Management of Severe Acute Malnutrition in SCD, in Northern Nigeria
Study Details
Study Description
Brief Summary
Except for children with HIV, all recommendations for treatment of childhood malnutrition are for children < 5 years of age. The overall goal of this randomized controlled nutritional feasibility trial is to identify whether families of children with sickle cell anemia (SCA) > 5 years of age agree to participate over a 12-week period. The investigators will also establish a safety protocol for monitoring potential complications associated with treating severe malnutrition in children > 5 years of age with and without SCA, in a low-resource setting.
Condition or Disease | Intervention/Treatment | Phase |
---|---|---|
|
Phase 2 |
Detailed Description
The overall goal of this feasibility trial is to determine the acceptability of a randomized controlled trial to ascertain the optimal strategy for the treatment of severe malnutrition in children with sickle cell disease (SCD) older than 5 years of age. No international standard or evidence-based guidelines exist for the treatment of severe malnutrition (defined as BMI Z-score below -3) in children with SCD. With an expanding pediatric population of more than 75 million in Nigeria, coupled with decreasing childhood infectious disease-related mortality, the next emerging threats to preventable childhood deaths are non-communicable diseases. Data from our ongoing NIH-funded randomized controlled primary stroke prevention trial in Nigeria (NCT02560935), in which the investigators evaluated children with SCD between 5 and 12 years of age, demonstrated that 29% (230/803) of the cohort met criteria for severe malnutrition. Approximately 92% of the cohort in northern Nigeria identified as having severe malnutrition was below the 5th percentile for weight of children with SCD living in the US, Canada, or Europe. These data indicate older children with SCD living in northern Nigeria are undernourished when compared to children living with SCD in high-resource settings. A potentially unique attribute to treating malnutrition in children with SCD is the use of FDA approved anti-metabolite, hydroxyurea, to prevent vaso-occlusive pain events in children. The beneficial effects of hydroxyurea include, but are not limited to, decreased inflammation and increased hemoglobin levels. Preliminary evidence in this cohort of older children with sickle cell anemia (SCA) in northern Nigeria reveals that moderate fixed-dose hydroxyurea (20 mg/kg/day) significantly increases BMI in children with severe malnutrition. The investigators propose a randomized controlled feasibility trial in older children (5 to 12 years of age) with SCA living in northern Nigeria. In preparation for a definitive phase III trial to determine if a nutritional supplement (SoyaPlus) and moderate fixed-dose hydroxyurea therapy is superior to a nutritional supplement alone, the investigators will randomly allocate 100 children between 5 and 12 years of age with SCA and severe uncomplicated malnutrition to each of the two arms. In aim 1, the investigators will assess the feasibility (rate of recruitment, retention, and adherence) of a randomized controlled trial (RCT) in children with SCA and severe malnutrition to a 12-week intervention period. For aim 2, the investigators will establish the safety protocol to monitor for unknown rates of complications associated with treating malnutrition in children with SCD. To decrease the likelihood of sharing limited food resources in a poor family and to determine the specificity of malnutrition for children with SCD in northern Nigeria, the investigators will screen and treat up to 100 malnourished non-SCD siblings of the trial participants. After completion of this feasibility trial, the investigators will use the acquired knowledge to design a phase III trial to definitively determine the optimal treatment strategy for severe malnutrition in older children with SCD living in Africa, potentially affecting thousands of children in this region.
Study Design
Arms and Interventions
Arm | Intervention/Treatment |
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Experimental: Nutritional Supplement and Hydroxyurea 50 children (5-12 years old) with SCA and severe malnutrition will be randomly allocated to receive nutritional supplement and hydroxyurea (20mg/kg/day) |
Drug: hydroxyurea (20mg/kg/day)
Treatment of severe malnutrition in children with SCA in northern Nigeria
Other Names:
Dietary Supplement: Nutritional Supplement
Treatment of severe malnutrition in children with SCA in northern Nigeria per local protocol with SoyaPlus
Other Names:
|
Placebo Comparator: Nutritional Supplement alone 50 children (5-12 years old) with SCA and severe malnutrition will be randomly allocated to receive nutritional supplement alone |
Dietary Supplement: Nutritional Supplement
Treatment of severe malnutrition in children with SCA in northern Nigeria per local protocol with SoyaPlus
Other Names:
|
Placebo Comparator: non-SCD AND severe malnutrition To decrease the likelihood of sharing limited food resources, we will enroll 100 malnourished non-SCD siblings. |
Dietary Supplement: Nutritional Supplement
Treatment of severe malnutrition in children with SCA in northern Nigeria per local protocol with SoyaPlus
Other Names:
|
Outcome Measures
Primary Outcome Measures
- Therapy Acceptance and Adherence over 12-week Period [4 months]
The primary outcome measure will be adherence to daily administration of hydroxyurea and nutritional therapy. If adherence rate is less than 55%, alternative strategies must be considered for the definitive Phase III Trial.
Secondary Outcome Measures
- Nutritional Safety protocol for Children with Sickle Cell Anemia and Severe Malnutrition [6 months]
Study investigators will evaluate the use of a standard of care managament for severe malnutrition using the same protocol as World Health Organization (WHO). Study investigators expect the proportion of serious adverse reactions, as well as refeeding-related morbidity and mortality, to be very small compared to the benefits. Study investigators will compare the frequency of severe adverse events in the SCA group with children without SCD.
- Feasibility of a Definitive Phase III Trial for Hydroxyurea and Nutritional Therapy to Treat Severe Malnutrition in Sickle Cell Disease [6 months]
During the course of this study, study investigators will prepare a manual of operations and case report forms for the proposed trial. Investigators will also solidify working relationships with our colleagues and collaborators at sites in Kano, Nigeria; and develop and organize all committees, collaborators and study procedures necessary for initiation of a successful, definitive, Phase III Trial
Eligibility Criteria
Criteria
Inclusion Criteria:
-
confirmed diagnoses of SCA, comparison children without SCD
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severe malnutrition defined as a BMI z-score < -3
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age between 5 and 12 years (assessment can take place up until the 13th birthday)
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pass the appetite test
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uncomplicated malnutrition (good appetite, alert, no signs of infection of respiratory distress)
Exclusion Criteria:
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children with complicated severe acute malnutrition
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children with electrolyte disturbances (serum Na, K, Ca, PO4) at baseline
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children on disease-modifying therapy (hydroxyurea or regular blood transfusion therapy)
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children enrolled in other studies
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children with diabetes and other chronic illnesses
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children with known HIV infection
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children with a known allergy to dairy or peanuts.
Contacts and Locations
Locations
Site | City | State | Country | Postal Code | |
---|---|---|---|---|---|
1 | Vanderbilt University Medical Center | Nashville | Tennessee | United States | 37232-9000 |
2 | Aminu Kano Teaching Hospital | Kano | Nigeria | ||
3 | Murtala Mohammad Specialist Hospital | Kano | Nigeria |
Sponsors and Collaborators
- Vanderbilt University Medical Center
- Aminu Kano Teaching Hospital
- Murtala Muhammad Specialist Hospital
Investigators
- Principal Investigator: Michael DeBaun, Vanderbilt University Medical Center
Study Documents (Full-Text)
None provided.More Information
Publications
None provided.- 170577