Hospital management of severely malnourished children: comparison of locally adapted protocol with WHO protocol. Growth, morbidity, and mortality of children in Dhaka after treatment for severe malnutrition: a prospective study. 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. Breast milk intake is not reduced more by the introduction of energy dense complementary food than by typical infant porridge. Comparison of the efficacy of a solid ready-to-use food and a liquid, milk-based diet for the rehabilitation of severely malnourished children: a randomized trial. Home‐based therapy with ready‐to‐use therapeutic food is of benefit to malnourished, HIV‐infected Malawian children Home based therapy for severe malnutrition with ready-to-use food Probiotics and prebiotics for severe acute malnutrition (PRONUT study): a double-blind efficacy randomised controlled trial in Malawi Supplementary feeding with either ready-to-use fortified spread or corn-soy blend in wasted adults starting antiretroviral therapy in Malawi: randomised, investigator blinded, controlled trial Home-Based Treatment of Malnourished Malawian Children with Locally Produced or Imported Ready-to-Use Food Effectiveness of ready-to-use therapeutic food compared to a corn/soy-blend-based pre-mix for the treatment of childhood moderate acute malnutrition in Niger. Nutritional recovery in HIV-infected and HIV-uninfected children with severe acute malnutrition [Spiruline as a food supplement in case of infant malnutrition in Burkina-Faso]. Randomized clinical trial comparing hospital to ambulatory rehabilitation of malnourished children in Niger. Supplementary feeding with fortified spreads results in higher recovery rates than with a corn/soy blend in moderately wasted children. Limited impact of a targeted food supplementation programme in Bangladeshi urban slum children. Controlled trial of three approaches to the treatment of severe malnutrition Treatment of moderate acute malnutrition with ready-to-use supplementary food results in higher overall recovery rates compared with a corn-soya blend in children in southern Ethiopia: an operations research trial. Supplementary feeding with fortified spread among moderately underweight 6-18-month-old rural Malawian children. Supplementary Feeding of Underweight, Stunted Malawian Children With a Ready-To-Use Food A novel fortified blended flour, corn-soy blend "plus-plus," is not inferior to lipid-based ready-to-use supplementary foods for the treatment of moderate acute malnutrition in Malawian children. The impact of HIV on mortality during in-patient rehabilitation of severely malnourished children in Malawi. A ready-to-use therapeutic food containing 10% milk is less effective than one with 25% milk in the treatment of severely malnourished children. Children successfully treated for moderate acute malnutrition remain at risk for malnutrition and death in the subsequent year after recovery.
OBJECTIVES To compare the effectiveness of locally adapted Institute of Child and Mother Health ( ICMH ) protocol with the WHO protocol for the management of severely malnourished children in Bangladesh . DESIGN Quasi-experimental non-r and omized clinical trial . SETTING Hospital based . PARTICIPANTS Severely malnourished children ( 2 - 59 mo ) with weight for height<70 % ( n=60 ) . INTERVENTION Children treated with either WHO protocol ( Group I , n=30 ) or ICMH protocol ( Group II , n=30 ) . OUTCOME VARIABLES Clinical improvement , weight gain , time taken to achieve target weight gain , and mortality among the study subjects . RESULTS Mean ( SD ) weight related to gain in Group I and Group II was 11.2 ( 4.1 ) and 11.1 ( 3.9 ) g/kg/day , respectively . The weight gain was not related to the age group or type of malnutrition . The time taken for edema to subside ( 7.3 d vs 8 d ) and for improvement of appetite ( 6.5 d to 7.3 d vs 6.7 d to 8.4 d ) was similar between the groups . The target weight gain was achieved in 28.3 ( 11.5 ) days in Group I against 27.9 ( 6.2 ) days in Group II ( P=0.88 ) . The mortality rate was 6.7 % in each group . CONCLUSION Treatment of severe malnutrition with locally adapted ICMH protocol using locally available foods is as efficacious as the WHO protocol Over 1300 severely malnourished children ( < 60 % of US National Center for Health Statistics weight-for-height , with edema , or both ) are admitted each year to the Children 's Nutrition Unit in Dhaka . Fatality during treatment is low and recovery is rapid . Our aim was to determine whether this initial success is sustained when children return home . A previous attempt to address this question was frustrated by the difficulty in tracing children after discharge because most are from slum settlements and families move frequently . This prospect i ve study with fortnightly monitoring was therefore undertaken . The main outcomes of interest were anthropometric status , relapse , morbidity , and mortality .  