Ready-to-use therapeutic foods are an important component of effective outpatient treatment of severe wasting.
However, their effectiveness in the population-based prevention of moderate and severe wasting has not been evaluated.
Dr Sheila Isanaka and colleagues evaluated the effect of a 3-month distribution of ready-to-use therapeutic foods on the nutritional status, mortality, and morbidity of children aged 6 to 60 months in Niger.
The team conducted a cluster randomized trial of 12 villages in Maradi, Niger.
|The adjusted effect of the intervention from baseline to the end of follow-up was thus 0.22 z|
|Journal of the American Medical Association|
The research team randomized 6 villages to intervention, and 6 to no intervention.
All children in the study villages aged 6 to 60 months were eligible for recruitment.
Children with weight-for-height 80% or more of the National Center for Health Statistics reference median in the 6 intervention villages received a monthly distribution of 1 packet per day of ready-to-use therapeutic foods in 2006.
Children in the 6 nonintervention villages received no preventive supplementation.
Active surveillance for conditions requiring medical or nutritional treatment was conducted monthly in all 12 study villages from 2006 to 2007.
The team's main outcome measures included changes in weight-for-height z score according to the World Health Organization Child Growth Standards and incidence of wasting over 8 months of follow-up.
The research team found that the number of children with height and weight measurements in August, October, December, and February was 3166, 3110, 2936, and 3026, respectively.
The difference between the intervention and nonintervention groups was -0.10 z at baseline and 0.12 z after 8 months of follow-up.
The adjusted effect of the intervention from baseline to the end of follow-up was 0.22 z.
The team found that the absolute rate of wasting and severe wasting, respectively, was 0.17 events per child-year, and 0.03 events per child-year in the intervention villages.
In the non-intervention villages, the absolute rate of wasting and severe wasting was 0.26 events per child-year, and 0.07 events per child-year.
The intervention thus resulted in a 36% reduction in the incidence of wasting, and a 58% reduction in the incidence of severe wasting.
There was no reduction in mortality, with a mortality rate of 0.01 deaths per child-year in the intervention villages and 0.02 deaths per child-year in the nonintervention villages.
Dr Isanaka's team commented, "Short-term supplementation of nonmalnourished children with ready-to-use therapeutic foods reduced the decline in the weight-for-height z score, and the incidence of wasting and severe wasting over 8 months."