PloS one
Effect of eligibility for referral following mass screening for severe acute malnutrition using mid-upper arm circumference: A prospective regression discontinuity design
By Hu H, Ouattara M, Bountogo M and 10 others.
Abstract
Background
Severe Acute Malnutrition (SAM) is a major cause of morbidity and mortality in children under five. Mid-upper arm circumference (MUAC) is widely used for community screening, but the effect of referral eligibility on subsequent outcomes is uncertain.
Objective
This study assesses the intention-to-treat effect of eligibility for referral to a nutritional program, triggered by MUAC below 11.5 cm, on subsequent nutritional status and all-cause mortality among children in Burkina Faso.
Methods
A prospective regression discontinuity (RD) analysis was nested within the Community Health with Azithromycin Treatment (CHAT) trial, a cluster-randomized controlled trial in Nouna District, Burkina Faso (ClinicalTrials.gov NCT03676764). Children aged 6-59 months were screened during twice-yearly censuses; MUAC <11.5 cm triggered a referral recommendation. Because treatment uptake was unmeasured, the estimand was referral eligibility, not treatment receipt. Outcomes were MUAC at the next census and death before that census. Primary analyses used outcome-specific Imbens-Kalyanaraman bandwidths and mixed-effects models with a child random intercept.