Children ( n = 437 ) who had been treated for severe malnutrition when aged 12 - 59 mo and had reached the discharge criterion of 80 % of weight-for-height , were followed for the next 12 mo . During follow-up , 7.5 % were lost without trace , 0.6 % relapsed , and 2.3 % died . Morbidity was high , with a mean of seven episodes of diarrhea during the year . Outpatient visits for diarrhea occurred for 67 % of children , and 58 % had pneumonia ( 10 % had pneumonia three times ) . After 12 mo , mean weight-for-height was 91 % ( -0.92 z score ) but mean height-for-age remained at 84 % ( -4.14 z score ) . Weight gain , but not height gain , tended to be lower in children who experienced more diarrhea . Fever and cough were not associated with either weight or height gain . The high prevalence of illness highlights the need for continued accessible health care and for interventions to reduce disease acquisition 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 The effect of different energy densities of complementary foods on breast milk consumption is not well understood . In this study , we tested the hypothesis that provision of fortified spread ( FS ) , a micronutrient fortified , energy-dense ( 22 kJ/g ) , ready-to-use food , to Malawian infants would not decrease their breast milk intake more than a traditional corn + soy blended flour ( CSB ) .  Forty-four healthy 6-mo-old infant and mother pairs were enrolled in a prospect i ve , parallel group , investigator-blinded , r and omized controlled complementary feeding trial . Infants were r and omized to receive 25 g/d of FS , 50 g/d of FS , or 72 g/d of CSB . The primary outcome was the difference in breast milk intake after 1 mo of complementary feeding as measured by the dose-to-mother deuterium oxide dilution technique . Outcomes were compared using repeated measures ANOVA . A total of 41 mother-infant pairs completed the study . At enrollment , 88 % of the infants had received corn porridge .  At baseline , the infants consumed 129 + /- 18 g.kg body wt(-1 ) x d(-1 ) ( mean + /- SD ) of breast milk . After 1 mo of complementary feeding with 25 g/d FS , 50 g/d FS , or 72 g/d CSB , their breast milk consumption was 115 + /- 18 g.kg body wt(-1 ) x d(-1 ) , a significant reduction ; however , the effects of the complementary foods did not differ from one another ( F-value model = 4.33 , P = 0.0008 for effect of time and P = 0.69 for effect of type of food ) . The results suggest that complementary feeding of Malawian infants with FS has the same effect on their breast milk intake as complementary feeding with traditional CSB porridge BACKGROUND The World Health Organization recommends a liquid , milk-based diet ( F100 ) during the rehabilitation phase of the treatment of severe malnutrition . A dry , solid , ready-to-use food ( RTUF ) that can be eaten without adding water has been proposed to eliminate the risk of bacterial contamination from added water . The efficacies of RTUF and F100 have not been compared . OBJECTIVE The objective was to compare the efficacy of RTUF and F100 in promoting weight gain in malnourished children . DESIGN In an open-labeled , r and omized trial , 70 severely malnourished Senegalese children aged 6 - 36 mo were r and omly allocated to receive 3 meals containing either F100 ( n = 35 ) or RTUF ( n = 35 ) in addition to the local diet . The data from 30 children in each group were analyzed . RESULTS The mean ( + /- SD ) daily energy intake in the RTUF group was 808 + /- 280 ( 95 % CI : 703.8 , 912.9 ) kJ x kg body wt(-1 ) x d(-1 ) , and that in the F100 group was 573 + /- 201 ( 95 % CI : 497.9 , 648.7 ) kJ. kg body wt(-1 ) x d(-1 ) ( P < 0.001 ) . The average weight gains in the RTUF and F100 groups were 15.6 ( 95 % CI : 13.4 , 17.8 ) and 10.1 ( 95 % CI : 8.7 , 11.4 ) g x kg body wt(-1 ) x d(-1 ) , respectively ( P < 0.001 ) . The difference in weight gain was greater in the most wasted children ( P < 0.05 ) . The average duration of rehabilitation was 17.3 ( 95 % CI : 15.6 , 19.0 ) d in the F100 group and was 13.4 ( 95 % CI : 12.1 , 14.7 ) d in the RTUF group ( P < 0.001 ) . CONCLUSIONS This study indicated that RTUF can be used efficiently for the rehabilitation of severely malnourished children Aim : To determine if home‐based nutritional therapy will benefit a significant fraction of malnourished , HIV‐infected Malawian children , and to determine if ready‐to‐use therapeutic food ( RUTF ) is more effective in home‐based nutritional therapy than traditional foods . Methods : 93 HIV‐positive children > 1 y old discharged from the nutrition unit in Blantyre , Malawi were systematic ally allocated to one of three dietary regimens : RUTF , RUTF supplement or blended maize/soy flour . RUTF and maize/soy flour provided 730 kJ·kg−1·d−1 , while the RUTF supplement provided a fixed amount of energy , 2100 kJ/d . These children  did not receive antiretroviral chemotherapy . Children were followed fortnightly . Children completed the study when they reached 100 % weight‐for‐height , relapsed or died . Outcomes were compared using regression modeling to account for differences in the severity of malnutrition between the dietary groups . Results : 52/93 ( 56 % ) of all children reached 100 % weight‐for‐height . Regression modeling found that the children receiving RUTF  gained weight more rapidly and were more likely to reach 100 % weight‐for‐height than the other two dietary groups ( p<0.05 ) 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 BACKGROUND Severe acute malnutrition affects 13 million children worldwide and causes 1 - 2 million deaths every year . Our aim was to assess the clinical and nutritional efficacy of a probiotic and prebiotic functional food for the treatment of severe acute malnutrition in a HIV-prevalent setting . METHODS We recruited 795 Malawian children ( age range 5 to 168 months [ median 22 , IQR 15 to 32 ] ) from July 12 , 2006 , to March 7 , 2007 , into a double-blind , r and omised , placebo-controlled efficacy trial . For generalisability , all admissions for severe acute malnutrition treatment were eligible for recruitment . After stabilisation with milk feeds , children were r and omly assigned to ready-to-use therapeutic food either with ( n=399 ) or without ( n=396 ) Synbiotic2000 Forte . Average prescribed Synbiotic dose was 10(10 ) colony-forming units or more of lactic acid bacteria per day for the duration of treatment ( median 33 days ) . Primary outcome was nutritional cure ( weight-for-height > 80 % of National Center for Health Statistics median on two consecutive outpatient visits ) . Secondary outcomes included death , weight gain , time to cure , and prevalence of clinical symptoms ( diarrhoea , fever , and respiratory problems ) . Analysis was on an intention-to-treat basis . This trial is registered as an International St and ard R and omised Controlled Trial , number IS RCT N19364765 . FINDINGS Nutritional cure was similar in both Synbiotic and control groups ( 53.9 % [ 215 of 399 ] and 51.3 % [ 203 of 396 ] ; p=0.40 ) . Secondary outcomes were also similar between groups . HIV seropositivity was associated with worse outcomes overall , but did not modify or confound the negative results . Subgroup analyses showed possible trends towards reduced outpatient mortality in the Synbiotic group ( p=0.06 ) . INTERPRETATION In Malawi , Synbiotic2000 Forte did not improve severe acute malnutrition outcomes . The observation of reduced outpatient mortality might be caused by bias , confounding , or chance , but is biologically plausible , has potential for public health impact , and should be explored in future studies . FUNDING Department for International Development ( DfID ) Objective To investigate the effect of two different food supplements on body mass index ( BMI ) in wasted Malawian adults with HIV who were starting antiretroviral therapy . Design R and omised , investigator blinded , controlled trial . Setting Large , public clinic associated with a referral hospital in Blantyre , Malawi . Participants 491 adults with BMI < 18.5 . Interventions Ready-to-use fortified spread ( n=245 ) or corn-soy blend ( n=246 ) . Main outcome measures Primary outcomes : changes in BMI and fat-free body mass after 3.5 months . Secondary outcomes : survival , CD4 count , HIV viral load , quality of life , and adherence to antiretroviral therapy . Results The mean BMI at enrolment was 16.5 . After 14 weeks , patients receiving fortified spread had a