There is currently a lack of international guidance on the most appropriate treatment for moderate acute malnutrition (MAM), and discrepancies in national treatment guidelines exist. We aimed to explore whether food interventions are effective for MAM children 6-59 months old and whether they result in better outcomes compared with no treatment or management with nutrition counselling. A systematic literature search was conducted in October 2018, identifying studies that compared treating MAM children with food products versus management with counselling or no intervention. A total of 673 abstracts were screened, 101 full texts were read, and one study was identified that met our inclusion criteria. After broadening the criteria to include micronutrients in the control group and enrolment based on outdated anthropometric criteria, 11 studies were identified for inclusion. Seven of these found food products to be superior for anthropometric outcomes compared with counselling and/or micronutrient supplementation; two of the studies found no significant benefit of a food product intervention; and two studies were inconclusive.Hence, the majority of studies in this review found that food products resulted in greater anthropometric gains than counselling or micronutrient interventions. This was especially true if the supplementary food provided was of suitable quality and provided for an adequate duration. Improving quality of and adherence to counselling may improve its effectiveness, particularly in food secure contexts. There is currently a paucity of comparable studies on this topic as well as a lack of studies that include important functional outcomes beyond anthropometric proxies.

Background: Program decision-making to prevent and treat acute malnutrition in an emergency can be hampered by a lack of accessible and relevant overviews of directly available robust research evidence. There is often evidence from related settings such as from low-income countries, but this is dispersed across many databases, may be inaccessible and requires assessment of its relevance to the humanitarian setting. We describe a process whereby a multidisciplinary , international group of specialists worked together to build relevant and effective collections of available systematic reviews on acute malnutrition, published and disseminated as online collections, to improve access to the evidence and concise, synthesised, relevant up to date evidence for programming. By describing this process, we hope to inspire other professional groups to take part in similar multi-stakeholder, multidisciplinary projects. Objectives: This project was designed to make the evidence from relevant systematic reviews about malnutrition as accessible as possible to support evidence-based decision-making and to guide future research on the prevention and treatment of acute malnutrition in humanitarian emergencies. Methods: Between March 2017 and March 2018, a large group (21 volunteers and stakeholders) with different backgrounds collaborated to review and curate collections of systematic reviews of interventions for the prevention and treatment of moderate and severe acute malnutrition relevant to humanitarian emergencies. The methodology loosely followed general guidance for overviews of systematic reviews with a pre-defined question (formulated using the PICOS format) and search strategies applied to multiple databases. Pairs of collaborators first screened the search yields to identify potentially eligible reviews, where after other pairs screened the list of potentially eligible reviews for relevance and thus included in the final collections.

The World Food Programme (WFP) remains committed to exploring new modalities to improve early detection and treatment coverage for moderate acute malnutrition (MAM) and severe acute malnutrition (SAM) and, more importantly, to prevent malnutrition altogether. The article contains various wrong assertions about WFP nutrition programming. First, WFP Nigeria has not experienced any budget reduction for MAM treatment in recent years. Equally, WFP South Sudan does not have restrictions to subcontract monitoring. Incidentally, ready-to-use supplementary food (RUSF) is not the only food supplement utilised by WFP for treating MAM children. RUSF and Super Cereal Plus are used in Niger, Nigeria and South Sudan. Similarly, in Nigeria, where targeted supplementary feeding programmes (TSFP) are not included in the national protocol, WFP has been treating MAM children using RUSF and Super Cereal Plus through blanket supplementary feeding programme (BSFP) platforms since 2017 in conflict affected areas. This article analyses the perspectives of stakeholders interviewed by the authors, affiliated with IRC, about the Combined Protocol which utilises ready-to-use therapeutic food (RUTF). Availability of RUSF was used as a proxy indicator of RUSF pipeline reliability. However, the use of Super Cereal Plus for MAM children and the provision of MAM treatment through BSFP, both related to RUSF availability, were overlooked. To assess RUSF and RUTF pipeline reliability, considering the increased caseload resulting from treating SAM and MAM with one product, the authors should have examined supply chain elements such as last mile delivery and volume, since worldwide MAM children outnumber by far SAM children.