title: Effect of ready-to-use foods for preventing child undernutrition in Niger: analysis of a prospective intervention study over 15 months of follow-up.
abstract: Strategies for preventing undernutrition comprise a range of interventions, including education, provision of complementary food and cash transfer. Here, we compared monthly distributions of two different lipid-based nutrient supplements (LNS), large-quantity LNS (LNS-LQ) and medium-quantity LNS (LNS-MQ) for 15 months on prevention of undernutrition among children 6 to 23 months. Both groups also received cash transfer for the first 5 months of the intervention. We conducted a prospective intervention study in Maradi, Niger, between August 2011 and October 2012. Six and 11 villages were randomly allocated to LNS-LQ/Cash and LNS-MQ/Cash, respectively. Children measuring 60-80 cm were enrolled in the respective groups and followed up monthly. Poisson regression was used to assess differences between interventions and adjust for baseline characteristics, intervention periods and child-feeding practices. The analysis included 2586 children (1081 in the LNS-LQ/Cash group and 1505 in the LNS-MQ/Cash group). This study suggests that provision of LNS-LQ (reference) or LNS-MQ had, overall, similar effect on incidence of severe acute malnutrition (RR = 0.97; 95% CI: 0.67-1.40; P = 0.88), moderate acute malnutrition (RR = 1.20; 95% CI: 0.97-1.48; P = 0.08), severe stunting (RR = 0.94; 95% CI: 0.70-1.26; P = 0.69), moderate stunting (RR = 0.95; 95% CI: 0.76-1.19; P = 0.67) and mortality (RR = 0.83; 95% CI: 0.41-1.65; P = 0.59). Compared with LNS-LQ, LNS-MQ showed a greater protective effect on moderate acute malnutrition among children with good dietary adequacy: RR = 0.72; 95% CI: 0.56-0.94; P = 0.01. These results highlight the need to design context-specific programmes. Provision of LNS-LQ might be more appropriate when food insecurity is high, while when food security is better, distribution of LNS-MQ might be more appropriate.
authors.affiliation: Epicentre, Paris, France.
authors.forename: Claudine
authors.initials: C
authors.lastname: Prudhon
authors.affiliation: Epicentre, Paris, France.
authors.forename: Céline
authors.initials: C
authors.lastname: Langendorf
authors.affiliation: Epicentre, Paris, France.
authors.forename: Thomas
authors.initials: T
authors.lastname: Roederer
authors.affiliation: Médecins Sans Frontières, Paris, France.
authors.forename: Stéphane
authors.initials: S
authors.lastname: Doyon
authors.affiliation: Epicentre, Niamey, Niger.
authors.forename: Abdoul-Aziz
authors.initials: AA
authors.lastname: Mamaty
authors.affiliation: Epicentre, Niamey, Niger.
authors.forename: Lynda
authors.initials: L
authors.lastname: Woi-Messe
authors.affiliation: Regional Department of the Ministry of Public Health, Maradi, Niger.
authors.forename: Mahamane L
authors.initials: ML
authors.lastname: Manzo
authors.affiliation: Nutrition Division, World Food Program, Rome, Italy.
authors.forename: Saskia
authors.initials: S
authors.lastname: de Pee
authors.affiliation: Epicentre, Paris, France.
authors.forename: Rebecca F
authors.initials: RF
authors.lastname: Grais
mesh_terms: D000208:Acute Disease; D004032:Diet; D019587:Dietary Supplements; D057140:Fast Foods; D005260:Female; D005500:Follow-Up Studies; D006130:Growth Disorders / Q000453:epidemiology* / Q000517:prevention & control; D006801:Humans; D007223:Infant; D016014:Linear Models; D008297:Male; D044342:Malnutrition / Q000453:epidemiology* / Q000517:prevention & control*; D009548:Niger / Q000453:epidemiology; D009752:Nutritional Status; D011446:Prospective Studies
keywords: Niger; cash transfer; lipid-based nutrient supplement; prevention; stunting; undernutrition