greater increase in BMI and fat-free body mass than those receiving corn-soy blend : 2.2 ( SD 1.9 ) v 1.7 ( SD 1.6 ) ( difference 0.5 , 95 % confidence interval 0.2 to 0.8 ) , and 2.9 ( SD 3.2 ) v 2.2 ( SD 3.0 ) kg ( difference 0.7 kg , 0.2 to 1.2 kg ) , respectively . The mortality rate was 27 % for those receiving fortified spread and 26 % for those receiving corn-soy blend . No significant differences in the CD4 count , HIV viral load , assessment of quality of life , or adherence to antiretroviral therapy were noted between the two groups . Conclusion Supplementary feeding with fortified spread result ed in a greater increase in BMI and lean body mass than feeding with corn-soy blend . Trial registration Current Controlled Trials IS RCT N67515515 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 St and ard nutritional treatment of moderate acute malnutrition ( MAM ) relies on fortified blended flours though their importance to treat this condition is a matter of discussion . With the newly introduced World Health Organization growth st and ards , more children at an early stage of malnutrition will be treated following the dietary protocol s as for severe acute malnutrition , including ready-to-use therapeutic food ( RUTF ) . We compared the effectiveness of RUTF and a corn/soy-blend (CSB)-based pre-mix for the treatment of MAM in the supplementary feeding programmes ( SFPs ) supported by Médecins Sans Frontières , located in the Zinder region ( south of Niger ) . Children measuring 65 to < 110 cm , newly admitted with MAM [ weight-for-height ( WHM% ) between 70 % and < 80 % of the NCHS median ] were r and omly allocated to receive either RUTF ( Plumpy'Nut ® , 1000 kcal day(-1 ) ) or a CSB pre-mix ( 1231 kcal day(-1 ) ) . Other interventions were similar in both groups ( e.g. weekly family ration and ration at discharge ) . Children were followed weekly up to recovery ( WHM% ≥ 85 % for 2 consecutive weeks ) . In total , 215 children were recruited in the RUTF group and 236 children in the CSB pre-mix group with an overall recovery rate of 79.1 and 64.4 % , respectively ( p < 0.001 ) . There was no evidence for a difference between death , defaulter and non-responder rates . More transfers to the inpatient Therapeutic Feeding Centre ( I-TFC ) were observed in the CSB pre-mix group ( 19.1 % ) compared to the RUTF group ( 9.3 % ) ( p = 0.003 ) . The average weight gain up to discharge was 1.08 g kg(-1 ) day(-1 ) higher in the RUTF group [ 95 % confidence interval : 0.46 - 1.70 ] and the length of stay was 2 weeks shorter in the RUTF group ( p < 0.001 ) . For the treatment of childhood MAM in Niger  , RUTF result ed in a higher weight gain , a higher recovery rate , a shorter length of stay and a lower transfer rate to the I-TFC compared to a CSB pre-mix . This might have important implication s on the efficacy and the quality of SFPs Objective : Few studies have reported on nutritional recovery , survival and growth among severely malnourished children with HIV . This study explores nutritional recovery in HIV-infected and HIV-uninfected children during inpatient nutrition rehabilitation and 4 months of follow-up . Design : Prospect i ve cohort study . Setting : Lilongwe district , Malawi . Main outcome measures : Weight gain , anthropometrics . Results : In our sample of 454 children with severe acute malnutrition ( SAM ) , 17.4 % ( n = 79 ) of children were HIV infected . None of the children were on antiretroviral therapy upon admission . Among the HIV-infected children , 35.4 % ( 28/79 ) died , compared with 10.4 % ( 39/375 ) in HIV-uninfected children ( p<0.001 ) . All children who survived achieved nutritional recovery ( > 85 % weight for height and no oedema ) , regardless of HIV status . HIV-infected children had similar weight gain to HIV-uninfected children ( 8.9 vs 8.0 g/kg/d , not significant ( NS ) ) . Mean increases in z-scores for both subscapular ( 2.72 vs 2.69 , NS ) and triceps ( 1.26 vs 1.48 , NS ) skinfolds were similar between HIV-infected and HIV-uninfected children , respectively , during nutrition rehabilitation . 