Comparison of home-based therapy with ready-to-use therapeutic food with standard therapy in the treatment of malnourished Malawian children: a controlled, clinical effectiveness trial

Ciliberto, Michael A.; Sandige, Heidi; Ndekha, MacDonald; Ashorn, Per; Briend, André; Ciliberto, Heather; Manary, Mark J.

doi:10.1093/ajcn/81.4.864

Cited by 224 publications

(285 citation statements)

References 12 publications

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“…Three trials compared home based management of RUTF with the standard practise using F-100 formula at therapeutic centres. Of these, two studies started home therapy after initial stabilization at a facility (6)(7)(8). A previously conducted meta-analysis showed an advantage of weight gain of 3.0 g/kg/day (WMD = 3.0; 95% CI= -1.70, 7.70) in favour of RUTF against F-100; however, the results were statistically not significant (4).…”

Section: Controlled Trialsmentioning

confidence: 99%

Efficacy and safety of therapeutic nutrition products for home based therapeutic nutrition for severe acute malnutrition: A systematic review

Gera

2010

Indian Pediatr

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Section: Controlled Trialsmentioning

confidence: 99%

Efficacy and safety of therapeutic nutrition products for home based therapeutic nutrition for severe acute malnutrition: A systematic review

Gera

2010

Indian Pediatr

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“…Strategies that rely on ready-to-use-therapeutic-foods (RUTFs) have proven effective in the treatment of moderate and severe acute malnutrition (Ciliberto et al, 2005;Dossou, Ndour, Briend & Wade, 2003;Manary, Ndekha, Ashorn, Maleta, & Briend, 2004;Matilsky, Maleta, Castleman, & Manary, 2009;Sandige, Ndekha, Briend, Ashorn, & Manary, 2004). Similarly, distributions of Ready-to-Use-Supplementary-Food (RUSF) have been shown to reduce moderate and severe acute malnutrition (Adu-Afarwuah et al, 2007;Defourny et al, 2009;Kuusipalo, Maleta, Briend, Manary, & Ashhorn, 2006;Patel et al, 2005).…”

Section: Introductionmentioning

confidence: 99%

Intra-household use and acceptability of Ready-to-Use-Supplementary-Foods distributed in Niger between July and December 2010

Cohuet¹,

Marquer²,

Shepherd

et al. 2012

Appetite

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“…Increasing evidence and operational experience have demonstrated that community-based treatment of uncomplicated SAM is effective (4)(5)(6)(7) and cost-effective (8,9) .…”

mentioning

confidence: 99%

Comparison of weight-for-height and mid-upper arm circumference (MUAC) in a therapeutic feeding programme in South Sudan: is MUAC alone a sufficient criterion for admission of children at high risk of mortality?

Grellety¹,

Krause²,

Eldin

et al. 2015

Public Health Nutr.

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Objective: The present study was performed to describe the operational implications of using mid-upper arm circumference (MUAC) as a single admission criterion for treatment of severe acute malnutrition in South Sudan. Design: We performed a retrospective analysis of routine programme data of children with severe acute malnutrition aged 6-59 months admitted to a therapeutic feeding programme using weight-for-height Z-score (WHZ) and/or MUAC. To understand the implications of using MUAC as a single admission criterion, we compared patient characteristics and treatment outcomes for children admitted with MUAC < 115 mm (irrespective of WHZ) v. children admitted with WHZ < −3 and MUAC ≥ 115 mm. Results: Of 2205 children included for analysis, 719 (32·6 %) were admitted to the programme with MUAC < 115 mm and 1486 (67·4 %) with WHZ < −3 and MUAC ≥ 115 mm. Children who would have been admitted using a single MUAC < 115 mm criterion were more severely malnourished and more likely to be female and younger. Compared with children admitted with WHZ < −3 and MUAC ≥ 115 mm, children who would have been admitted using MUAC < 115 mm were less likely to recover (54 % v. 69 %) and had higher risk of death (4 % v. 1 %), but responded to treatment with greater weight and MUAC gains. MUAC < 115 mm would have failed to identify 33 % of deaths, while 98 % were identified by WHZ < −3 alone and 100 % by MUAC < 130 mm. Conclusions: The study shows that MUAC < 115 mm identified more severely malnourished children with a higher risk of mortality but failed to identify a third of the children who died. Admission criteria for therapeutic feeding should be adapted to the programmatic context with consideration for both operational and public health implications. Keywords Child malnutrition Mid-upper arm circumferenceWeight-for-height Z-score Admission criteria Community-based management of acute malnutritionAcute malnutrition represents a major cause of childhood morbidity and mortality worldwide. The number of children under the age of 5 years with severe acute malnutrition (SAM) at any time is currently estimated from prevalence data to be nearly 19 million, with the burden or number of incident cases occurring each year presumably higher (1) . SAM contributes to over a million child deaths annually, as children with SAM are estimated to have an approximately ninefold increased risk of death compared with well-nourished children (2,3) . Traditionally, treatment for SAM was conducted exclusively in in-patient settings, an approach that was both costly and limited access to, and impact of, such programmes.In 2007, a new model for the community-based management of acute malnutrition (CMAM) was endorsed by the WHO, UNICEF, World Food Programme and the UN System Standing Committee on Nutrition, in which children with uncomplicated cases of SAM and appetite could be treated on an out-patient basis with the provision of ready-to-use therapeutic foods and weekly or biweekly follow-up (3) . Increasing evidence and operational experience ha...

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Comparison of home-based therapy with ready-to-use therapeutic food with standard therapy in the treatment of malnourished Malawian children: a controlled, clinical effectiveness trial

Abstract: Home-based therapy with RUTF is associated with better outcomes for childhood malnutrition than is standard therapy.

Cited by 224 publications

References 12 publications

Efficacy and safety of therapeutic nutrition products for home based therapeutic nutrition for severe acute malnutrition: A systematic review

Efficacy and safety of therapeutic nutrition products for home based therapeutic nutrition for severe acute malnutrition: A systematic review

Intra-household use and acceptability of Ready-to-Use-Supplementary-Foods distributed in Niger between July and December 2010

Comparison of weight-for-height and mid-upper arm circumference (MUAC) in a therapeutic feeding programme in South Sudan: is MUAC alone a sufficient criterion for admission of children at high risk of mortality?

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