title: Outpatient treatment of severe acute malnutrition: response to treatment with a reduced schedule of therapeutic food distribution.
abstract: Background:Community-based management of severe acute malnutrition (SAM) has been shown to be safe and cost-effective, but program coverage remains low. Treatment models that maintain high levels of clinical effectiveness but allow for increased coverage are still needed. A reduced schedule of follow-up, in which children receive clinical follow-up and therapeutic foods on a monthly rather than weekly basis, may be one alternative.Objective:We aimed to describe the safety and feasibility of a monthly distribution of ready-to-use therapeutic food (RUTF) in the treatment of uncomplicated SAM, in terms of clinical response to treatment and household RUTF use.Design:We conducted a nonrandomized pilot intervention study in which 115 children eligible for outpatient treatment of SAM were provided a monthly ration of RUTF. Anthropometric measurements were taken weekly for 4 wk to monitor treatment response. Unannounced household spot checks were conducted over 4 wk to assess household use of RUTF and storage practices.Results:Adequate weight and midupper arm circumference (MUAC) gain were found throughout the 4-wk follow-up period. Observed mean ± SD weight gain from admission was 9.8 ± 6.8 g · kg-1· d-1in week 1 and 4.2 ± 2.1 g · kg-1· d-1by week 4. Unplanned household spot checks found an average surplus of RUTF sachets compared with the number expected based on the date of distribution and recommended dosing throughout the 4 wk of follow-up. The frequency at which more than the recommended dose was used (i.e., deviance of >2 sachets between available and expected stocks) was 4% and 22% of households visited in week 1 and week 4, respectively.Conclusion:Adequate treatment response and RUTF use in the outpatient treatment of SAM was maintained over 4 wk of follow-up with a monthly schedule of RUTF distribution. This study was registered at clinicaltrials.gov as NCT02994212.
authors.affiliation: Departments of Nutrition and sheila.isanaka@epicentre.msf.org.|Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA; and.|Epicentre and.
authors.forename: Sheila
authors.initials: S
authors.lastname: Isanaka
authors.affiliation: Departments of Nutrition and.
authors.forename: Stephen R
authors.initials: SR
authors.lastname: Kodish
authors.affiliation: Epicentre Niger, and.
authors.forename: Fatou
authors.initials: F
authors.lastname: Berthé
authors.affiliation: Epicentre and.
authors.forename: Ian
authors.initials: I
authors.lastname: Alley
authors.affiliation: Epicentre and.
authors.forename: Fabienne
authors.initials: F
authors.lastname: Nackers
authors.affiliation: Médecins Sans Frontières, Operational Center Paris, Paris, France.
authors.forename: Kerstin E
authors.initials: KE
authors.lastname: Hanson
authors.affiliation: Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA; and.|Epicentre and.
authors.forename: Rebecca F
authors.initials: RF
authors.lastname: Grais
mesh_terms: D000553:Ambulatory Care / Q000379:methods*; D015362:Child Nutrition Disorders / Q000178:diet therapy*; D002675:Child, Preschool; D005191:Family Characteristics; D057140:Fast Foods; D005260:Female; D005527:Food, Fortified; D006760:Hospitalization; D006801:Humans; D007223:Infant; D008297:Male; D010045:Outpatients; D015397:Program Evaluation; D000067011:Severe Acute Malnutrition / Q000178:diet therapy*; D016896:Treatment Outcome; D015430:Weight Gain
keywords: CMAM; RUTF; SAM; community-based management of acute malnutrition; household utilization; ready-to-use therapeutic food; severe acute malnutrition; treatment response