Low‐dose RUTF protocol and improved service delivery lead to good programme outcomes in the treatment of uncomplicated SAM: a programme report from Myanmar

Abstract

The treatment of uncomplicated severe acute malnutrition (SAM) requires substantial amounts of ready-to-use therapeutic food (RUTF). In 2009, Action Contre la Faim anticipated a shortfall of RUTF for their nutrition programme in Myanmar. A low-dose RUTF protocol to treat children with uncomplicated SAM was adopted. In this protocol, RUTF was dosed according to beneficiary's body weight, until the child reached a Weight-for-Height z-score of ≥−3 and mid-upper arm circumference ≥110 mm. From this point, the child received a fixed quantity of RUTF per day, independent of body weight until discharge. Specific measures were implemented as part of this low-dose RUTF protocol in order to improve service quality and beneficiary support. We analysed individual records of 3083 children treated from July 2009 to January 2010. Up to 90.2% of children recovered, 2.0% defaulted and 0.9% were classified as non-responders. No deaths were recorded. Among children who recovered, median [IQR] length of stay and weight gain were 42 days [28; 56] and 4.0 g kg–1 day–1 [3.0; 5.7], respectively. Multivariable logistic regression showed that children older than 48 months had higher odds of non-response to treatment than younger children (adjusted odds ratio: 3.51, 95% CI: 1.67–7.42). Our results indicate that a low-dose RUTF protocol, combined with specific measures to ensure good service quality and beneficiary support, was successful in treating uncomplicated SAM in this setting. This programmatic experience should be validated by randomised studies aiming to test, quantify and attribute the effect of the protocol adaptation and programme improvements presented here.

Mid-upper-arm circumference based case-detection, admission, and discharging of under five children in a large-scale community-based management of acute malnutrition program in Nigeria

“…This is similar to that reported elsewhere [ 22 , 26 , 27 ]. In our study, it was also found that the length of stay for those recovered children was 7 weeks / 49 days which is lower than the study in Gedaref, Northern Sudan which showed 60 days [ 23 ], 54 days in Burkina Faso [ 22 ] and higher than 42 days reported from Myanmar [ 27 ]. These differences might be attributed to the different discharge criteria used in the different settings, which can influence the length of stay.…”

The role of dietary diversity in the response to treatment of uncomplicated severe acute malnutrition among children in Niger: a prospective study

“…This finding was in line with Gebremichael et al, who showed that weight at recruitment lower than the mean increased nutritional recovery time for severely malnourished children [26]. James et al also found that WHZ less than − 3.5 was associated with lower odds for recovery among children in Myanmar [27]. Similarly, in an inpatient program of non-edematous children aged 6-59 months in Uganda, low WHZ at admission was a significant risk factor for mortality [28].…”

Impact of nutrition interventions on pediatric mortality and nutrition outcomes in humanitarian emergencies: A systematic review

“…While many studies used WHO 2006 reference standards to define moderate and severe stunting and wasting (labelled ‘WHO’ in Table ), others used the National Center for Health Statistics (NCHS)/WHO international growth reference standards (labelled NCHS in Table ) . Wasting (WFH) was used as an outcome in 15 studies , stunting (HFA) in five studies , underweight (WFA) in five studies and MUAC in five studies . Four studies described weight gain and one described linear growth .…”

“…Recovery rates of 67–81% were seen in two studies examining take‐home selective supplementary feeding for those with mild or moderate malnutrition using millet gruel and corn–soy blend, respectively . Rates of over 90% were seen in therapeutic feeding studies using RUTF in those with severe malnutrition . However, recovery rates were defined differently in each study: Nielsen used MUAC >130 mm, Vautier used >85% WFH, James used 15% weight gain or MUAC >110 mm and Amthor used WFH >100% reference standard.…”

“…While studies describing anthropological markers typically utilised 2006 WHO definitions of moderate and severe stunting and wasting, some studies used the National Center for Health Statistics (NCHS)/WHO international growth reference from 1977 . Perhaps more importantly, studies differed in their definition of what constituted ‘recovery’ from malnutrition . While similar definitions of anaemia were used, some studies assessed ‘any’ anaemia and some examined severe, moderate and mild anaemia, with a subset of authors stratifying by age .…”