362 children were followed for 4 months , at which time mean weight for height z-score was similar in HIV-infected and HIV-uninfected children ( −0.85 vs −0.64 , NS ) . Conclusions : HIV-infected children with SAM have higher mortality rates than HIV-uninfected children . Among those who survive , however , nutritional recovery is similar in HIV-infected and HIV-uninfected children BACKGROUND Spiruline , a microscopic algae with nutritious quality was put forward as food supplement to fight malnutrition in infant . POPULATION AND METHODS To assess its effectiveness , a survey was carried out among children with malnutrition whose Z-score was < 2 for their age , in the Koudougou province , Burkina-Faso . Within five centers , three groups were defined at r and omization : group 1 with usual nutritional rehabilitation program , group 2 as above + 5 g x d(-1 ) of spiruline , group 3 as above + spiruline + fish .  182 children , aged three months - three years , were originally involved . Six died ( 3.3 % ) and 11 hospitalised were excluded ; the study was carried out on 165 children and lasted three months . Judging criteria were : length per aged , weight for length group evolution and the corresponding Z-score at 60 et 90 days . RESULTS At the inclusion , children were aged 14.6 months on average and weighed 6.7 kg ( Z-score of -3.2 weight/age ) with a length of 71.4 cm ( -2.0 Z-score length/age ) and weight for length of 0.093 ( -2.5 Z-score ) . 9.4 % had oedema .  There were no noticeable differences between the three groups as to weight gain , length gain , weight for length gain . CONCLUSION A 5 g x d(-1 ) spiruline dose does not bring any benefit over 90 days , compared to traditional renutrition . Furthermore , at the moment , it is costly , and the battle against infant malnutrition can not be based on one single element , such as a wonder drug , but on a national or local policy based on training , education , economical aid , and nutritional rehabilitation centers and infection treatment This study compared hospital to ambulatory nutritional rehabilitation outcomes and costs . Following a hospital stay to resolve initial acute medical conditions , 100 malnourished children ( 54 per cent male , ages 5 to 28 months ) in Niger were r and omly assigned to either hospital or ambulatory nutritional rehabilitation .  Anthropometric measures were assessed at 15 , 30 , 60 , 90 and 180 days post-r and omization . Following r and omization , the hospital group received a mean of 12.9 days of hospital rehabilitation and 5.6 days of ambulatory rehabilitation , while the ambulatory group received 2.2 days of hospital rehabilitation and 11.9 days of ambulatory rehabilitation . No significant differences between the two study groups in mortality rates or weight gain were found . The mean cost for hospital rehabilitation  was 120 per cent higher ( P < 0.001 ) than ambulatory rehabilitation . This study was the first r and omized clinical trial directly comparing hospital to ambulatory nutritional rehabilitation and suggests that ambulatory rehabilitation is more cost-effective Moderate childhood wasting is defined as having a weight-for-height Z-score ( WHZ ) < -2 , but > or = -3 . These children are typically given fortified corn/soy blended flour ( CSB ) , but this intervention has shown limited effectiveness . Fortified spreads ( FS ) can be used as supplementary foods instead ; they are energy-dense , lipid-based pastes with added powdered micronutrients . In this r and omized clinical effectiveness trial , the recovery rates were compared among children with moderate wasting who received either milk/peanut FS , soy/peanut FS , or CSB .  Children received isoenergetic quantities of food , 314 kJ x kg(-1 ) x d(-1 ) , for up to 8 wk with biweekly follow-up . The primary outcome was recovery , defined as having a WHZ > -2 . Time-event analysis was used to compare the recovery rate . A total of 1362 children were enrolled in the study . Children receiving soy/peanut FS had a similar recovery rate to those receiving milk/peanut FS and children in either FS group were more likely to recover than those receiving CSB ( 80 % in both FS groups vs. 72 % in the CSB group ; P < 0.01 ) . The rate of weight gain in the first 2 wk was greater among children receiving milk/peanut FS ( 2.6 g x kg(-1 ) x d(-1 ) , n = 465 ) or children receiving soy/peanut FS ( 2.4 g x kg(-1 ) x d(-1 ) , n = 450 ) than among children receiving CSB ( 2.0 g x kg(-1 ) x d(-1 ) , n = 447 ; P < 0.05 ) . Rates of length gain did not differ among the 3 groups . A total of 8 % of children in each feeding group developed edema , indicative of severe malnutrition , while receiving supplemental feeding . We conclude that FS are superior supplementary foods to CSB for moderately wasted Malawian children An energy-dense supplementary food , together