The Kusamala Program for Primary Caregivers of Children with Severe Acute Malnutrition in Malawi
Bibliographic record
Abstract
Children with severe acute malnutrition (SAM) with clinical co-morbidities who require nutritional rehabilitation unit (NRU) treatment are prone to poor long-term developmental and nutritional outcomes. The Kusamala Program is a four-day hospital-based counselling program for caregivers of children with SAM that integrates nutrition, water, sanitation and hygiene, and psychosocial stimulation, aimed at improving these outcomes. The objective of this research was to evaluate the effects of the Kusamala Program on child development and nutritional status in children with SAM six months after NRU discharge. Furthermore, we aimed to qualitatively understand perceptions and experiences of caregivers of children with SAM who participated in the intervention. We conducted a cluster-randomized controlled trial with caregivers and their children 6-59 months of age with SAM admitted to the Moyo NRU in Blantyre, Malawi. The primary outcome of the trial was child development according to Malawi Developmental Assessment Tool (MDAT) composite z-scores of gross motor, fine motor, language, and social domains. A qualitative component with focus group discussions and in-depth interviews was also completed with a subset of caregivers who participated in the trial. Sixty-eight caregivers and children were enrolled to clusters by week and randomized to the comparison arm and 104 to the intervention arm. There were no differences in child development, with mean MDAT composite z-scores in the comparison arm of -1.2 (95% CI: -2.1, -0.22) and in the intervention arm of -1.1 (95% CI: -1.9, -0.40) (p=0.93). The qualitative evaluation with 20 caregivers indicated that the three modules of the Kusamala Program were appropriate and that caregivers applied many of the lessons learned at home. In conclusion, the Kusamala Program did not result in improved developmental or nutritional outcomes, yet it was viewed positively by caregivers according to qualitative results. Future research should evaluate more intensive interventions for caregivers and children with SAM.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.004 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".