Academic journal article Journal of Health Population and Nutrition

Supplemental Feeding with Ready-to-Use Therapeutic Food in Malawian Children at Risk of Malnutrition

Academic journal article Journal of Health Population and Nutrition

Supplemental Feeding with Ready-to-Use Therapeutic Food in Malawian Children at Risk of Malnutrition

Article excerpt


Malawi is a poor, agrarian, food insecure nation in sub- Saharan Africa where half of children aged less than five years are stunted. Over half of deaths of these children are attributed to malnutrition (1). When a crisis compromises food production in nations, such as Malawi, nongovernmental organizations and international agencies often respond with supplementary feeding targeted to vulnerable children, hoping to prevent severe malnutrition and excess mortality. Supplementary feeding is defined as the distribution of food to supplement energy and other nutrients missing from the diet of those who have special nutritional requirements (2). Most supplementary foods are micronutrient-fortified combinations of cereals and legumes, the one used most commonly is corn/soy-blend. Children at risk of malnutrition are identified by low weight-for-height. However, the results of such programmes have been disappointing, with over 50% of the programmes in sub-Saharan Africa reporting no significant weight gain with take-home supplementary feeding (3). An analysis of supplementary feeding programmes in Lesotho found no improvement in weight gain with their intervention, but there was improvement in clinic attendance (4). Acomprehensive review of supplementary feeding published in 1999 did not identify any efficacy studies assessing the effect of fortified corn/ soy-blended foods (5), and a Medline search of the subsequent time period did not reveal any such studies either.

Ready-to-use therapeutic food (RUTF) has recently been introduced in Malawi in conjunction with homebased therapy for severe childhood malnutrition (6-8). RUTF is an energy-dense paste that does not require cooking, resists bacterial growth because of its low water content, and can be stored without spoiling for several months (9). Recovery rates among severely-malnourished Malawian children using RUTF were 78% compared to 46% using the standard protocol advocated by the World Health Organization (WHO) (10).

This study tested the hypothesis that supplemental feeding with RUTF would result in better growth in Malawian children at risk of malnutrition (80%



Children, aged 10-60 months at risk of malnutrition, weight-for-height >80%, but <85% of the standard reference values of WHO (11) without oedema, were eligible for the study. These anthropometric criteria defining children at risk of malnutrition are those specified by the Malawian national guidelines. This group is targeted for supplementary feeding. Children presenting to any of seven nutritional rehabilitation units (NRUs) from December 2002 to May 2003 were screened for eligibility for the supplementary feeding programme. This study was done in conjunction with a study of homebased therapeutic feeding of severely-malnourished children (10). The children screened included all inpatients in the NRUs and children brought by caretakers from the surrounding community. The participating NRUs were three mission hospitals and four public-health centres in small towns and rural areas of southern Malawi. Children aged less than 10 months were excluded from the study because of the concern that supplementary feeding might interfere with breastfeeding.

Informed consent was obtained from all participating caretakers. The Research and Ethics Committee of the College of Medicine, University of Malawi, and the Human Studies Committee of Washington University in St. Louis approved the study.

Experiment design

This was a controlled, comparative clinical effectiveness trial of two different management strategies for supplementary feeding of children at risk for development of malnutrition.

Since randomized assignment to supplementary feeding with RUTF or corn/soy-blend was not possible in this setting due to resource constraints and cultural beliefs, prospective systematic allocation using a stepped-wedge design was employed (12). …

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