Wasting affects approximately 10% of the world’s children younger than 5 years, and is an important contributor to the population-attributable risk of child mortality and overall burden of disease. In Niger,
a country of 14 million people, household food production is linked to rain fed agriculture. Staple crops such as millet and sorghum are harvested once per year from September to October.
Each year the decrease in food quantity and quality experienced in the months preceding the harvest (August to October) is associated with an increase in wasting among children younger than 5 years.
The authors assessed whether Ready-to-Use Therapeutic Food (RUTF) would prevent declines in individual weight-for-height and reduce the incidence of wasting in children aged 6 to 60 months over a period of 8 months. These foods are energy-dense, micronutrient-enriched pastes with a nutritional profile similar to the traditional F-100 milk-based diet used in inpatient therapeutic feeding programs and often made up of peanuts, oil, sugar and milk powder.
Between August and October 2006, half of the villages in the study received a monthly distribution of 1 sachet per day of RUTF (92g [500 kcal/d]; Plumpy nut; Nutriset, Malaunay for their children under five years.
During monthly follow-up visits, measurements were taken of children’s height and weight. The primary outcome measures were individual WHZ score according to the World Health Organization Child Growth Standards, and wasting (WHZ < -2. Secondary measures included severe wasting (WHZ < -3), height-for-age z score (HAZ) according to the World Health Organization Child Growth Standards, stunting (HAZ < -2), severe stunting (HAZ < -3), mortality, and prevalence of malaria, diarrhea, and respiratory tract infection.
The intervention resulted in a 36% (95% CI, 17% to 50%; P < .001) reduction in the incidence of wasting and a 58% (95% CI, 43% to 68%; P < .001) reduction in the incidence of severe wasting. There was no observed effect of the intervention on the prevalence of malaria, diarrhea or respiratory tract infection.
Possible problems with this study :
♣ There was a limited effect of RUTF on stunting, possible due to the short duration of supplementation.♣ The intervention did not have a significant effect on diarrhea and respiratory tract infection.
♣ The authors were unable to measure dietary intakes at recruitment or during the intervention.
♣ Although the authors found no evidence for this, there was a concern that the packets of high-energy food might be resold in local markets.
To read this study in its entirety, go to JAMA, January 21 2009–Vol 301. No.3, pp. 277-285.
-–Cynthia Haggard is a medical writer and teacher who lives in Washington DC. She owns her own business, Clarifying Concepts, which provides technical writing, writing for the public, teaching, and regulatory affairs services. To see more, please go to clarifyingconcepts. (c) 2009 All rights reserved.
