11 research outputs found
Effect of Short-Term Supplementation with Ready-to-Use Therapeutic Food or Micronutrients for Children after Illness for Prevention of Malnutrition : A Randomised Controlled Trial in Nigeria
Background Globally, Médecins Sans Frontières (MSF) treats more than 300,000
severely malnourished children annually. Malnutrition is not only caused by
lack of food and poor infant and child feeding practices but also by
illnesses. Breaking the vicious cycle of illness and malnutrition by providing
ill children with nutritional supplementation is a potentially powerful
strategy for preventing malnutrition that has not been adequately
investigated. Therefore, MSF investigated whether incidence of malnutrition
among ill children <5 y old could be reduced by providing a fortified food
product or micronutrients during their 2-wk convalescence period. Two trials,
one in Nigeria and one in Uganda, were conducted; here we report on the trial
that took place in Goronyo, a rural region of northwest Nigeria with high
morbidity and malnutrition rates. Methods and Findings We investigated the
effect of supplementation with ready-to-use therapeutic food (RUTF) and a
micronutrient powder (MNP) on the incidence of malnutrition in ill children
presenting at an outpatient clinic in Goronyo during February to September
2012. A three-armed, partially-blinded, randomised controlled trial was
conducted in children diagnosed as having malaria, diarrhoea, or lower
respiratory tract infection. Children aged 6 to 59 mo were randomised to one
of three arms: one sachet/d of RUTF; two sachets/d of micronutrients or no
supplement (control) for 14 d for each illness over 6 mo. The primary outcome
was the incidence of first negative nutritional outcome (NNO) during the 6 mo
follow-up. NNO was a study-specific measure used to indicate occurrence of
malnutrition; it was defined as low weight-for-height z-score (<−2 for non-
malnourished and <−3 for moderately malnourished children), mid-upper arm
circumference <115 mm, or oedema, whichever came first. Of the 2,213
randomised participants, 50.0% were female and the mean age was 20.2 (standard
deviation 11.2) months; 160 (7.2%) were lost to follow-up, 54 (2.4%) were
admitted to hospital, and 29 (1.3%) died. The incidence rates of NNO for the
RUTF, MNP, and control groups were 0.522 (95% confidence interval (95% CI),
0.442–0.617), 0.495 (0.415–0.589), and 0.566 (0.479–0.668) first events/y,
respectively. The incidence rate ratio was 0.92 (95% CI, 0.74–1.15; p = 0.471)
for RUTF versus control; 0.87 (0.70–1.10; p = 0.242) for MNP versus control
and 1.06 (0.84–1.33, p = 0.642) for RUTF versus MNP. A subgroup analysis
showed no interaction nor confounding, nor a different effectiveness of
supplementation, among children who were moderately malnourished compared with
non-malnourished at enrollment. The average number of study illnesses for the
RUTF, MNP, and control groups were 4.2 (95% CI, 4.0–4.3), 3.4 (3.2–3.6), and
3.6 (3.4–3.7). The proportion of children who died in the RUTF, MNP, and
control groups were 0.8% (95% CI, 0.3–1.8), 1.8% (1.0–3.3), and 1.4%
(0.7–2.8). Conclusions A 2-wk supplementation with RUTF or MNP to ill children
as part of routine primary medical care did not reduce the incidence of
malnutrition. The lack of effect in Goronyo may be due to a high frequency of
morbidity, which probably further affects a child’s nutritional status and
children’s ability to escape from the illness–malnutrition cycle. The duration
of the supplementation may have been too short or the doses of the supplements
may have been too low to mitigate the effects of high morbidity and pre-
existing malnutrition. An integrated approach combining prevention and
treatment of diseases and treatment of moderate malnutrition, rather than
prevention of malnutrition by nutritional supplementation alone, might be more
effective in reducing the incidence of acute malnutrition in ill children
Effect of Short-Term Supplementation with Ready-to-Use Therapeutic Food or Micronutrients for Children after Illness for Prevention of Malnutrition: A Randomised Controlled Trial in Uganda
Background Globally, Médecins Sans Frontières (MSF) treats more than 300,000
severely malnourished children annually. Malnutrition is not only caused by
lack of food but also by illnesses and by poor infant and child feeding
practices. Breaking the vicious cycle of illness and malnutrition by providing
ill children with nutritional supplementation is a potentially powerful
strategy for preventing malnutrition that has not been adequately
investigated. Therefore, MSF investigated whether incidence of malnutrition
among ill children <5 y old could be reduced by providing a fortified food
