Malnutrition enteropathy in Zambian and Zimbabwean children with severe acute malnutrition: A multi-arm randomized phase II trial.

Malnutrition underlies almost half of all child deaths globally. Severe Acute Malnutrition (SAM) carries unacceptable mortality, particularly if accompanied by infection or medical complications, including enteropathy. We evaluated four interventions for malnutrition enteropathy in a multi-centre phase II multi-arm trial in Zambia and Zimbabwe and completed in 2021. The purpose of this trial was to identify therapies which could be taken forward into phase III trials. Children of either sex were eligible for inclusion if aged 6-59 months and hospitalised with SAM (using WHO definitions: WLZ <-3, and/or MUAC <11.5 cm, and/or bilateral pedal oedema), with written, informed consent from the primary caregiver. We randomised 125 children hospitalised with complicated SAM to 14 days treatment with (i) bovine colostrum (n = 25), (ii) N-acetyl glucosamine (n = 24), (iii) subcutaneous teduglutide (n = 26), (iv) budesonide (n = 25) or (v) standard care only (n = 25). The primary endpoint was a composite of faecal biomarkers (myeloperoxidase, neopterin, α1-antitrypsin). Laboratory assessments, but not treatments, were blinded. Per-protocol analysis used ANCOVA, adjusted for baseline biomarker value, sex, oedema, HIV status, diarrhoea, weight-for-length Z-score, and study site, with pre-specified significance of P < 0.10. Of 143 children screened, 125 were randomised. Teduglutide reduced the primary endpoint of biomarkers of mucosal damage (effect size -0.89 (90% CI: -1.69,-0.10) P = 0.07), while colostrum (-0.58 (-1.4, 0.23) P = 0.24), N-acetyl glucosamine (-0.20 (-1.01, 0.60) P = 0.67), and budesonide (-0.50 (-1.33, 0.33) P = 0.32) had no significant effect. All interventions proved safe. This work suggests that treatment of enteropathy may be beneficial in children with complicated malnutrition. The trial was registered at ClinicalTrials.gov with the identifier NCT03716115

THERAPEUTIC APPROACHES TO MALNUTRITION ENTEROPATHY (TAME): A RANDOMISED CONTROLLED TRIAL IN CHILDREN WITH SEVERE ACUTE MALNUTRITION IN ZAMBIA AND ZIMBABWE

Meeting Abstrac

A Synthesis of Determinants of Urban Resilience in Sub-Saharan Africa

Urban resilience to natural and human-induced shocks and stresses has become an important issue in the contemporary world. Several reviews exist on urban resilience, but limited attempts have been made to critically review studies that shed light on determinants of urban resilience in sub-Saharan Africa (SSA). This study synthesizes both peer-reviewed and grey literature on the determinants of urban resilience to natural and human-induced shocks and stresses in SSA. A considerable number of studies that shed some light on the determinants of urban resilience in SSA have been conducted since the year 2000, but limited attempts have been made to synthesize and integrate them into the pool of knowledge. In this study, the preferred reporting items for systematic reviews and meta-analysis (PRISMA) protocol was followed. Findings indicate that urban resilience in SSA is understood, firstly, as a social and organizational construct and, secondly, as a social, organizational, and ecological construct. The most reported determinants of resilience in cities of SSA are access to basic services, social networks, employment, ownership of productive assets, involvement in none-agricultural activities, building flood retention facilities, and environmental preservation. In conclusion, necessity exists to conduct more studies in secondary cities in SSA while considering the social, institutional, economic, and ecological aspects of resilience so as to understand the multidimensional, location-specific dynamics of the determinants of resilience, given the growing role that secondary cities will play in the strong urban growth trajectories projected over the next decades