Effect of Mass Supplementation with Ready-to-Use Supplementary Food during an Anticipated Nutritional Emergency

Abstract

BackgroundPrevious studies have shown the benefits of ready-to-use supplementary food (RUSF) distribution in reducing the incidence and prevalence of severe acute malnutrition.Methods and FindingsTo compare the incidence of wasting, stunting and mortality between children aged 6 to 23 mo participating and not participating in distributions of RUSF, we implemented two exhaustive prospective cohorts including all children 60 cm to 80 cm, resident in villages of two districts of Maradi region in Niger (n = 2238). Villages (20) were selected to be representative of the population. All registered children were eligible for the monthly distributions between July and October 2010. Age, sex, height, weight, and Mid-Upper Arm Circumference (MUAC) were measured at baseline and two weeks after each distribution; the amount and type of distribution and the amount shared and remaining were also assessed. We compared the incidence of wasting, stunting, and mortality among children participating in the distribution (intervention) of RUSF versus children not participating in the distribution (comparison). The absolute rate of wasting was 4.71 events per child-year (503 events/106.59 child-year) in the intervention group and 4.98 events per child-year (322 events/64.54 child-year) in the comparison group. The intervention group had a small but higher weight-for-length Z-score gain (−0.2z vs. −0.3z) and less loss of MUAC than the comparison group (−2.8 vs. −4.0 mm). There was no difference in length gain (2.7 vs. 2.8 cm). Mortality was lower for children whose households received the intervention than those who did not (adjusted HR 0.55, 95% CI: 0.32–0.98).ConclusionsShort-term distribution with RUSF for children 6 to 23 months improve the nutritional status of children at risk for malnutrition. Fewer children who participated in the RUSF distribution died than those who did not.

Observational Bias during Nutrition Surveillance: Results of a Mixed Longitudinal and Cross-Sectional Data Collection System in Northern Nigeria

“…This was observed despite the fact that the SAM children were offered treatment and the moderately malnourished children were not treated. This could be explained by the relatively low point coverage of the treatment program and the extensive sharing of the therapeutic food documented elsewhere [19].…”

“…Even though there were few SAM children, their treatment could have changed the mean MUAC found as the clusters were repeatedly surveyed. Furthermore, sharing of the therapeutic food [19] given only in the surveyed clusters could have increased the MUAC of children who had not presented with SAM. We suggest that if the larger number of moderately malnourished children (MAM) had also been offered treatment the effect upon the mean MUAC of the “sentinel clusters” would have led to a much greater bias.…”

“…For these reasons, surveys at sentinel sites are relatively rapid and less costly than those which select new sites at each round. However, malnourished children within the village must be referred for treatment for ethical reasons, and this in time should modify the nutritional status of the children within that village, particularly if there is sharing of the therapeutic food [19]. Furthermore, the team itself will offer advice and referral of sick children, feed-back data to the village elders which will sensitise them to the nutritional problems within the village and if the team offers incentives to informants or spends money to purchase food or other items this has the potential to change the economics of the village.…”

Recovery, Relapse, and Episodes of Default in the Management of Acute Malnutrition in Children in Humanitarian Emergencies: A systematic review

“…The observational cohort studies (n=7) and programme evaluation reports (n=7) were evaluated based on the CASP Cohort Study Checklist. Three of the observational studies were assessed to be of high quality (Amthor et al, 2009;Grellety et al, 2012;Linneman et al, 2007); two were assessed to be of medium quality (Collins and Sadler, 2002;Lagrone et al, 2010); and two were assessed to be of low quality (Chaiken et al, 2006;Gaboulaud et al, 2006). All seven of the programme evaluation reports were assessed to be of low quality (Deconinck, 2004;Lurqin, 2003;Morgan et al, 2015;Querubin, 2006;Taylor, 2002;UNICEF, 2012;Walker, 2004).…”

Nutritional and other types of oedema, albumin, complex carbohydrates and the interstitium – a response to Malcolm Coulthard's hypothesis: Oedema in kwashiorkor is caused by hypo-albuminaemia

“…234 In Niger, sharing was extensive with only 18% of participants receiving the supplement exclusively. 235 In Burkino Faso, nearly all mothers reported almost complete compliance, but direct observation showed that about 60% received the food supplement, which was tasty and perceived as food, but only 30% the zinc tablet. 236 Such low compliance and how it is assessed can be a major reason why randomized controlled trials report false negative results.…”