scholarly journals Ready-to-Use Therapeutic Food Made From Locally Available Food Ingredients Is Well Accepted by Children Having Severe Acute Malnutrition in Bangladesh

2017 ◽  
Vol 39 (1) ◽  
pp. 116-126 ◽  
Author(s):  
Nuzhat Choudhury ◽  
Tahmeed Ahmed ◽  
Md Iqbal Hossain ◽  
M. Munirul Islam ◽  
Shafiqul A. Sarker ◽  
...  
Keyword(s):  
Energy Content ◽  
Severe Acute Malnutrition ◽  
Diarrhoeal Disease ◽  
Acute Malnutrition ◽  
Community Based ◽  
Food Ingredients ◽  
Total Energy Content ◽  
Significant Difference ◽  
The Mean ◽  
Therapeutic Food

Background: With a prevalence of 3.1%, approximately, 450 000 children in Bangladesh are having severe acute malnutrition (SAM). There is currently no national community-based program run by government to take care of these children, one of the reasons being lack of access to ready-to-use therapeutic food (RUTF). Objective: To develop RUTF using locally available food ingredients and test its acceptability. Methods: A checklist was prepared for all food ingredients available and commonly consumed in Bangladesh that have the potential of being used for developing a RUTF. Linear programming was used to identify the combinations of nutrients that would result in an ideal RUTF. To test the acceptability of 2 local RUTFs compared to the prototype RUTF, Plumpy’Nut, a clinical trial with a crossover design was conducted among 30 children in the Dhaka Hospital of International Centre for Diarrhoeal Disease Research, Bangladesh. The acceptability was determined by using the mean proportion of offered food consumed by the children themselves. Results: Two RUTFs were developed, one based on chickpea and the other on rice–lentils. The total energy content of 100 g of chickpea and rice–lentil-based RUTF were 537.4 and 534.5 kcal, protein 12.9 and 13.5 g, and fat 31.8 and 31.1 g, respectively, without any significant difference among the group. On an average, 85.7% of the offered RUTF amount was consumed by the children in 3 different RUTF groups which implies that all types of RUTF were well accepted by the children. Conclusion: Ready-to-use therapeutic foods were developed using locally available food ingredients—rice, lentil, and chickpeas. Chickpea-based and rice–lentil-based RUTF were well accepted by children with SAM.

Report of a Pilot Program Using a Milk-Free Ready-to-Use Therapeutic Food Made From Soya, Maize, and Sorghum to Treat Severe Acute Malnutrition

2021 ◽  
Vol 42 (1) ◽  
pp. 91-103
Author(s):  
Theresa Banda ◽  
Khataza Chawanda ◽  
Wakako Tsuchida ◽  
Slyvester Kathumba
Keyword(s):  
Severe Acute Malnutrition ◽  
Primary Source ◽  
Performance Standards ◽  
Acute Malnutrition ◽  
Community Based ◽  
Arm Circumference ◽  
Feeding Program ◽  
The Mean ◽  
Minimum Performance ◽  
Therapeutic Food

Background: Globally, ready-to-use therapeutic food (RUTF) with peanut and milk as the primary source of protein is used to treat children having severe acute malnutrition (SAM). Valid Nutrition in collaboration with Ajinomoto Co., Inc has developed a nonmilk RUTF from soybean, maize, and sorghum (SMS-RUTF) and demonstrated its efficacy. Objective: To pilot SMS-RUTF in treatment of SAM within Community-Based Management of Acute Malnutrition (CMAM) program in Malawi, Africa. Methods and Findings: This was implemented from January to July 2018 and its performance was based on the SPHERE criteria and Ministry of Health CMAM guidelines. A total of 742 children were treated with SMS-RUTF. Of these, 94.5% (95% CI: 92.6-96.0) were successfully discharged to supplementary feeding program (SFP) with middle upper arm circumference (MUAC) ≥115 mm or directly to their homes with MUAC ≥125 mm; 3.6% (95% CI: 2.4-5.3) defaulted, 1.9 % (95% CI: 1.0-2.1) died, and 0.0% nonresponders. Analysis of 222 children who were discharged home with MUAC ≥125 mm gave a recovery rate of 88.3% (95% CI: 88.3-92.2), a defaulter rate of 6.8 % (95% CI: 3.8-10.9), a mortality rate of 1.3% (95% CI: 0.3-3.9), and a nonresponders rate of 1.8% (95% CI: 0.5-4.5). These outcomes exceed SPHERE minimum performance standards. The mean (standard deviation) length of stay of children discharged to SFP and discharged directly home were 42.0 (20.9) and 46.1 (21.1) days, respectively. These outcomes are within the recommended average duration of <60 days. Conclusion: The pilot CMAM program using SMS-RUTF recipe that contains no milk or peanuts achieved SPHERE minimum standards. Based on this evidence, SMS-RUTF should be encouraged for treatment of SAM in children between 6 and 59 months in routine CMAM programs in Malawi and globally.

