Impact of reduced dose of ready-to-use therapeutic foods in children with uncomplicated severe acute malnutrition in Burkina Faso
Research snapshot1
A randomised non-inferiority trial was undertaken to investigate the efficacy of a reduced ready-to-use therapeutic food (RUTF) dose in community-based treatment of uncomplicated severe acute malnutrition (SAM) in Burkina Faso. Between October 2016 and July 2018, 801 children aged 6–59 months with uncomplicated SAM were enrolled from 10 community health centres and randomly assigned into one of two study arms: (a) a standard RUTF dose for two weeks, followed by a reduced dose thereafter (reduced); or (b) a standard RUTF dose throughout the treatment (standard). The mean weight gain velocity from admission to discharge was 3.4 g/kg/day and did not differ between study arms (Δ 0.0 g/kg/day; 95% CI −0.4 to 0.4; p = 0.92), confirming non-inferiority (p = 0.013). No differences were found in length of stay or recovery rate between arms, nor in mid-upper arm circumference (MUAC) gain velocity. However, after two weeks, the weight gain velocity was significantly lower in the reduced dose, with a mean of 2.3 g/kg/day compared with 2.7 g/kg/day in the standard dose (Δ −0.4 g/kg/day; 95% CI −0.8 to −0.02; p = 0.041). The reduced RUTF dose also led to a small but significant negative effect, 0.2 mm/week (95% CI 0.04 to 0.4; p = 0.015), on height gain velocity, with a mean height gain of 2.6 mm/week with reduced and 2.8 mm/week with standard RUTF dose. The impact was more pronounced in children under 12 months of age (interaction, p = 0.019). The authors recommend that a reduced-dose approach is tested in a routine programmatic setting and in different food-security contexts before scale-up.
Endnote
1Kangas ST, Salpe´teur C, Nikièma V, Talley L, Ritz C, Friis H, et al. (2019) Impact of reduced dose of ready-to-use therapeutic foods in children with uncomplicated severe acute malnutrition: A randomised non-inferiority trial in Burkina Faso. PLoS Med 16(8): e1002887. https://doi.org/10.1371/journal.pmed.1002887
More like this
FEX: Effect of short-term supplementation with ready-to-use therapeutic food or micronutrients for children after illness for prevention of malnutrition: a randomised controlled trial in Uganda
Summary of research1 Location: Uganda What we know: The potential for nutritional supplementation of sick children as a strategy for preventing malnutrition has not been...
FEX: Does nutritional supplementation for two weeks prevent malnutrition in ill children?
Summary of research1 Location: DRC, Uganda and Nigeria What we know: Ill children are at increased risk of malnutrition due to the infection-malnutrition cycle. What this...
en-net: Weight Gaining
1. what is the average weight gain per child on RUTF when given correctly per week? in the treatment of severe acute malnutrition? Response to treatment might be measured...
en-net: A new publication on efficacy of RUTF reduced dose in Burkina in PLoS Med
Paris, September 2019 The first results of the MANGO clinical trial led by AAH and scientific partners are now published in PLoS Medicine journal...
FEX: Efficacy of three feeding regimens for home-based management of children with uncomplicated severe acute malnutrition
Summary of research Bhandari N, Mohan SB, Bose A, et al. Efficacy of three feeding regimens for home-based management of children with uncomplicated severe acute malnutrition:...
FEX: Promoting linear growth when treating child wasting
View this article as a pdf This article discusses the state of evidence surrounding the treatment of wasted and stunted children considering current challenges and possible...
FEX: Comparison of milk free v milk containing RUTF in SAM treatment in Zambia
Summary of published research1 Location: Zambia What we know: Global SAM treatment relies on internationally produced RUTF that is expensive. RUTF formulations that exclude...
FEX: Management of moderate acute malnutrition with RUTF in Niger
Isabelle Defourny and Géza Harczi By Isabelle Defourny, Gwenola Seroux, Issaley Abdelkader, and Géza Harczi Isabelle Defourny is Deputy Desk Manager, MSF-France, Paris Géza...
FEX: Effectiveness of food supplements in increasing fat-free tissue accretion in children with moderate acute malnutrition in Burkina Faso
Summary of research1 Location: Burkina Faso What we know: There is no consensus on the effectiveness of lipid-nutrient supplement (LNS) compared to corn-soy blend (CSB) in...
FEX: Effect of adding RUSF to ageneral food distribution on child nutritional status and morbidity: a cluster randomised controlled trial
Summary of research1 Child during appetite test at a health facility offering treatment in Monrovia, Liberia The authors of a recent study hypothesized that including a daily...
FEX: Routine amoxicillin use in treatment of uncomplicated SAM in children
Summary of research1 Location: Niger What we know: Routine use of broad-spectrum antibiotics is recommended in uncomplicated SAM case management; there is a lack of evidence...
FEX: Combined protocol for SAM/MAM treatment: The ComPAS study
By Jeanette Bailey, Rachel Chase, Marko Kerac, André Briend, Mark Manary, Charles Opondo, Maureen Gallagher and Anna Kim Jeanette Bailey is the Project Director for...
FEX: Short malnourished children and fat accumulation with food supplementation
Research snapshot1 Supplementary feeding programmes (SFPs) commonly do not to measure the mid-upper arm circumference (MUAC) of children whose length is <67 cm. These...
FEX: Response to malnutrition treatment in low weight-for-age children: secondary analyses of ComPAS trial data
View this article as a pdf Research summary1 Location: Kenya and South Sudan What we know: Children who are concurrently wasted and stunted (WaSt) have a very high mortality...
FEX: Diluted F100 v infant formula in treatment of severely malnourished infants < 6 months
By Caroline Wilkinson and Sheila Isanaka Caroline Wilkinson was Nutrition Advisor with Action Contre la Faim - France (ACF-F), until November 2008. She spent most of 2007 in...
FEX: The “ComPAS” trial combined treatment model for acute malnutrition: study protocol for the economic evaluation
Research snapshot1 Acute malnutrition is currently divided into severe (SAM) and moderate (MAM), based on level of wasting. SAM and MAM currently have separate treatment...
FEX: Modelling an alternative nutrition protocol generalisable to outpatient (MANGO) study
View this article as a pdf Upcoming research Action Against Hunger conducts operational research with academic partners to contribute to building the scientific and...
FEX: Alternative ready-to-use therapeutic food yields less recovery than the standard for treating acute malnutrition in children from Ghana
View this article as a pdf Research snapshot1 Only 20% of children with severe acute malnutrition (SAM) have access to ready-to-use therapeutic food (RUTF), the cost of which...
FEX: Integrated protocol for severe and moderate acute malnutrition in Sierra Leone
Summary of research1 Location: Sierra Leone What we know: Impliementing separate protocols for MAM and SAM treatment can be administratively cumbersome in emergency...
FEX: TreatFOOD study in Burkina Faso
Summary of presentation1 of published research2 View this article as a pdf By Susan Shepherd Dr Susan Shepherd is Director of Clinical and Operational Research for...
Reference this page
Impact of reduced dose of ready-to-use therapeutic foods in children with uncomplicated severe acute malnutrition in Burkina Faso. Field Exchange 61, November 2019. p36. www.ennonline.net/fex/61/impactofreduceddose
(fex.61.557)