Home‐based therapy for oedematous malnutrition with ready‐to‐use therapeutic food Could nutritional rehabilitation at home complement or replace centre-based therapeutic feeding programmes for severe malnutrition? 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. Home based therapy for severe malnutrition with ready-to-use food Home-Based Treatment of Malnourished Malawian Children with Locally Produced or Imported Ready-to-Use Food Nutrition rehabilitation of undernourished children utilizing Spiruline and Misola
Background : St and ard recommendations are that children with oedematous malnutrition receive inpatient therapy with a graduated feeding regimen . Aim : To investigate exclusive home‐based therapy for children with oedematous malnutrition . Methods : Children with oedematous malnutrition , good appetite and no complications were treated at home with ready‐to‐use therapeutic food ( RUTF ) and followed up fortnightly for up to 8 wk . Setting and participants : 219 children aged 1–5 y with oedema enrolled in one of two therapeutic nutritional studies in Malawi in 2003–2004 . Results : The overall recovery rate was 83 % ( 182/219 ) , and the case‐fatality rate was 5 % ( 11/219 ) . For children with wasting and oedematous malnutrition , 65 % ( 55/85 ) recovered and 7 % ( 6/85 ) died . The average weight gain was 2.8±3.2 g/kg/d ( mean±SD ) To measure the success rate of three different strategies used in Médecins Sans Frontières large-scale therapeutic nutritional rehabilitation programme in Niger , we analysed three cohorts of severely malnourished patients in terms of daily weight gain , length of stay , recovery , case fatality and defaulting . A total of 1937 children aged 6 - 59 months were followed prospect ively from 15 August 2002 to 21 October 2003 . For the three cohorts , 660 children were maintained in the therapeutic feeding centre ( TFC ) during the entire treatment , 937 children were initially treated at the TFC and completed treatment at home and 340 children were exclusively treated at home . For all cohorts , average time in the programme and average weight gain met the international st and ards ( 30 - 40 days , > 8 g/kg/day ) . Default rates were 28.1 , 16.8 and 5.6 % for TFC only , TFC plus home-based and home-based alone strategies , respectively . The overall case fatality rate for the entire programme was 6.8 % . Case fatality rates were 18.9 % for TFC only and 1.7 % for home-based alone . No deaths were recorded in children transferred to rehabilitation at home . This study suggests that satisfactory results for the treatment of severe malnutrition can be achieved using a combination of home and hospital-based strategies BACKGROUND Childhood malnutrition is common in Malawi , and the st and ard treatment , which follows international guidelines , results in poor recovery rates . Higher recovery rates have been seen in pilot studies of home-based therapy with ready-to-use therapeutic food ( RUTF ) . OBJECTIVE The objective was to compare the recovery rates among children with moderate and severe wasting , kwashiorkor , or both receiving either home-based therapy with RUTF or st and ard inpatient therapy .  DESIGN A controlled , comparative , clinical effectiveness trial was conducted in southern Malawi with 1178 malnourished children . Children were systematic ally allocated to either st and ard therapy ( 186 children ) or home-based therapy with RUTF ( 992 children ) according to a stepped wedge design to control for bias introduced by the season of the year . Recovery , defined as reaching a weight-for-height z score > -2 , and relapse or death were the primary outcomes . The rate of weight gain and the prevalence of fever , cough , and diarrhea were the secondary outcomes . RESULTS Children who received home-based therapy with RUTF were more likely to achieve a weight-for-height z score > -2 than were those who received st and ard therapy ( 79 % compared with 46 % ; P < 0.001 ) and were less likely to relapse or die ( 8.7 % compared with 16.7 % ; P < 0.001 ) . Children who received home-based therapy with RUTF had greater rates of weight gain ( 3.5 compared with 2.0 g . kg(-1 ) . d(-1 ) ; difference : 1.5 ; 95 % CI : 1.0 , 2.0 g . kg(-1 ) . d(-1 ) ) and a lower prevalence of fever , cough , and diarrhea than did children who received st and ard therapy . CONCLUSION Home-based therapy with RUTF is associated with better outcomes for childhood malnutrition than is st and ard therapy Background : The st and ard treatment of severe malnutrition in Malawi often utilises prolonged inpatient care , and after discharge results in high rates of relapse . Aims : To test the hypothesis that the recovery rate , defined as catch-up growth such that weight-for-height z score > 0 ( WHZ , based on initial height ) for ready-to-use food ( RTUF ) is greater than two other home based dietary regimens in the treatment of malnutrition . Methods : HIV negative children > 1 year old discharged from the nutrition unit in Blantyre , Malawi were systematic ally allocated to one of three dietary