Effect of Preventive Supplementation With Ready-to-Use Therapeutic Food on the Nutritional Status, Mortality, and Morbidity of Children Aged 6 to 60 Months in Niger

Abstract

Context Ready-to-use-therapeutic foods are an important component of the effective outpatient treatment of severe wasting, however, their effectiveness in the population-based prevention of moderate and severe wasting has not been evaluated. Objective To evaluate the effect of a 3-month distribution of ready-to-use-therapeutic food on the nutritional status, mortality and morbidity of children 6 to 60 mo of age. Design, Settings, and Participants A cluster randomized trial of 12 villages in Maradi, Niger. Six villages were randomized to intervention and 6 to no intervention. Villages were visited monthly from August 2006 to March 2007. All children in the study villages between 6 and 60 mo of age were eligible for recruitment. Intervention Children with weight-for-height ≥ 80% of the NCHS reference median in the 6 intervention villages received a monthly distribution of one packet per day of ready-to-use-therapeutic food (500kcal / day) from August to October 2006. Children in the six non-intervention villages did not receive preventive supplementation with RUTF and comprised the control group. Active surveillance for conditions requiring medical or nutritional treatment was conducted in all twelve study villages throughout follow-up from August 2006 to March 2007. Main Outcome Measures Changes in weight-for-height Z score according to the World Health Organization Child Growth Standards and incidence of wasting (weight-for-height Z < −2) over 8 mo of follow-up. Results The number of children with height and weight measurements in August, October, December and February was 3,166, 3,110, 2,936 and 3,026, respectively. The adjusted effect of the intervention on weight-for-height Z score from baseline to the end of follow-up was 0.22 Z (95% CI: 0.13, 0.30). The absolute rate of wasting and severe wasting, respectively, was 0.17 events per child-year (140 wasting events / 841 child-years) and 0.03 events per child-year (29 wasting events / 943 child-years) in the intervention villages, as compared to 0.26 events per child-year (233 severe wasting events / 895 child-years) and 0.07 events per child year ( 71 severe wasting events / 1,029 child-years) in the non-intervention villages. The intervention thus resulted in a 36% (95% CI: 17% – 50%) reduction in the incidence of wasting and a 58% (95% CI: 43% – 68%) reduction in the incidence of severe wasting. The mortality rate was 0.007 deaths per child-year ( 7 deaths / 986 child-years) in the intervention villages and 0.016 deaths per child-year (16 deaths / 1,099 child-years) in the non-intervention villages, resulting in a non-significant 49% (95% CI: 0.25, 1.05) reduction in mortality. Conclusion Short-term supplementation of non-malnourished children with ready-to-use-therapeutic food reduced the decline in weight-for-height Z score and the incidence of wasting and severe wasting over 8 mo.

Moderate malnutrition in children aged five years and younger in South Africa: are wasting or stunting being treated?

“…However, linear growth has also improved in infants receiving long-term dietary supplementation with lipid-based spreads in vulnerable communities. 22,23 A distinction is not made between the treatment approaches to wasted and stunted children in South Africa. The treatment of MAM within the current targeted supplementation programme does not permit the long-term blanket supplementation of vulnerable infants to assess whether or not severe stunting can be prevented.…”

Ready-to-use food-allocation policy to reduce the effects of childhood undernutrition in developing countries

“…We construct a time-series model for the evolution (in the absence of treatment) of each child's WHZ and HAZ from 6 mo to 5 y using a longitudinal dataset of the weights and heights (up to six measurements at 3-mo intervals from October 1989 to February 1991) of a random cluster sample (16 villages out of a total of 52 villages) of 5,657 children from Bwamanda in the Democratic Republic of Congo (9). The effect of 3 mo of food intervention on subsequent HAZ and WHZ values is estimated using data from a cluster randomized trial (12 villages, with 6 receiving intervention) in Maradi, Niger, involving RUTF (10). We use logistic regression to estimate childhood mortality rates as a function of age, HAZ, and WHZ from data in ref.…”

“…RUTF (500 kcal/d) was administered for 3 mo to 1,671 children ages 6-60 mo in ref. 10, and for lack of data, we assume that the change in HAZ or WHZ as a result of intervention is independent of age, sex, and pretreatment HAZ and WHZ levels. We model the effect of 3 mo of food intervention on HAZ and WHZ by independent lognormal distributions (SI Appendix, Section 2).…”

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

“…Numerous nutritional interventions have been implemented in the region using different strategies and nutritional products. (Isanaka et al, 2009;Isanaka et al, 2010;Lapidus et al, 2009;Nackers et al, 2010).…”