product or micronutrients during their 2-wk convalescence period. Two trials,
one in Nigeria and one in Uganda, were conducted; here, we report on the trial
that took place in Kaabong, a poor agropastoral region of Karamoja, in east
Uganda. While the region of Karamoja shows an acute malnutrition rate between
8.4% and 11.5% of which 2% to 3% severe malnutrition, more than half (58%) of
the population in the district of Kaabong is considered food insecure. Methods
and Findings We investigated the effect of two types of nutritional
supplementation on the incidence of malnutrition in ill children presenting at
outpatient clinics during March 2011 to April 2012 in Kaabong, Karamoja
region, Uganda, a resource-poor region where malnutrition is a chronic problem
for its seminomadic population. A three-armed, partially-blinded, randomised
controlled trial was conducted in children diagnosed with malaria, diarrhoea,
or lower respiratory tract infection. Non-malnourished children aged 6 to 59
mo were randomised to one of three arms: one sachet/d of ready-to-use
therapeutic food (RUTF), two sachets/d of micronutrient powder (MNP), or no
supplement (control) for 14 d for each illness over 6 mo. The primary outcome
was the incidence of first negative nutritional outcome (NNO) during the 6 mo
follow-up. NNO was a study-specific measure used to indicate progression to
moderate or severe acute malnutrition; it was defined as weight-for-height
z-score <−2, mid-upper arm circumference (MUAC) <115 mm, or oedema, whichever
came first. Of the 2,202 randomised participants, 51.2% were girls, and the
mean age was 25.2 (±13.8) mo; 148 (6.7%) participants were lost to follow-up,
9 (0.4%) died, and 14 (0.6%) were admitted to hospital. The incidence rates of
NNO (first event/year) for the RUTF, MNP, and control groups were 0.143 (95%
confidence interval [CI], 0.107–0.191), 0.185 (0.141–0.239), and 0.213
(0.167–0.272), respectively. The incidence rate ratio was 0.67 (95% CI,
0.46–0.98; p = 0.037) for RUTF versus control; a reduction of 33.3%. The
incidence rate ratio was 0.86 (0.61–1.23; p = 0.413) for MNP versus control
and 0.77 for RUTF versus MNP (95% CI 0.52–1.15; p = 0.200). The average
numbers of study illnesses for the RUTF, MNP, and control groups were 2.3 (95%
CI, 2.2–2.4), 2.1 (2.0–2.3), and 2.3 (2.2–2.5). The proportions of children
who died in the RUTF, MNP, and control groups were 0%, 0.8%, and 0.4%. The
findings apply to ill but not malnourished children and cannot be generalised
to a general population including children who are not necessarily ill or who
are already malnourished. Conclusions A 2-wk nutrition supplementation
programme with RUTF as part of routine primary medical care to non-
malnourished children with malaria, LRTI, or diarrhoea proved effective in
preventing malnutrition in eastern Uganda. The low incidence of malnutrition
in this population may warrant a more targeted intervention to improve cost
effectiveness
Effect of Short-Term Supplementation with Ready- to-Use Therapeutic Food or Micronutrients for Children after Illness for Prevention of Malnutrition: A Randomised Controlled Trial in Nigeria Effect of Short-Term Supplementation with Ready-to-Use Therapeut
Abstract Backgroun
Flow diagram of participants of the supplementation study in Goronyo.
<p>MNP, micronutrient powder; RUTF, ready-to-use therapeutic food; SAM, severe acute malnutrition; TFC, therapeutic feeding centre.</p
The Double Burden of Obesity and Malnutrition in a Protracted Emergency Setting: A Cross-Sectional Study of Western Sahara Refugees
Flow diagram of participants’ supplementation study in Kaabong.
<p>ITT, intention to treat; MNP, micronutrient powder; RUTF, ready-to-use therapeutic food; TFC/SFC, therapeutic/supplementary feeding centre.</p
Double burden of malnutrition in refugee households.
<p>Proportion of households classified as normal, double burden, overweight, and undernourished in Western Sahara refugee camps. Overweight and the double burden in each stacked bar is based on two different indicators used to classify either obesity (BMI) or central obesity (WC).</p
Household demographics in the four surveyed Western Sahara refugee camps (strata).
<p>Household demographics in the four surveyed Western Sahara refugee camps (strata).</p
Overweight, obesity, and central obesity among refugee women by age.
<p>Scatterplot of the relationship between BMI (in kilograms/metre<sup>2</sup>; linear regression coefficient 0.22, constant 19.3) and WC (in centimetres; linear regression coefficient 0.60, constant 69.0) with age among Western Sahara refugee women.</p
Malnutrition in refugee households.
<p>Proportions of households with a member affected by malnutrition in women and children, Western Sahara refugee camps.</p