Abstract
Objective
To compare efficacy of indigenous Ready-to-use Therapeutic Food (Medical Nutrition Therapy) with Standard Nutrition Therapy in children with Severe acute malnutrition.
Design
Two facility-based and two community-based models: (i) Open prospective randomized controlled trial comparing Indigenous Ready-to-use Therapeutic Food (Medical Nutrition Therapy) with Standard Nutrition Therapy; (ii) Only Indigenous Ready-to-use Therapeutic Food (Medical Nutrition Therapy); (iii) Doorstep Child Care Centre; and (iv) Community-based Management of Acute Malnutrition.
Setting
(i) Urban Health Center, Dharavi, Mumbai; (ii) Two day care centers of Non-governmental Organization SNEHA–Mumbai; (iii) Urban slums, M East and L Ward, Mumbai
Participants
1105 children aged 6–60 months in community or hospital inpatient/ outpatient department diagnosed as Severe Acute Malnutrition by WHO definition.
Intervention
All subjects received either Indigenous Ready-touse Therapeutic Food (Medical Nutrition Therapy) or Standard Nutrition Therapy (protein calorie rich diet) for eight weeks and followed up for next four months.
Main outcome measures
Mean rate of weight gain (g/kg/day), target weight, change in nutritional status.
Results
Rate of weight gain was higher (P<0.05) at 2 weeks on indigenous Ready-to-use Therapeutic Food (Medical Nutrition Therapy) (5.63 g/kg/day) as compared to Standard Nutrition Therapy (3.43 g/kg/day). 61.2% subjects achieved target weight compared to 47.7% controls. At 8 weeks, 82.8% subjects recovered from Severe Acute Malnutrition compared to 19.3% controls (P<0.005). The results obtained in community were comparable to facility-based indigenous Ready-to-use Therapeutic Food (Medical Nutrition Therapy). The morbidity was less in study group at follow-up.
Conclusions
Indigenous Ready-to-use Therapeutic Food (Medical Nutrition Therapy) appeared to be superior to Standard Nutrition Therapy in promoting weight gain in children with Severe Acute Malnutrition.
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References
“The Indian exception”. The Economist. 2011 March 31; Mumbai. Available from: http://www.economist.com/node/18485871. Accessed February 2, 2018.
Golden MH. Evolution of nutritional management of acute malnutrition. Indian Pediatr. 2010;47:667–78.
Shah N, Murty S, Jadhav A, Manglani M, Fernandes L, Surve A. Indigenous production of ready-to-use therapeutic food to address severe acute malnutrition in Indian children. Int J Sci Res Publ. 2015;5:287–94.
World Health Organization (WHO) and United Nations Children’s Fund (UNICEF). WHO Child Growth Standards and the Identification of Severe Acute Malnutrition in Infants and Children-A Joint Statement by WHO and UNICEF. 2009. Available from: http://apps.who.int/iris/bitstream/10665/44129/1/9789241598163_eng.pdf?ua=1. Accessed February 2, 2018.
Mother and Child Nutrition. Management of Severe Acute Malnutrition in Children Under Five Years. 2016. Available from: http://motherchildnutrition.org/malnutritionmanagement/info/appetite-test.html. Accessed February 2, 2018.
Ciliberto M, Sandige H, Ndekha MJ, Ashorn P, Briend A, Ciliberto H, et al. Comparision of home-based therapy with ready-to-use therapeutic food with standard therapy in the treatment of malnourished Malawain children: A controlled, clinical effectiveness trial. Am J Clin Nutr. 2005;81:864–70.
Ciliberto MA, Manary MJ, Ndekha MJ, Briend A, Ashorn P. Home-based theraspy for oedamatous malnutrition with ready-to-use therapeutic food. Acta Paediatr. 2006;95:1012–5.
Diop EHI, Dossou NI, Ndour MM, Briend A, Wade S. Comparison of the efficacy of a solid ready-to-use food and a liquid, milk-based diet for the rehabilitation of severely malnourished children: a randomized trial. Am J Clin Nutr. 2003;78:302–7.
Manary M, Ndkeha MJ, Ashorn P, Maleta K, Briend A. Home based therapy for severe malnutrition with ready-to use food. Arch Dis Child. 2004;89:557–61.
