title: Treating moderate acute malnutrition in first-line health services: an effectiveness cluster-randomized trial in Burkina Faso.
abstract: BACKGROUND
  Management of moderate acute malnutrition (MAM) is, currently, focused on food supplementation approaches. However, the sustainability of these strategies remains weak in low- and middle-income countries. In food-secure settings, an educational/behavioral intervention could be an alternative for improving MAM management.
  
  
  OBJECTIVE
  This study compared the effectiveness of weekly context-appropriate child-centered counseling (CCC), with an improved corn-soy blend [corn-soy blend with added micronutrients (CSB++)] or a locally produced ready-to-use supplementary food (RUSF), in treating MAM through first-line rural health services.
  
  
  METHODS
  We used a cluster randomized controlled trial design with 3 arms, involving 18 rural health centers (6 by arm) and children aged 6-24 mo with uncomplicated MAM. In the first arm (CCC), trained health workers provided weekly personalized counseling to caretakers. In the 2 other arms, children received weekly either 455 g CSB++ or 350 g locally produced soy-based RUSF. Both food supplements provided ∼250 kcal/d.
  
  
  RESULTS
  The recovery rate after 3 mo of treatment was significantly lower with CCC (57.8%) than with CSB++ (74.5%) and RUSF (74.2%) (P < 0001). Mothers' attendance at health facilities was also substantially lower in the CCC arm (P < 0001); this arm had a high defaulter rate (P < 0.003). When the analysis was adjusted for attendance, we did not find a significant difference between the 3 arms, with incidence rate ratios of 1.14 (95% CI: 0.99, 1.31) and 1.13 (95% CI: 0.98, 1.30) for the CSB++ and RUSF arms, respectively, compared with the CCC arm.
  
  
  CONCLUSIONS
  Whereas supplement-based treatment of MAM was found to be more effective than the provision of CCC, we hypothesize that appropriate and specific nutrition counseling centered on children's needs, through primary health facilities, might be an alternative strategy for MAM treatment in rural food-secure areas, provided that attendance at counseling sessions by the caregiver is ensured. This trial was registered at clinicaltrials.gov as NCT01115647.
authors.affiliation: From the Institut de Recherche en Sciences de la Santé, Ministry of Scientific Research and Innovation, Ouagadougou, Burkina Faso (LN, HL, ST, SK, and BS); the Child Health and Nutrition Unit, Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium (DR, LH, and PK); and the Department of Food Safety and Food Quality, Ghent University, Ghent, Belgium (LH, KB, and PK).
authors.forename: Laetitia
authors.initials: L
authors.lastname: Nikièma
authors.affiliation: From the Institut de Recherche en Sciences de la Santé, Ministry of Scientific Research and Innovation, Ouagadougou, Burkina Faso (LN, HL, ST, SK, and BS); the Child Health and Nutrition Unit, Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium (DR, LH, and PK); and the Department of Food Safety and Food Quality, Ghent University, Ghent, Belgium (LH, KB, and PK).
authors.forename: Lieven
authors.initials: L
authors.lastname: Huybregts
authors.affiliation: From the Institut de Recherche en Sciences de la Santé, Ministry of Scientific Research and Innovation, Ouagadougou, Burkina Faso (LN, HL, ST, SK, and BS); the Child Health and Nutrition Unit, Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium (DR, LH, and PK); and the Department of Food Safety and Food Quality, Ghent University, Ghent, Belgium (LH, KB, and PK).
authors.forename: Patrick
authors.initials: P
authors.lastname: Kolsteren
authors.affiliation: From the Institut de Recherche en Sciences de la Santé, Ministry of Scientific Research and Innovation, Ouagadougou, Burkina Faso (LN, HL, ST, SK, and BS); the Child Health and Nutrition Unit, Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium (DR, LH, and PK); and the Department of Food Safety and Food Quality, Ghent University, Ghent, Belgium (LH, KB, and PK).
authors.forename: Hermann
authors.initials: H
authors.lastname: Lanou
authors.affiliation: From the Institut de Recherche en Sciences de la Santé, Ministry of Scientific Research and Innovation, Ouagadougou, Burkina Faso (LN, HL, ST, SK, and BS); the Child Health and Nutrition Unit, Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium (DR, LH, and PK); and the Department of Food Safety and Food Quality, Ghent University, Ghent, Belgium (LH, KB, and PK).
authors.forename: Simon
authors.initials: S
authors.lastname: Tiendrebeogo
authors.affiliation: From the Institut de Recherche en Sciences de la Santé, Ministry of Scientific Research and Innovation, Ouagadougou, Burkina Faso (LN, HL, ST, SK, and BS); the Child Health and Nutrition Unit, Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium (DR, LH, and PK); and the Department of Food Safety and Food Quality, Ghent University, Ghent, Belgium (LH, KB, and PK).
authors.forename: Kimberley
authors.initials: K
authors.lastname: Bouckaert
authors.affiliation: From the Institut de Recherche en Sciences de la Santé, Ministry of Scientific Research and Innovation, Ouagadougou, Burkina Faso (LN, HL, ST, SK, and BS); the Child Health and Nutrition Unit, Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium (DR, LH, and PK); and the Department of Food Safety and Food Quality, Ghent University, Ghent, Belgium (LH, KB, and PK).
authors.forename: Séni
authors.initials: S
authors.lastname: Kouanda
authors.affiliation: From the Institut de Recherche en Sciences de la Santé, Ministry of Scientific Research and Innovation, Ouagadougou, Burkina Faso (LN, HL, ST, SK, and BS); the Child Health and Nutrition Unit, Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium (DR, LH, and PK); and the Department of Food Safety and Food Quality, Ghent University, Ghent, Belgium (LH, KB, and PK).
authors.forename: Blaise
authors.initials: B
authors.lastname: Sondo
authors.affiliation: From the Institut de Recherche en Sciences de la Santé, Ministry of Scientific Research and Innovation, Ouagadougou, Burkina Faso (LN, HL, ST, SK, and BS); the Child Health and Nutrition Unit, Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium (DR, LH, and PK); and the Department of Food Safety and Food Quality, Ghent University, Ghent, Belgium (LH, KB, and PK).
authors.forename: Dominique
authors.initials: D
authors.lastname: Roberfroid
mesh_terms: D000208:Acute Disease; D002050:Burkina Faso / Q000453:epidemiology; D002675:Child, Preschool; D016000:Cluster Analysis; D003376:Counseling; D005260:Female; D005500:Follow-Up Studies; D005527:Food, Fortified; D006801:Humans; D007223:Infant; D007225:Infant Food / Q000032:analysis; D016015:Logistic Models; D008297:Male; D044342:Malnutrition / Q000178:diet therapy* / Q000453:epidemiology*; D018977:Micronutrients / Q000008:administration & dosage*; D045730:Soy Foods; D016896:Treatment Outcome; D003313:Zea mays
chemical_list: D018977:Micronutrients