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The effect of adding ready-to-use supplementary food to a general food distribution on child nutritional status and morbidity : a cluster-randomized controlled trial

(2012) PLOS MEDICINE. 9(9).
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Abstract
Background: Recently, operational organizations active in child nutrition in developing countries have suggested that blanket feeding strategies be adopted to enable the prevention of child wasting. A new range of nutritional supplements is now available, with claims that they can prevent wasting in populations at risk of periodic food shortages. Evidence is lacking as to the effectiveness of such preventive interventions. This study examined the effect of a ready-to-use supplementary food (RUSF) on the prevention of wasting in 6- to 36-mo-old children within the framework of a general food distribution program. Methods and Findings: We conducted a two-arm cluster-randomized controlled pragmatic intervention study in a sample of 1,038 children aged 6 to 36 mo in the city of Abeche, Chad. Both arms were included in a general food distribution program providing staple foods. The intervention group was given a daily 46 g of RUSF for 4 mo. Anthropometric measurements and morbidity were recorded monthly. Adding RUSF to a package of monthly household food rations for households containing a child assigned to the intervention group did not result in a reduction in cumulative incidence of wasting (incidence risk ratio: 0.86; 95% CI: 0.67, 1.11; p = 0.25). However, the intervention group had a modestly higher gain in height-for-age (+0.03 Z-score/mo; 95% CI: 0.01, 0.04; p < 0.001). In addition, children in the intervention group had a significantly higher hemoglobin concentration at the end of the study than children in the control group (+3.8 g/l; 95% CI: 0.6, 7.0; p = 0.02), thereby reducing the odds of anemia (odds ratio: 0.52; 95% CI: 0.34, 0.82; p = 0.004). Adding RUSF also resulted in a significantly lower risk of self-reported diarrhea (-29.3%; 95% CI: 20.5, 37.2; p < 0.001) and fever episodes (-22.5%; 95% CI: 14.0, 30.2; p < 0.001). Limitations of this study include that the projected sample size was not fully attained and that significantly fewer children from the control group were present at follow-up sessions. Conclusions: Providing RUSF as part of a general food distribution resulted in improvements in hemoglobin status and small improvements in linear growth, accompanied by an apparent reduction in morbidity.
Keywords
USE THERAPEUTIC FOOD, HOME-BASED THERAPY, BREAST-MILK INTAKE, PREVENTIVE SUPPLEMENTATION, ACUTE MALNUTRITION, FORTIFIED SPREADS, YOUNG-CHILDREN, MICRONUTRIENT SUPPLEMENTS, EPIDEMIOLOGIC ANALYSES, MALNOURISHED CHILDREN

