Effectiveness of Indigenous Ready-to-Use Therapeutic Food in Community-based Management of Uncomplicated Severe Acute Malnutrition: a Randomized Controlled Trial from India

Abstract

A randomized controlled trial was conducted in Chandigarh, India (2011), to determine the effectiveness of indigenous ready-to-use therapeutic food (RUTF) in community-based management of uncomplicated severe acute malnutrition (SAM). Intervention was through outpatient therapeutic program site (OTP). Study and control group children (6 months-5 years) were followed up weekly for 12 weeks, in OTP and at home. All children received supplementary nutrition through anganwadis under integrated child development scheme. Study children, in addition, received therapeutic dose of RUTF in OTP. Primary outcome, 115% of baseline weight, was attained in 6 of 13 (46.2%) and 1 of 13 (7.7%) children among study and control group, respectively [odds ratio: 10.28, 95% confidence interval (CI): 1.02-103.95]. Compared with control group, addition of RUTF in study group resulted in average additional increase in weight by 13 g/kg of baseline weight/week/child (95% CI: 2-23). Indigenous RUTF was effective in community-based management of uncomplicated SAM.

Potentials, Experiences and Outcomes of a Comprehensive Community Based Programme to Address Malnutrition in Tribal India

“…The AAM programme had a small sample for children under three years with SAM since it intended to provide care to children irrespective of nutritional status at village level. In our study, 26 of 45 SAM children (57.8%) gained more than 15% of baseline weight compared to a similar improvement seen in 46.2% of the cases in another CMAM programme [27], and to 65% in a study of an integrated model for the management of SAM (IM-SAM) where facility-based care was also involved [32]. MSF 'old' data, with a sample of 3873 children (under five) with SAM shows 71% children had a 15% weight gain [22].…”

“…Comparability of outcomes is also hampered by the fact that programmes are using varying standards to define entry and exits from the programme and 'cure' itself. For instance, some available studies on CMAM have tended to describe gains using weight gain of 5g/kg/day for short periods of time [26] or a 15% weight gain as recovery [27] 5 . UNICEF and WHO in their 3 WHO, in a statement on CMAM explains it as follows: "The community-based approach involves timely detection of severe acute malnutrition in the community and provision of treatment for those without medical complications with ready-to-use therapeutic foods or other nutrient-dense foods at home.…”

Severe acute malnutrition in children aged under 5 years can be successfully managed in a non‐emergency routine community healthcare setting in Ghana

“…At the health centre level, the health worker (nurse) also received additional training on nutritional status assessment of children <5 years, measured the weight and MUAC of the referred children, and conducted an assessment to identify any medical conditions, including bilateral pitting oedema. The health worker measured the weight of the children unclothed or very light cloths and with no necklaces using the Salter scale (Collins & Sadler, ; Grellety et al, ; Shewade et al ). The scale was calibrated before and after each measurement, using a standard weight, and was adjusted to zero before each measurement.…”

Effectiveness of Interventions for Managing Acute Malnutrition in Children under Five Years of Age in Low-Income and Middle-Income Countries: A Systematic Review and Meta-Analysis

“…Three studies [24,30,50] assessed cost-effectiveness of inpatient rehabilitation compared to outpatient or community-based management. Fourteen studies [25][26][27]29,31,32,36,37,39,42,48,51,54,55] compared community-based management of children with uncomplicated SAM with RUTF versus other foods. Other foods included non-dairy or reduced dairy-based RUTF, non-peanut butter-based RUTF, energy dense homemade food, corn soy blend (CSB), and F100.…”