Home based therapy for severe malnutrition with ready-to-use food.
BACKGROUND
The standard treatment of severe malnutrition in Malawi often utilises prolonged inpatient care, and after discharge results in high rates of relapse.


OBJECTIVE
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.
Manary
M J
MJ
Department of Pediatrics, Washington University School of Medicine, St Louis, MO, USA. manary@kids.wustl.edu
Ndkeha
M J
MJ
Ashorn
P
P
Maleta
K
K
Briend
A
A
D001827:Body Height / Q000502:physiology; D001835:Body Weight / Q000502:physiology; D015362:Child Nutrition Disorders / Q000178:diet therapy*; D002675:Child, Preschool; D005260:Female; D005527:Food, Fortified; D006701:Home Nursing / Q000379:methods; D006801:Humans; D007223:Infant; D008295:Malawi; D008297:Male; D016896:Treatment Outcome