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.

introductionPatient-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.

objectivesWe 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.

methodsWe 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.

resultsOf 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.