Trial reportBMJ global health2025
Adherence to ready-to-use therapeutic food in older children with sickle cell anaemia and severe acute malnutrition: a mixed-methods study in a low-income setting.
Trial report in BMJ global health, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT03634488 (Management of Severe Acute Malnutrition in Children With Sickle Cell Disease Greater Than 5 Years of Age Living in Northern Nigeria), which is not on this map. Not yet cited in PubMed.
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The trial behind it
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Management of Severe Acute Malnutrition in Children With Sickle Cell Disease Greater Than 5 Years of Age Living in Northern Nigeria
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Authors and funding
13 authors.
Funding
Abstract
introductionChildren with sickle cell anaemia (SCA) in Sub-Saharan Africa face a higher risk of malnutrition, increasing morbidity and mortality rates. We conducted a randomised controlled feasibility trial to treat children aged 5-12 years with SCA and severe acute malnutrition (body mass index Z-score <-3.0) in Kano, Nigeria (n=108). Despite high rates of ready-to-use therapeutic food (RUTF) consumption, as measured by returned RUTF sachets, suboptimal weight gain was observed, possibly due to widespread sharing of RUTF. In this ancillary study, we aimed to identify factors influencing adherence to the RUTF.
methodsWe conducted seven focus group discussions with 55 caregivers of trial participants in the two sites participating in the trial in Kano, Nigeria. We analysed transcripts using a hierarchical coding system and an iterative inductive-deductive approach informed by Social Cognitive Theory and the biopsychosocial model.
resultsAn interplay between person-level and contextual factors influenced adherence to RUTF. Caregivers' beliefs about nutrition and malnutrition changed when they saw positive changes in their child's health, increasing their motivation to adhere to RUTF. The male head of household and cultural beliefs increased adherence to RUTF for some mothers and were a barrier to adherence for others. Barriers to adherence included financial hardship, along with cultural norms and religious practices related to communal eating and sharing food. Caregivers employed strategies to promote adherence, including modifying food preparation and food storage practices and controlling meal timing and meal participants. Some households maintained or provided more food, while others reduced it and reallocated their savings.
conclusionFor older children with SCA and severe acute malnutrition living in Nigeria, social-cultural context, family dynamics and strategic modifications influence RUTF adherence. Insights from this study may guide the development of tailored strategies, family education and empowerment initiatives to enhance adherence to malnutrition interventions for children with SCA. TRIAL REGISTRATION NUMBER: SAMS trial (NCT03634488).
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