scholarly journals Factors Associated with Undernutrition of Children Admitted in Koshi Zonal Hospital Nutritional Rehabilitation Home

2018 ◽  
Vol 32 (2) ◽  
pp. 29-36
Author(s):  
Punam Kumari Mandal
Keyword(s):  
Mixed Method ◽  
Community Based ◽  
Number Of Children ◽  
Balanced Diet ◽  
Nutritious Food ◽  
Significant Difference ◽  
The Mean ◽  
Caste Groups ◽  
Improve Health ◽  
Therapeutic Food

This study follows mixed method with the objective to assess the factor associated with undernutrition among the children admitted in NRH. This study was conducted in Koshi Zonal Hospital. The study covers the children admitted in NRH and their mothers from 14th March to 28th May 2016 with sample size of 20. The study shows the highest number of children belonged to disadvantaged non Dalit Terai caste groups (35 %) and majorities (45 %) of the mothers found to be illiterate. A statistically significant difference was observed between the mean weight at discharge and the mean weight at admission for the study group (t=2.98, P<0.008, CI 0.46-2.65). The cause of malnutrition was lack of nutritious food, poverty, unhygienic condition at home, diseases and lack of nutritious food during pregnancy. There were knowledge gap regarding the nutrition, causes of malnutrition and its prevention, balanced diet and therapeutic food among the mothers. An urgent need to link these centers with community-based models was felt necessary to improve health education measures and awareness.

scholarly journals Costing of three feeding regimens for home-based management of children with uncomplicated severe acute malnutrition from a randomised trial in India

2018 ◽  
Vol 3 (2) ◽  
pp. e000702 ◽  
Author(s):  
Charu C Garg ◽  
Sarmila Mazumder ◽  
Sunita Taneja ◽  
Medha Shekhar ◽  
Sanjana Brahmawar Mohan ◽  
...  
Keyword(s):  
Severe Acute Malnutrition ◽  
Randomised Trial ◽  
National Income ◽  
Acute Malnutrition ◽  
Home Based ◽  
Life Years ◽  
Significant Difference ◽  
The Government ◽  
Treated Child ◽  
Therapeutic Food

Trial designThree feeding regimens—centrally produced ready-to-use therapeutic food, locally produced ready-to-use therapeutic food, and augmented, energy-dense, home-prepared food—were provided in a community setting for children with severe acute malnutrition (SAM) in the age group of 6–59 months in an individually randomised multicentre trial that enrolled 906 children. Foods, counselling, feeding support and treatment for mild illnesses were provided until recovery or 16 weeks.MethodsCosts were estimated for 371 children enrolled in Delhi in a semiurban location after active survey and identification, enrolment, diagnosis and treatment for mild illnesses, and finally treatment with one of the three regimens, both under the research and government setting. Direct costs were estimated for human resources using a price times quantity approach, based on their salaries and average time taken for each activity. The cost per week per child for food, medicines and other consumables was estimated based on the total expenditure over the period and children covered. Indirect costs for programme management including training, transport, non-consumables, infrastructure and equipment were estimated per week per child based on total expenditures for research study and making suitable adjustments for estimations under government setting.ResultsNo significant difference in costs was found across the three regimens per covered or per treated child. The average cost per treated child in the government setting was estimated at US$56 (<3500 rupees).ConclusionHome-based management of SAM with a locally produced ready-to-use therapeutic food is feasible, acceptable, affordable and very cost-effective in terms of the disability-adjusted life years saved and gross national income per capita of the country. The treatment of SAM at home needs serious attention and integration into the existing health system, along with actions to prevent SAM.Trial registration numberNCT01705769; Pre-results.

scholarly journals Locally prepared ready to use therapeutic food for the treatment of children with severe acute malnutrition: a randomized controlled trial

2017 ◽  
Vol 4 (4) ◽  
pp. 1491
Author(s):  
Ravichandra K. R. ◽  
Narendra Behera
Keyword(s):  
Weight Gain ◽  
Hospital Stay ◽  
Severe Acute Malnutrition ◽  
Controlled Trial ◽  
Acute Malnutrition ◽  
Study Cohort ◽  
Rapid Weight Gain ◽  
Duration Of Hospital Stay ◽  
Significant Difference ◽  
Therapeutic Food

