Reducing wasting in young children with preventive supplementation: a cohort study in Niger

Abstract

Objective: To compare the incidence of wasting, stunting, and mortality among children aged 6 to 36 months who are receiving preventive supplementation with either ready-to-use supplementary foods (RUSFs) or ready-to-use therapeutic foods (RUTFs).

Subjects and methods: Children aged 6 to 36 months in 12 villages of Maradi, Niger, (n = 1645) received a monthly distribution of RUSFs (247 kcal [3 spoons] per day) for 6 months or RUTFs (500-kcal sachet per day) for 4 months. We compared the incidence of wasting, stunting, and mortality among children who received preventive supplementation with RUSFs versus RUTFs.

Results: The effectiveness of RUSF supplementation depended on receipt of a previous preventive intervention. In villages in which a preventive supplementation program was previously implemented, the RUSF strategy was associated with a 46% (95% confidence interval [CI]: 6%-69%) and 59% (95% CI: 17%-80%) reduction in wasting and severe wasting, respectively. In contrast, in villages in which the previous intervention was not implemented, we found no difference in the incidence of wasting or severe wasting according to type of supplementation. Compared with the RUTF strategy, the RUSF strategy was associated with a 19% (95% CI: 0%-34%) reduction in stunting overall.

Conclusion: We found that the relative performance of a 6-month RUSF supplementation strategy versus a 4-month RUTF strategy varied with receipt of a previous nutritional intervention. Contextual factors will continue to be important in determining the dose and duration of supplementation that will be most effective, acceptable, and sustainable for a given setting.

Figure 1

As part of the parent trial, RUTF (500 kcal/sachet/day) were distributed in 6 villages (3 villages in Madarounfa and Guidan Roumdji) for 3 mo from August to October 2006 to children aged 6 to 60 mo with weight-for-height ≥80% of the NCHS reference median. During this time, no supplements were distributed in 6 other study villages (3 villages in Madarounfa and Guidan Roumdji). Subsequently, RUSF (247 kcal/3 spoons/day) were distributed in the 6 study villages of Guidan Roumdji for 6 mo from May to October 2007 to all children aged 6 to 36 mo as part of district-wide preventive program. RUTF (500 kcal/sachet/day) were distributed in the 6 study villages of Madarounfa for 4 mo from July to October 2007 to all non-malnourished children aged 6 to 60 mo. As the preventive supplementation strategies were determined at the village-level, children were eligible to receive only one type of preventive supplementation and there was no overlap between the RUSF and RUTF strategies. In villages where RUTF were distributed as part of the previous trial, 79.4% of children in the RUSF group and 77.5% of children in the RUTF group would have been eligible by the age criterion to receive the previous nutrition intervention for at least 1 mo between August and October 2006. Monthly follow-up was conducted in all 12 study villages by nutritional assistants and research nurses from August 2006 to March 2008, with follow-up from April 2007 to March 2008 included in this cohort analysis. During monthly follow-up visits from April 2007 to March 2008, all children aged 0 to 60 mo received a physical examination and anthropometric assessment and were referred to treatment if WHZ < -3 (weight-for-height < 70% of the NCHS reference median in April 2007) or edema. In addition, at the site of RUSF distributions, children in attendance were screened for mid-upper arm circumference < 110 mm or edema by nutritional assistants and referred children to the MSF nutritional treatment program when indicated.