Escaping the malnutrition cycle: Studies aim to optimise nutrition supplementation
These studies provide evidence of how effective supplementation can be if local factors such as levels of morbidity can be taken into account. Current fortification programmes rely on region-wide assumptions that aren’t tailored to a population’s diverse nutritional needs.
Multiple factors can cause malnutrition among children, including not having enough to eat and being given the wrong types of food. In addition, recurrent infections are a major cause of malnutrition among children in many tropical countries.
Inadequate nutrition hinders recovery from infection and the ability of the immune system to fight off new infection, thereby setting up a vicious cycle of malnutrition and illness.
Both studies were carried out by Médecins Sans Frontières (MSF). One was conducted in Kaabong, located in the region of Karamoja, east Uganda. Here, the acute malnutrition rate among its semi nomadic population was between 8.4% and 11.5% of which 2 to 3% represents severe malnutrition. More than half (58%) of the population in the district of Kaabong is considered food insecure.
The other study was situated in Goronyo, a rural region of northwest Nigeria also characterised with high morbidity and malnutrition rates amongst its population.
In both locations, the effects of two types of nutritional supplementation on malnutrition rates in ill children were investigated.
Non-malnourished children aged six to 59 months diagnosed with malaria, diarrhoea, or lower respiratory tract infection were randomised to one of three groups: one sachet per day of therapeutic food (RUTF), two sachets/day of micronutrient powder (MNP), or no supplement (control) for 14 days for each illness over six months.
MNP is consumed by mixing it with porridge or other meals and contains vitamins and minerals that are needed in small quantities for immune system function and for good health.
RUTF, which is based on peanut butter, contains dried skim milk, vitamins and micronutrients and is supplied as a paste to be eaten directly.
The primary outcome for both studies was the incidence of first negative nutritional outcome (NNO) during the six month follow-up. In other words, whether short-term provision of RUTF or MNP prevented the development of malnutrition among ill children.
In the Ugandan study, incidence rates of negative nutritional outcome (NNO) – a measure of malnutrition occurrence (first event/year), for the RUTF, MNP, and control groups were 0.143, and 0.213 (0.167–0.272), respectively.
The incidence rate ratio was 0.67 for RUTF versus control: a reduction of 33.3%. The incidence rate ratio was 0.86 for MNP versus control and 0.77 for RUTF versus MNP. The average numbers of study illnesses for the RUTF, MNP, and control groups were 2.3 and 2.3.
In the Nigerian study, the incidence rates of NNO for the RUTF, MNP, and control groups were 0.522 and 0.566 first events per year, respectively. The incidence rate ratio was 0.92 for RUTF versus control; 0.87 for MNP versus control and 1.06 for RUTF versus MNP. The average number of study illnesses for the RUTF, MNP, and control groups were 4.2, 3.4, and 3.6.
“Among non-malnourished children with malaria, lower respiratory tract infection, or diarrhoea living in Kaabong, Uganda, provision of an RUTF-based nutritional supplement for 14 days following an illness as part of routine primary medical care prevented malnutrition,” the study authors noted.
In contrast the trial conducted in Goronyo, Nigeria found no reduction in the incidence of malnutrition among non-malnourished and moderately acutely malnourished children following short-term supplementation with either RUTF or MNP.
The researchers suggest the different results in the two trials may reflect the higher incidence of malnutrition and illness in Goronyo compared to Kaabong. The duration and/or dose of supplementation was insufficient to mitigate the effects of high levels of illness and pre-existing malnutrition present in this setting.
Given the low incidence of malnutrition in Kaabong, the researchers suggest a more targeted intervention such as only providing RUTF to ill children younger than 3 year old might be more cost-effective than providing nutritional supplementation to all ill children in Kaabong and similar settings.
Regarding Goronyo, they suggested an integrated approach that combined the prevention and treatment of diseases with the treatment of moderate malnutrition to break the illness–malnutrition cycle among children living in this region and similar settings.
Source: Plos Medicine
Published online ahead of print, DOI: 10.1371/journal.pmed.1001951
“Effect of Short-Term Supplementation with Ready-to-Use Therapeutic Food or Micronutrients for Children after Illness for Prevention of Malnutrition: A Randomised Controlled Trial in Uganda.”
Authors: Saskia van der Kam, Stephanie Roll, Todd Swarthout, Grace Edyegu-Otelu, Akiko Matsumoto, Francis Xavier Kasujja, Cristian Casademont, Leslie Shanks, Nuria Salse-Ubach
Source: Plos Medicine
Published online ahead of print, DOI: 10.1371/journal.pmed.1001952
“Effect of Short-Term Supplementation with Ready-to-Use Therapeutic Food or Micronutrients for Children after Illness for Prevention of Malnutrition: A Randomised Controlled Trial in Nigeria.”
Authors: Saskia van der Kam , Nuria Salse-Ubach, Stephanie Roll, Todd Swarthout, Sayaka Gayton-Toyoshima, Nma Mohammed Jiya, Akiko Matsumoto, Leslie Shanks.