BACKGROUND: The standard treatment of severe malnutrition in Malawi often utilises prolonged inpatient care, and after discharge results in high rates of relapse. AIMS: To test the hypothesis that the recovery rate, defined as catch-up growth such that weight-for-height z score >0 (WHZ, based on initial height) for ready-to-use food (RTUF) is greater than two other home based dietary regimens in the treatment of malnutrition. METHODS: HIV negative children >1 year old discharged from the nutrition unit in Blantyre, Malawi were systematically allocated to one of three dietary regimens: RTUF, RTUF supplement, or blended maize/soy flour. RTUF and maize/soy flour provided 730 kJ/kg/day, while the RTUF supplement provided a fixed amount of energy, 2100 kJ/day. Children were followed fortnightly. Children completed the study when they reached WHZ >0, relapsed, or died. Outcomes were compared using a time-event model. RESULTS: A total of 282 children were enrolled. Children receiving RTUF were more likely to reach WHZ >0 than those receiving RTUF supplement or maize/soy flour (95% v 78%, RR 1.2, 95% CI 1.1 to 1.3). The average weight gain was 5.2 g/kg/day in the RTUF group compared to 3.1 g/kg/day for the maize/soy and RTUF supplement groups. Six months later, 96% of all children that reached WHZ >0 were not wasted. CONCLUSIONS: Home based therapy of malnutrition with RTUF was successful; further operational work is needed to implement this promising therapy.
BACKGROUND: The standard treatment of severe malnutrition in Malawi often utilises prolonged inpatient care, and after discharge results in high rates of relapse. AIMS: To test the hypothesis that the recovery rate, defined as catch-up growth such that weight-for-height z score >0 (WHZ, based on initial height) for ready-to-use food (RTUF) is greater than two other home based dietary regimens in the treatment of malnutrition. METHODS: HIV negative children >1 year old discharged from the nutrition unit in Blantyre, Malawi were systematically allocated to one of three dietary regimens: RTUF, RTUF supplement, or blended maize/soy flour. RTUF and maize/soy flour provided 730 kJ/kg/day, while the RTUF supplement provided a fixed amount of energy, 2100 kJ/day. Children were followed fortnightly. Children completed the study when they reached WHZ >0, relapsed, or died. Outcomes were compared using a time-event model. RESULTS: A total of 282 children were enrolled. Children receiving RTUF were more likely to reach WHZ >0 than those receiving RTUF supplement or maize/soy flour (95% v 78%, RR 1.2, 95% CI 1.1 to 1.3). The average weight gain was 5.2 g/kg/day in the RTUF group compared to 3.1 g/kg/day for the maize/soy and RTUF supplement groups. Six months later, 96% of all children that reached WHZ >0 were not wasted. CONCLUSIONS: Home based therapy of malnutrition with RTUF was successful; further operational work is needed to implement this promising therapy.
Authors: Abel H Irena; Paluku Bahwere; Victor O Owino; ElHadji I Diop; Max O Bachmann; Clara Mbwili-Muleya; Filippo Dibari; Kate Sadler; Steve Collins Journal: Matern Child Nutr Date: 2015-12 Impact factor: 3.092
Authors: John Phuka; Chrissie Thakwalakwa; Kenneth Maleta; Yin Bun Cheung; André Briend; Mark Manary; Per Ashorn Journal: Matern Child Nutr Date: 2009-04 Impact factor: 3.092
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Authors: Valerie L Flax; Kenneth Maleta; Ulla Ashorn; Mark J Manary; André Briend; Per Ashorn Journal: J Health Popul Nutr Date: 2008-12 Impact factor: 2.000