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
Year: 2025
Type: article
Abstract: INTRODUCTION: Children 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. METHODS: We 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. RESULTS: An 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. CONCLUSION: For 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).
Source: BMJ Global Health
Language: English
Subfield: Nutrition and Dietetics
Field: Nursing
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $3,679
Funders: Vanderbilt University, Vanderbilt Institute for Clinical and Translational Research, Vanderbilt University Medical Center, National Institutes of Health, Fogarty International Center, National Institute of Diabetes and Digestive and Kidney Diseases, National Institute of Child Health and Human Development, National Center for Advancing Translational Sciences, Eunice Kennedy Shriver National Institute of Child Health and Human Development
Awards: G1182793083, G12661278, Vanderbilt-Emory-Cornell-Duke Consortium for Global Health Fellows (VECDor), G4425699080, Management of severe acute malnutrition in children with sickle cell disease greater than 5 years of age living in northern Nigeria, G5679716143, G6438752309, The Vanderbilt Institute for Clinical and Translational Research (VICTR), G9000033427, G9000074899
OpenAlex ID: W4413055571