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ORIGINAL RESEARCH COMMUNICATION |
1 From the Department of Pediatrics, Washington University School of Medicine, St Louis, MO (MAC, HS, HMC, and MJM); the College of Medicine, University of Malawi, Blantyre, Malawi (MJN and MJM); the Institut de Recherche pour le Développement, Paris, France (AB); and the Paediatric Research Centre, Tampere University Hospital, Tampere, Finland (PA).
Background: Childhood malnutrition is common in Malawi, and the standard treatment, which follows international guidelines, results in poor recovery rates. Higher recovery rates have been seen in pilot studies of home-based therapy with ready-to-use therapeutic food (RUTF).
Objective: The objective was to compare the recovery rates among children with moderate and severe wasting, kwashiorkor, or both receiving either home-based therapy with RUTF or standard inpatient therapy.
Design: A controlled, comparative, clinical effectiveness trial was conducted in southern Malawi with 1178 malnourished children. Children were systematically allocated to either standard therapy (186 children) or home-based therapy with RUTF (992 children) according to a stepped wedge design to control for bias introduced by the season of the year. Recovery, defined as reaching a weight-for-height z score > –2, and relapse or death were the primary outcomes. The rate of weight gain and the prevalence of fever, cough, and diarrhea were the secondary outcomes.
Results: Children who received home-based therapy with RUTF were more likely to achieve a weight-for-height z score > –2 than were those who received standard therapy (79% compared with 46%; P < 0.001) and were less likely to relapse or die (8.7% compared with 16.7%; P < 0.001). Children who received home-based therapy with RUTF had greater rates of weight gain (3.5 compared with 2.0 g · kg–1 · d–1; difference: 1.5; 95% CI: 1.0, 2.0 g · kg–1 · d–1) and a lower prevalence of fever, cough, and diarrhea than did children who received standard therapy.
Conclusion: Home-based therapy with RUTF is associated with better outcomes for childhood malnutrition than is standard therapy.
Key Words: Malnutrition • ready-to-use therapeutic food • RUTF • home-based therapy • Malawi • kwashiorkor • protein-energy malnutrition
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