regimens : RTUF , RTUF supplement , or blended maize/soy flour . RTUF and maize/soy flour provided 730 kJ/kg/day , while the RTUF supplement provided a fixed amount of energy , 2100 kJ/day . Children were followed fortnightly . Children completed the study when they reached WHZ > 0 , relapsed , or died . Outcomes were compared using a time-event model . Results : A total of 282 children were enrolled . Children receiving RTUF were more likely to reach WHZ > 0 than those receiving RTUF supplement or maize/soy flour ( 95 % v 78 % , RR 1.2 , 95 % CI 1.1 to 1.3 ) . The average weight gain was 5.2 g/kg/day in the RTUF group compared to 3.1 g/kg/day for the maize/soy and RTUF supplement groups . Six months later , 96 % of all children that reached WHZ > 0 were not wasted . Conclusions : Home based therapy of malnutrition with RTUF was successful ; further operational work is needed to implement this promising therapy Objectives : To determine the efficacy of home-based therapy with ready-to-use food ( RTUF ) in producing catch-up growth in  malnourished children and to compare locally produced RTUF with imported RTUF for this purpose . Methods : After a brief inpatient stabilization , 260 children with severe malnutrition were enrolled and systematic ally allocated to receive home therapy with either imported , commercially produced RTUF or locally produced RTUF . Each child received 730 kJ/kg/day and was followed up fortnightly . Children completed the study when they reached a  weight-for-height Z score > −0.5 ( WHZ ) , relapsed , died , or failed to achieve WHZ > −0.5 after 16 weeks . Analyses were stratified by human immunodeficiency virus ( HIV ) status . Results : 78 % of all children reached WHZ > −0.5 , 95 % of those with HIV-negative status and 59 % of those with HIV-positive status . Eighty percent of those receiving locally produced RTUF and 75 % of those receiving imported RTUF reached WHZ > −0.5 . The difference between recovery rates was 5 % ( 95 % confidence interval [ CI ] , −5–15 % ) . The rate of weight gain was 0.4 g/kg/day ( 95 % CI , −0.6 , 1.4 ) greater among children receiving locally produced RTUF . The prevalence of diarrhea reported by mothers was 3.7 % for locally produced RTUF and 4.3 % for imported RTUF . After completion of home therapy and resumption of habitual diet for 6 months , 91 % of all children maintained a normal WHZ . Conclusions : Home-based therapy with RTUF was successful in affecting complete catch-up growth . In this study , locally produced and imported RTUF were similar in efficacy in treating of  severe childhood malnutrition Background Malnutrition constitutes a public health problem throughout the world and particularly in developing countries . Aims The objective of the study is to assess the impact of an elementary integrator composed of Spiruline ( Spirulina platensis ) and Misola ( millet , soja , peanut ) produced at the Centre Medical St Camille ( CMSC ) of Ouagadougou , Burkina Faso , on the nutritional status of undernourished children . Material s and methods 550 undernourished children of less than 5 years old were enrolled in this study , 455 showed severe marasma , 57 marasma of medium severity and 38 kwashiorkor plus marasma . We divided the children r and omly into four groups : 170 were given Misola ( 731 ± 7 kcal/day ) , 170 were given Spiruline plus traditional meals ( 748 ± 6 kcal/day ) , 170 were given Spiruline plus Misola ( 767 ± 5 kcal/day ) . Forty children received only traditional meals ( 722 ± 8 kcal/day ) and functioned as the control group . The duration of this study was eight weeks . Results and Discussion Anthropometrics and haematological parameters allowed us to appreciate both the nutritional and biological evolution of these children . The rehabilitation with Spiruline plus Misola ( this association gave an energy intake of 767 ± 5 kcal/day with a protein assumption of 33.3 ± 1.2 g a day ) , both greater than Misola or Spiruline alone , seems to correct weight loss more quickly . Conclusion Our results indicate that Misola , Spiruline plus traditional meals or Spiruline plus Misola are all a good food supplement for undernourished children , but the rehabilitation by Spiruline plus Misola seems synergically favour the nutrition rehabilitation better than the simple addition of protein and energy intake
Context Severe acute malnutrition ( SAM ) in children is a significant public health problem in India with associated increased morbidity and mortality .
The current WHO recommendations on management of SAM are based on facility based treatment .
Given the large number of children with SAM in India and the involved costs to the care-provider as well as the care-seeker , incorporation of alternative strategies like home based management of uncomplicated SAM is important .
The present review assesses ( a ) the efficacy and safety of home based management of SAM using ‘ therapeutic nutrition products ’ or ready to use therapeutic foods ( RUTF ) ; and ( b ) efficacy of these products in comparison with F-100 and home-based diet .