Nutrition News for Africa

Abstract - April 15, 2006

A study entitled ‘Supplemental Feeding with Ready-to-Use Therapeutic Food (RUTF) in Malawian Children at Risk of Malnutrition’ by Patel et al was published in the December 2005 Journal of Health Population and Nutrition 23 (4):351-357.

Background. Malawi is a rural and extremely food insecure country with half of its children under 5 stunted from chronic malnutrition. Several NGOs and UN agencies have responded to this by providing supplementary feeding to children at risk of malnutrition. The most common supplementary food provided in Malawi is micronutrient-fortified corn soy blend (CSB).

Objectives. This study tested the hypothesis that supplemental feeding with RUTF would result in better growth in Malawian malnourished children than feeding with corn soy blend (CSB).

Methods. This was a controlled, comparative clinical effectiveness trial. Children 10-60 months at risk for malnutrition (weight-for-height > 80% but < 85%) and without oedema attending one of seven nutritional rehabilitation units (NRUs) from December 2002 to May 2003 (the preharvest season) were screened for eligibility. A prospective systematic allocation using a stepped-wedge design was used to recruit a total of 372 children. Three hundred and thirty one mothers received RUTF (seven kg/month) and 41 received CSB (50 kg.month). Informed consent was obtained from all the participants. The RUTF provided 5, 700 k J per day and the CSB provided 28 000 kJ per day. The RUTF consisted of peanut butter, sugar, milk powder, vegetable oil and a vitamin/mineral supplement and was produced locally. Mothers were asked to feed their children seven times a day and to attend clinic assessments every two weeks. Study participation was eight weeks. Primary outcomes assessed were the attainment of weight-for-height > 90%, or ‘recovery’, remaining oedema-free, relapse/death and the rate of weight gain. Secondary outcomes were rates of growth in length and mid-upper arm circumference.

Results. Children receiving RUTF were more likely to recover (58% vs 22%; difference 36%; 95% C.I. 20-52) and had greater rates of weight gain (3.1g/kg.d vs 1.4 g/kg. d; difference 1.7; 95% CI 0.8-2.6) than children receiving CSB.

Discussion. One of the main weaknesses of this study was that the design was not random. The authors explain that randomization was impossible because the community found it impossible to accept blatant differences in the type of food given among mothers. In addition, randomization would have necessitated the creation of two different feeding options, which was logistically difficult for the Malawian health services.

Conclusion. This study suggests that supplementary feeding with RUTF promotes better growth for Malawian children at risk of malnutrition than CSB. However, the authors caution that research findings do not always represent programme realities and therefore advocate for the provision of data from large scale supplementation programmes.