with nutrition education , was given to a group of moderately malnourished children aged 6 - 12 months in a poor slum community of urban Bangladesh . An age- and sex-matched control group received only nutrition education . Both groups were followed monthly with respect to weight gain and morbidity . The purpose of the study was to assess the differential impact of a targeted supplementary feeding programme with nutrition education and a nutrition education programme alone on monthly weight gain during 6 months . During the 1st 3 months of the intervention , the monthly weight gain of the supplemented children was 205 g vs 159 g in the control children ( p less than 0.05 ) . In the following 3 months , differences in weight gain were no more significant . Several possible explanations for this transient impact are discussed . It is suggested that nutrition education in the control group may have been responsible for the limited difference between the two groups , but seasonal and epidemiological factors may also have played a part Domiciliary treatment of severely malnourished children could have economic and practical advantages over other methods . We compared three approaches in a controlled trial . 437 children in Dhaka ( < 60 % weight-for-height , and /or oedema ) aged 12 - 60 months were sequentially allocated to treatment as in patients , to day-care , or to care at home after one week of day-care .  Institutional and parental costs incurred to reach 80 % weight-for-height were compared . Costs for inpatient , day-care , and at-home groups averaged 6363 , 2517 , and 1552 taka ( 60 taka = UK pound 1 ) . Mortality was low ( < 5 % ) in all three groups . Day-care treatment approached inpatient care for speed of recovery at less than half the cost , but it was unpopular with parents . The at-home group took significantly longer to attain 80 % weight-for-height than the other groups , but did so at the lowest average cost . Parental costs were highest for the at-home group as no food supplements were provided ; nevertheless this was the most popular option . We conclude that at-home management of severely malnourished children  after 1 week of inpatient care is a cost-effective strategy BACKGROUND Moderate and severe acute malnutrition affects 13 % of children < 5 y of age worldwide . Severe acute malnutrition affects fewer children but is associated with higher rates of mortality and morbidity . Supplementary feeding programs aim to treat moderate acute malnutrition and prevent the deterioration to severe acute malnutrition . OBJECTIVE The aim was to compare recovery rates of children with moderate acute malnutrition in supplementary feeding programs by using the newly recommended ration of ready-to-use supplementary food ( RUSF ) and the more conventional ration of corn-soya blend ( CSB ) in Ethiopia . DESIGN A total of 1125 children aged 6 - 60 mo with moderate acute malnutrition received 16 wk of CSB or RUSF . Children were r and omly assigned to receive one or the other food . The daily rations were purpose ly based on the conventional treatment rations distributed at the time of the study in Ethiopia : 300 g CSB and 32 g vegetable oil in the control group ( 1413 kcal ) and 92 g RUSF in the intervention group ( 500 kcal ) . The higher ration size of CSB was provided because of expected food sharing . RESULTS The HR for children in the CSB group was 0.85 ( 95 % CI : 0.73 , 0.99 ) , which indicated that they had 15 % lower recovery ( P = 0.039 ) . Recovery rates of children at the end of the 16-wk treatment period trended higher in the RUSF group ( 73 % ) than in the CSB group ( 67 % ) ( P = 0.056 ) . CONCLUSION In comparison with CSB , the treatment of moderate acute malnutrition with RUSF result ed in higher recovery rates in children , despite the large ration size and higher energy content of the conventional CSB ration We aim ed to analyse growth and recovery from undernutrition among moderately underweight ambulatory children receiving micronutrient-fortified maize-soy flour ( Likuni Phala , LP ) or ready-to-use fortified spread ( FS ) supplementary diet . One hundred and seventy-six 6 - 18-month-old individuals were r and omized to receive 500 g LP or 350 g FS weekly for 12 weeks . Baseline and end of intervention measurements were used to calculate anthropometric gains and recovery from underweight , wasting and stunting . Mean weight-for-age increased by 0.22 ( 95 % CI 0.07 - 0.37 ) and 0.28 ( 0.18 - 0.40 ) Z-score units in the LP and FS groups respectively . Comparable increase for mean weight-for-length was 0.39 ( 0.20 - 0.57 ) and 0.52 ( 0.38 - 0.65 ) Z-score units . Recovery from underweight and wasting was 20 % and 93 % in LP group and 16 % and 75 % in FS group . Few individuals recovered from stunting and mean length-for-age was not markedly changed . There were no statistically significant differences between the outcomes in the two intervention groups . In a poor food-security setting , underweight infants and children receiving supplementary feeding for 12 weeks with ready-to-use FS or maize-soy flour porridge show similar recovery from moderate wasting and underweight . Neither intervention , if limited to a 12-week duration , appears to have significant impact on the process of linear growth or stunting Objective Maize and soy flour mixes are often used in the treatment of moderate malnutrition in Malawi . Their efficacy has not been formally evaluated . A recently developed ready-to-use food ( RTUF ) effectively promotes growth among severely malnourished children . The authors compared the effect of maize and soy flour with that of RTUF in the home treatment of moderately malnourished children . Methods Sixty-one underweight , stunted children 42 to 60 months of age were recruited in rural Malawi , in southeastern Africa . They received either RTUF or maize and soy flour for 12 weeks . Both supplements provided 2 MJ ( 500Kcal ) of energy daily but had different energy and nutrient densities . Outcome variables were weight and height gain and dietary intake . Results Before intervention , the mean dietary intake and weight and height gain were similar in the two groups . During the supplementation phase , the consumption of staple food fell among children receiving maize and soy flour but not among those receiving RTUF . There was thus higher intake of energy , fat , iron , and zinc in the RTUF group . Both supplements result ed in modest weight gain , but the effect lasted longer after RTUF supplementation . Height gain was not affected in either group . Periodic 24-hour dietary recalls suggested that the children received only 30 % and 43 % , respectively , of the supplementary RTUF and maize and soy flour provided . Conclusions RTUF is an acceptable alternative to maize and soy flour for dietary supplementation of moderately malnourished children . Approaches aim ed at increasing the consumption of supplementary food by the selected recipients are needed BACKGROUND Children with moderate acute malnutrition ( MAM ) are often treated with fortified blended flours , most commonly a corn-soy blend ( CSB ) . However , recovery rates remain < 75 % , lower than the rate achieved with peanut paste-based ready-to-use supplementary foods ( RUSFs ) . To bridge this gap , a novel CSB recipe fortified with oil and dry skim milk , " CSB++ , " has been developed . OBJECTIVE In this trial we compared CSB++ with 2 RUSF products for the treatment of MAM to test the hypothesis that the recovery rate achieved with CSB++ will not be > 5 % worse than that achieved with either RUSF . DESIGN We conducted a prospect i ve , r and omized , investigator-blinded , controlled noninferiority trial involving rural Malawian children aged 6 - 59 mo with MAM . Children received 75 kcal CSB++ · kg(-1 ) · d(-1 ) , locally produced soy RUSF , or an imported soy/whey RUSF for ≤12 wk . RESULTS The recovery rate  for CSB++ ( n = 763 of 888 ; 85.9 % ) was similar to that for soy RUSF ( 795 of 806 , 87.7 % ; risk difference : -1.82 % ; 95 % CI : -4.95 % , 1.30 % ) and soy/whey RUSF ( 807 of 918 , 87.9 % ; risk difference : -1.99 % ; 95 % CI : -5.10 % , 1.13 % ) . On average , children who received CSB++ required 2 d longer to recover , and the rate of weight gain was less than that with either RUSF , although height gain was the same among all 3 foods studied . CONCLUSIONS A novel , locally produced , fortified blended flour ( CSB++ ) was not inferior to a locally produced soy RUSF and an imported soy/whey RUSF in facilitating recovery from MAM . The recovery rate observed for CSB++ was higher than that for any other fortified blended flour tested previously . This trial is registered at clinical trials.gov as NCT00998517 A prospect i ve cohort study measured mortality during nutritional rehabilitation among HIV-infected and uninfected children , aged 6 - 59 months , with severe acute malnutrition ( SAM ) . Children were tested for HIV