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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

Lieven Huybregts UGent, Freddy Houngbé UGent, Cécile Salpéteur, Rebecca Brown, Dominique Roberfroid, Myriam Ait-Aissa and Patrick Kolsteren UGent (2012) PLOS MEDICINE. 9(9).
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.
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author
organization
year
type
journalArticle (original)
publication status
published
subject
keyword
HOME-BASED THERAPY, USE THERAPEUTIC FOOD, BREAST-MILK INTAKE, PREVENTIVE SUPPLEMENTATION, ACUTE MALNUTRITION, FORTIFIED SPREADS, YOUNG-CHILDREN, MICRONUTRIENT SUPPLEMENTS, EPIDEMIOLOGIC ANALYSES, MALNOURISHED CHILDREN
journal title
PLOS MEDICINE
PLos Med.
volume
9
issue
9
article_number
e1001313
pages
11 pages
Web of Science type
Article
Web of Science id
000309542500010
ISSN
1549-1277
DOI
10.1371/journal.pmed.1001313
language
English
UGent publication?
yes
classification
A1
copyright statement
I have retained and own the full copyright for this publication
id
2130715
handle
http://hdl.handle.net/1854/LU-2130715
date created
2012-06-04 11:46:13
date last changed
2013-02-19 12:40:28
@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 {\textlangle} 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 {\textlangle} 0.001) and fever episodes (-22.5\%; 95\% CI: 14.0, 30.2; p {\textlangle} 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 Houngb{\'e}, Freddy and Salp{\'e}teur, C{\'e}cile and Brown, Rebecca and Roberfroid, Dominique and Ait-Aissa, Myriam and Kolsteren, Patrick},
  issn         = {1549-1277},
  journal      = {PLOS MEDICINE},
  keyword      = {HOME-BASED THERAPY,USE THERAPEUTIC FOOD,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},
}

Chicago
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).
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).
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).
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.