djitida Hagre
Purpose
This research project addresses child mortality associated with acute malnutrition. Globally 16.6 million children under 5 years of age suffer from severe acute malnutrition (UNICEF 2021). The prevailing community-based management of acute malnutrition (CMAM) model consists of regular use of therapeutic food and outpatient visits and inpatient care for children with acute complications (WHO 2007). Referral to hospital is guided by the World Health Organization’s (WHO) ‘danger-signs’ and inpatient care through established guidelines (WHO 2005, WHO 2013). With this approach, hospital mortality remains high with many children dying shortly after admission (Houssin 2017). A 4-part RISQ System has been developed, which includes a 7-item severity of illness score (Dale 2022), and score-matched care recommendations and an implementation program for the System. Application of the RISQ System to complement current practice may improve outcomes.
Dr Youssouf Djidita Hagre
University of N'djamena
In sub-Saharan Africa, malnutrition is a major factor in child mortality. The evaluation of children in a malnutrition situation is not always obvious, which means that many children die at home despite having been in a health facility. It is essential to have reliable tools to detect children in severe situations. The RISQ score will contribute to a better detection of these children.
Expected Outcomes
Implementation of the RISQ system will facilitate recognition of sick versus less-sick children and should provide a decision tool to render triage less subjective. Triage is essential in humanitarian contexts where large numbers of children presenting for nutritional screening must be evaluated in short time periods due to security constraints The results of our research will contribute to improving the function of a health system by addressing the following WHO health system building blocks:
‘Health service delivery’ is improved on both an individual and system level
‘Health workforce’ is strengthened through improved clinical assessment skills.
‘Information’ is improved by the clinical presentation of the RISQ system documentation as a standardized tool
‘Medical products, vaccines, technologies’ is improved through the introduction of pulse oximeters into both inpatient and outpatient care settings
Two health care workers examine a child as part of the OptiMA project in Ngouri. Credits: Dénis Sassou Gueipeur, Ngouri. January 2023.
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