and CD4 % on admission to the nutrition rehabilitation unit ( NRU ) . Mortality was assessed by following children to 4 months post discharge from the NRU or death if earlier . Overall mortality was 14.8 % ( 67/454 ) and HIV prevalence was 17.4 % ( 79/454 ) . HIV-infected children were significantly more likely to die than uninfected children [ 35.4 % ( 28/79 ) vs. 10.4 % ( 39/375 ) , P<0.001 ] , and 85.7 % of deaths occurred in children with a CD4 % less than 20 . Forty percent ( 18/45 ) of HIV-infected children with a CD4 % < 20 died , in contrast to 15 % ( 3/20 ) of HIV-infected children with a CD4 % > 20 ( P=0.05 ) . Routine testing and treatment for HIV among all malnourished children is necessary to improve quality of care and reduce mortality among children with SAM St and ard therapy for severe acute malnutrition ( SAM ) is home-based therapy with ready-to-use therapeutic food ( RUTF ) containing 25 % milk . In an effort to lower the cost of RUTF and increase availability , some have suggested that a portion of milk be replaced with soy . This trial was design ed to determine whether treating children with SAM with 10 % milk RUTF containing soy would result in a similar recovery rate compared with the 25 % milk RUTF . This was a r and omized , double-blind , controlled , clinical , quasi-effectiveness trial of isoenergetic amounts of 2 locally produced RUTF to treat SAM in Malawi among children aged 6 - 59 mo . A total of 1874 children were enrolled . Children were assessed every fortnight and participated in the study until they clinical ly recovered or received 8 wk of treatment . The primary outcome was recovery ( weight-for-height Z score > -2 and no edema ) . Secondary outcomes were rates of weight and height gain . Survival analysis was used to compare the recovery rates . Recovery among children receiving 25 % milk RUTF was greater than children receiving 10 % milk RUTF , 64 % compared with 57 % after 4 wk , and 84 % compared with 81 % after 8 wk ( P < 0.001 ) . Children receiving 25 % milk RUTF also had higher rates of weight and height gain compared with children receiving 10 % milk RUTF . Treating children with SAM with 10 % milk RUTF is less effective compared with treatment with the st and ard 25 % milk RUTF . These findings also emphasize that clinical evidence should be examined before recommending any changes to the formulation of RUTF Moderate acute malnutrition ( MAM ) affects 11 % of children < 5 y old worldwide and increases their risk for morbidity and mortality . It is assumed that successful treatment of MAM reduces these risks . A total of 1967 children aged 6 - 59 mo successfully treated for MAM in rural Malawi following r and omized treatment with corn-soy blend plus milk and oil ( CSB++ ) , soy ready-to-use supplementary food ( RUSF ) , or soy/whey RUSF were followed for 12 mo . The initial supplementary food was given until the child reached a weight-for-height Z-score ( WHZ ) > -2 . The median duration of feeding was 2 wk , with a maximum of 12 wk . The hypothesis tested was that children treated with either RUSF would be more likely to remain well-nourished than those treated with CSB++ . The primary outcome , remaining well-nourished , was defined as mid-upper arm circumference ≥12.5 cm or WHZ ≥-2 for the entire duration of follow-up . During the 12-mo follow-up period , only 1230 ( 63 % ) children remained well-nourished , 334 ( 17 % ) relapsed to MAM , 190 ( 10 % ) developed severe acute malnutrition , 74 ( 4 % ) died , and 139 ( 7 % ) were lost to follow-up . Children who were treated with soy/whey RUSF were more likely to remain well-nourished ( 67 % ) than those treated with CSB++ ( 62 % ) or soy RUSF ( 59 % ) ( P = 0.01 ) . A seasonal pattern of food insecurity and adverse clinical outcomes was observed . This study demonstrates that children successfully treated for MAM with soy/whey RUSF are more likely to remain well-nourished ; however , all children successfully treated for MAM remain vulnerable
Background Globally , moderate acute malnutrition ( MAM ) and severe acute malnutrition ( SAM ) affect approximately 52 million children under five .
This systematic review evaluates the effectiveness of interventions for SAM including the World Health Organization ( WHO ) protocol for inpatient management and community-based management with ready-to-use-therapeutic food ( RUTF ) , as well as interventions for MAM in children under five years in low- and middle-income countries .