Thakur GS, Singh HP, Patel C. Locally prepared ready-touse therapeutic food for children with severe acute malnutrition: A controlled trial. Indian Pediatr. 2013;50:295–9.
Patel D, Gupta P, Shah D, Sethi K. Home-base rehabilitation of severely malnourished children in resource poor setting. Indian Pediatr. 2010;47:694–701.
Gera T. Efficacy and study of therapeutic nutrition products for Home based therapeutic nutrition for severe acute malnutrition: A systematic review. Indian Pediatr. 2010;47:709–18.
United Nations Children’s Fund (UNICEF). Ready-to-use Therapeutic Food for Children with Severe Acute Malnutrition. 2013. Available from: https://www.unicef.org/media/files/Position_Paper_Ready-to-use_therapeutic_food_for_children_with_severe_acute_malnutrition__June_2013.pdf. Accessed February 13, 2018.
World Health Organization (WHO). Guideline Updates on the Management of Severe Acute Malnutrition in Infants and Children. 2013. Available from: http://apps.who.int/iris/bitstream/10665/95584/1/9789241506328_eng.pdf. Accessed February 13, 2018.
Golden M, Grellety Y, Schwartz H, Tchibindat F. Report of a Meeting to Harmonise the Criteria for Monitoring and Evaluation of the Treatment of Acute Malnutrition in West and Central Africa. Dakar, Senegal. 30th November–1st December 2010. Available from: http://files.ennonline.net/attachments/1202/consensus-meeting-on-m-e-imam-dakar-2010-eng.pdf. Accessed February 2, 2018.
Singh AS, Kang G, Ramachandran A, Sarkar R, Peter P, Bose A. Locally made ready-to use therapeutic food for treatment of malnutrition: A randomized controlled trial. Indian Pediatr. 2010;47:679–86.
Linneman Z, Matilsky D, Ndekha M, Maleta K, Manary MJ. A large-scale operational study of home based therapy with ready-to-use therapeutic food in childhood malnutrition in Malawi. Maternal Child Nutr. 2007;3: 206–15.
Sachdev HPS, Kapil U, Vir S. Consensus Statement: National Consensus Workshop on Management of SAM Children through Medical Nutrition Therapy. Indian Pediatr. 2010;47:661–5.
Black RE, Victora CG, Walker SP, Bhutta ZA, Christian P, de Onis M, et al. Maternal and child undernutrition and overweight in low-income and Middle income countries. Lancet. 2013;382:427–51.
Ashworth A, Khanum S, Jackson A, Schofield C. Guidelines for the Inpatient Treatment of Severely Malnourished Children. Geneva: World Health Organization, 2003. Available from: http://www.who.int/nutrition/publications/guide_inpatient_text.pdf. Accessed February 2, 2018.
Oakley E, Reinking J, Sandige H, Trehan I, Kennedy G, Maleta K, et al. A ready-to-use therapeutic food containing 10% milk is less effective than one with 25% milk in the treatment of severely malnourished children. J Nutr. 2010;140:2248–52.
Integrated management of childhood illness: Caring for Newborns and Children in the Community. Geneva: World Health Organization; 2011. Available from: http://apps.who.int/iris/bitstream/10665/44398/4/9789241548045_Chart_Booklet_eng.pdf. Accessed February 2, 2018.
Prudhon C, Golden MH, Briend A, Mary JY. A model to standardize mortality of severely malnourished children using nutritional status on admission to therapeutic feeding centres. Eur J Clin Nutr. 1997;51:771–7.
Golden MH. The development of concepts of malnutrition. J Nutr, 2002;132:2117S–22S.
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Jadhav, A.R., Karnik, P., Fernandes, L. et al. Indigenously Prepared Ready-to-use Therapeutic Food (RUTF) in Children with Severe Acute Malnutrition. Indian Pediatr 56, 287–293 (2019). https://doi.org/10.1007/s13312-019-1516-4
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DOI: https://doi.org/10.1007/s13312-019-1516-4
Keywords
- Medical Nutrition Therapy
- Micronutrients
- Nutritional rehabilitation
- Protein energy malnutrition
- Ready-to-use-food