title: Comparison of home-based therapy with ready-to-use therapeutic food with standard therapy in the treatment of malnourished Malawian children: a controlled, clinical effectiveness trial.
abstract: BACKGROUND
  Childhood malnutrition is common in Malawi, and the standard treatment, which follows international guidelines, results in poor recovery rates. Higher recovery rates have been seen in pilot studies of home-based therapy with ready-to-use therapeutic food (RUTF).
  
  
  OBJECTIVE
  The objective was to compare the recovery rates among children with moderate and severe wasting, kwashiorkor, or both receiving either home-based therapy with RUTF or standard inpatient therapy.
  
  
  METHODS
  A controlled, comparative, clinical effectiveness trial was conducted in southern Malawi with 1178 malnourished children. Children were systematically allocated to either standard therapy (186 children) or home-based therapy with RUTF (992 children) according to a stepped wedge design to control for bias introduced by the season of the year. Recovery, defined as reaching a weight-for-height z score > -2, and relapse or death were the primary outcomes. The rate of weight gain and the prevalence of fever, cough, and diarrhea were the secondary outcomes.
  
  
  RESULTS
  Children who received home-based therapy with RUTF were more likely to achieve a weight-for-height z score > -2 than were those who received standard therapy (79% compared with 46%; P < 0.001) and were less likely to relapse or die (8.7% compared with 16.7%; P < 0.001). Children who received home-based therapy with RUTF had greater rates of weight gain (3.5 compared with 2.0 g . kg(-1) . d(-1); difference: 1.5; 95% CI: 1.0, 2.0 g . kg(-1) . d(-1)) and a lower prevalence of fever, cough, and diarrhea than did children who received standard therapy.
  
  
  CONCLUSIONS
  Home-based therapy with RUTF is associated with better outcomes for childhood malnutrition than is standard therapy.
authors.affiliation: Department of Pediatrics, Washington University School of Medicine, St Louis, MO, USA.
authors.forename: Michael A
authors.initials: MA
authors.lastname: Ciliberto
authors.forename: Heidi
authors.initials: H
authors.lastname: Sandige
authors.forename: Macdonald J
authors.initials: MJ
authors.lastname: Ndekha
authors.forename: Per
authors.initials: P
authors.lastname: Ashorn
authors.forename: André
authors.initials: A
authors.lastname: Briend
authors.forename: Heather M
authors.initials: HM
authors.lastname: Ciliberto
authors.forename: Mark J
authors.initials: MJ
authors.lastname: Manary
mesh_terms: D002675:Child, Preschool; D005260:Female; D005527:Food, Fortified; D006699:Home Care Services; D006801:Humans; D007223:Infant; D007732:Kwashiorkor / Q000178:diet therapy* / Q000401:mortality; D008295:Malawi; D008297:Male; D016896:Treatment Outcome