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MLA
Huybregts, Lieven, Freddy Houngbé, Cécile Salpéteur, et al. “The Effect of Adding Ready-to-use Supplementary Food to a General Food Distribution on Child Nutritional Status and Morbidity : a Cluster-randomized Controlled Trial.” PLOS MEDICINE 9.9 (2012): n. pag. Print.
APA
Huybregts, L., Houngbé, F., Salpéteur, C., Brown, R., Roberfroid, D., Ait-Aissa, M., & Kolsteren, P. (2012). The effect of adding ready-to-use supplementary food to a general food distribution on child nutritional status and morbidity : a cluster-randomized controlled trial. PLOS MEDICINE, 9(9).
Chicago author-date
Huybregts, Lieven, Freddy Houngbé, Cécile Salpéteur, Rebecca Brown, Dominique Roberfroid, Myriam Ait-Aissa, and Patrick Kolsteren. 2012. “The Effect of Adding Ready-to-use Supplementary Food to a General Food Distribution on Child Nutritional Status and Morbidity : a Cluster-randomized Controlled Trial.” Plos Medicine 9 (9).
Chicago author-date (all authors)
Huybregts, Lieven, Freddy Houngbé, Cécile Salpéteur, Rebecca Brown, Dominique Roberfroid, Myriam Ait-Aissa, and Patrick Kolsteren. 2012. “The Effect of Adding Ready-to-use Supplementary Food to a General Food Distribution on Child Nutritional Status and Morbidity : a Cluster-randomized Controlled Trial.” Plos Medicine 9 (9).
Vancouver
1.
Huybregts L, Houngbé F, Salpéteur C, Brown R, Roberfroid D, Ait-Aissa M, et al. The effect of adding ready-to-use supplementary food to a general food distribution on child nutritional status and morbidity : a cluster-randomized controlled trial. PLOS MEDICINE. 2012;9(9).
IEEE
[1]
L. Huybregts et al., “The effect of adding ready-to-use supplementary food to a general food distribution on child nutritional status and morbidity : a cluster-randomized controlled trial,” PLOS MEDICINE, vol. 9, no. 9, 2012.
@article{2130715,
  abstract     = {Background: Recently, operational organizations active in child nutrition in developing countries have suggested that blanket feeding strategies be adopted to enable the prevention of child wasting. A new range of nutritional supplements is now available, with claims that they can prevent wasting in populations at risk of periodic food shortages. Evidence is lacking as to the effectiveness of such preventive interventions. This study examined the effect of a ready-to-use supplementary food (RUSF) on the prevention of wasting in 6- to 36-mo-old children within the framework of a general food distribution program. 
Methods and Findings: We conducted a two-arm cluster-randomized controlled pragmatic intervention study in a sample of 1,038 children aged 6 to 36 mo in the city of Abeche, Chad. Both arms were included in a general food distribution program providing staple foods. The intervention group was given a daily 46 g of RUSF for 4 mo. Anthropometric measurements and morbidity were recorded monthly. Adding RUSF to a package of monthly household food rations for households containing a child assigned to the intervention group did not result in a reduction in cumulative incidence of wasting (incidence risk ratio: 0.86; 95% CI: 0.67, 1.11; p = 0.25). However, the intervention group had a modestly higher gain in height-for-age (+0.03 Z-score/mo; 95% CI: 0.01, 0.04; p < 0.001). In addition, children in the intervention group had a significantly higher hemoglobin concentration at the end of the study than children in the control group (+3.8 g/l; 95% CI: 0.6, 7.0; p = 0.02), thereby reducing the odds of anemia (odds ratio: 0.52; 95% CI: 0.34, 0.82; p = 0.004). Adding RUSF also resulted in a significantly lower risk of self-reported diarrhea (-29.3%; 95% CI: 20.5, 37.2; p < 0.001) and fever episodes (-22.5%; 95% CI: 14.0, 30.2; p < 0.001). Limitations of this study include that the projected sample size was not fully attained and that significantly fewer children from the control group were present at follow-up sessions. 
Conclusions: Providing RUSF as part of a general food distribution resulted in improvements in hemoglobin status and small improvements in linear growth, accompanied by an apparent reduction in morbidity.},
  articleno    = {e1001313},
  author       = {Huybregts, Lieven and Houngbé, Freddy and Salpéteur, Cécile and Brown, Rebecca and Roberfroid, Dominique and Ait-Aissa, Myriam and Kolsteren, Patrick},
  issn         = {1549-1277},
  journal      = {PLOS MEDICINE},
  keywords     = {USE THERAPEUTIC FOOD,HOME-BASED THERAPY,BREAST-MILK INTAKE,PREVENTIVE SUPPLEMENTATION,ACUTE MALNUTRITION,FORTIFIED SPREADS,YOUNG-CHILDREN,MICRONUTRIENT SUPPLEMENTS,EPIDEMIOLOGIC ANALYSES,MALNOURISHED CHILDREN},
  language     = {eng},
  number       = {9},
  pages        = {11},
  title        = {The effect of adding ready-to-use supplementary food to a general food distribution on child nutritional status and morbidity : a cluster-randomized controlled trial},
  url          = {http://dx.doi.org/10.1371/journal.pmed.1001313},
  volume       = {9},
  year         = {2012},
}

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