Presented at the conference of the American Society of Tropical Medicine and Hygiene 200

Djibo, A

Gabonland, V

Grais, Rebecca F

Guerin, P

Isanaka, Sheila

Nombella, N

Van Beckhoven, D

English

MSF Field Research

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Title: Effect of ready-to-use-therapeutic food supplementation on the nutritional status, mortality and morbidity of children 6 to 60 months in Niger: a cluster
randomized trial
Author Block: Sheila Isanaka
1, Nohelly Nombella
2, Ali Djibo
3, Marie Poupard
2, Dominique Van Beckhoven
2, Valerie Gaboulaud
2, Philippe J. Guerin
2, Rebecca F. Grais
2
1Departments of Epidemiology and Nutrition, Harvard School of Public Health, Boston, MA, United States, 
2Epicentre, Paris, France, 
3Ministry of Health,
Niamey, Niger
Disclosure Block:  R.F. Grais, None.
Background: Ready-to-use-therapeutic foods (RUTF) are becoming an important component of the effective outpatient treatment of severe wasting. Their utility for prevention of
wasting, however, has not been evaluated. Further, some findings of adverse health effects due to iron and folic acid supplementation suggest that iron supplementation in settings
where the prevalence of malaria and other infectious diseases is high should be proceeded with cautiously. We evaluate the effect of a 3-month preventative supplementary feeding
using RUTF on the nutritional status, mortality and morbidity of children 6 to 60 months.
Methods: A cluster randomized trial of 12 villages in Maradi, Niger. Six villages were randomized to intervention and 6 to no intervention. Villages were visited monthly from August 2006
to March 2007. All children in the study villages between 6 and 60 mo of age were eligible for recruitment. The monthly distribution consisted of one packet per day of RUTF
(PlumpyNut®, 500kcal/day) to each eligible child with weight-for-height ³ 80% of the NCHS reference median from August to October 2006. Our main outcome was change in weight-
for-height Z (WHZ) score according to the WHO Standards and incidence of wasting (WHZ < -2) over 8 months of follow up.
Results: The adjusted overall effect of the intervention on WHZ change was 0.18 Z (95% CI: 0.09, 0.27) over 8 mo. This effect was strongest in children 24 mo or younger at baseline.
The intervention resulted in a 36% (95% CI: 20% - 49%) reduction in the incidence of wasting and a 57% (95% CI: 43% - 68%) reduction in the incidence of severe wasting. There was
no evidence of increased risk of malaria associated with RUTF supplementation. There was a non-significant 49% reduction in mortality associated with the intervention.
Conclusions: In a setting of acute food insecurity, short-term preventative supplementation with RUTF reduced the decline in WHZ and incidence of wasting and severe wasting. This
study suggests that this product fortified with 11.5 mg of iron/100g did not aggravate malaria but further research is needed.
 
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Effect of ready-to-use-therapeutic food supplementation on the nutritional status, mortality and morbidity of children 6 to 60 months in Niger, a cluster randomized trial

Effect of ready-to-use-therapeutic food supplementation on the nutritional status, mortality and morbidity of children 6 to 60 months in Niger, a cluster randomized trial

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