Background: Severe acute malnutrition (SAM) remains as one of the major killers of children under five years of age. As per WHO are guidelines, dietary management plays a big role in the longer rehabilitation phase of management of SAM. RUTFs are now being used as a substitute to F-100 diet in the management of SAM around the globe. The objective of the study was to compare the efficacy of locally-prepared ready-to-use therapeutic food (LRUTF) and F-100 diet in promoting weight-gain in children with SAM.Methods: A total of 120 children were included in the study. The control cohort received F-100 while the study cohort received LRUTF diet. Both the groups received a total of 6 feeds per day which included 3 feeds of either LRUTF or F100 and 3 feeds from family pot. Outcome was measured in terms of Rate of weight gain/kg/day, duration of hospital stays and recovery rates.Results: There were 60 subjects in each group. Rate of weight gain was found to be (9.15±3.39 gm/kg/day) in LRUTF group and (6.72±1.05 gm/kg/day) in F-100 group. Significant difference in rate of weight gain was observed in LRUTF group. Duration of hospital stay was lesser in LRUTF group than F-100 group... Recovery rates in LRUTF group were better than F-100 group.Conclusions: LRUTF promotes more rapid weight-gain when compared with F100 in patients with SAM during rehabilitation phase. Duration of hospital stay is lesser in LRUTF group than that of F-100 group.

scholarly journals Effect of the Timing of Antiretroviral Treatment Initiation on Outcomes in Children Living With Human Immunodeficiency Virus Admitted With Severe Acute Malnutrition

2020 ◽  
Author(s):  
Moherndran Archary ◽  
Benn Sartorius ◽  
Philip La Russa ◽  
Thobekile Sibaya ◽  
Micheal Healy ◽  
...  
Keyword(s):  
Antiretroviral Treatment ◽  
Severe Acute Malnutrition ◽  
Acute Malnutrition ◽  
Controlled Study ◽  
Z Score ◽  
Pragmatic Approach ◽  
Art Initiation ◽  
Significant Difference ◽  
The Mean ◽  
Living With Hiv

Abstract Background Delays in early infant diagnosis and antiretroviral treatment (ART) initiation in developing countries frequently result in malnutrition at initial presentation with associated higher mortality and delayed immune recovery. The optimal timing of ART initiation is yet to be established. Methods Eighty-two children admitted with HIV and severe acute malnutrition (SAM) between July 2012 and December 2015 were enrolled. Patients were randomized to initiate ART within 14 days from admission (early arm) or delay ART initiation until nutritional recovery and &gt;14 days after admission (delayed arm). All patients received a standardized treatment and feeding protocol and were followed to 48 weeks. Results The mean age of the patients at baseline was 23.3 months (standard deviation [SD], 27.9; range, 1.6–129 months). The mean time from admission to ART initiation was 5.6 days (SD, 4.4) in the early arm and 23 days (SD, 5.8) in the delayed arm (P &lt; .001). There was no significant difference in mortality (P = .62), virologic response (P = .53), and anthropometric response (P = .57) between the 2 groups at 48 weeks. However, the rates of change in CD4, viral load, weight for age z score, and height for age z score occurred earlier and favored the delayed arm at early time points but were not significant at 24 and 48 months. Conclusions Despite initial improved responses in the delayed arm, lack of difference in outcome at 48 weeks supports a pragmatic approach with earlier ART initiation in children living with HIV admitted with SAM. In this randomised controlled study of ART initiation in children admitted with HIV and severe acute malnutrition (SAM), despite initial improved responses in the delayed arm, lack of difference in outcome at 48 weeks supports a pragmatic approach with earlier ART initiation in children living with HIV admitted with SAM. Clinical Trials Registration PACTR 21609001751384.

scholarly journals Serum iron and serum retinol level of severe acute malnourished children on therapeutic intervention with WHO/UNICEF recommended therapeutic food and home based therapeutic food

2021 ◽  
Vol 8 (2) ◽  
pp. 337
Author(s):  
Bharti Bhandari ◽  
Anita Mehta
Keyword(s):  
Serum Iron ◽  
Severe Acute Malnutrition ◽  
Vitamin A Deficiency ◽  
Controlled Trial ◽  
Acute Malnutrition ◽  
P Value ◽  
Serum Retinol ◽  
Home Based ◽  
Significant Difference ◽  
Therapeutic Food

Background: The prevalence of anaemia and vitamin A deficiency among children with severe acute malnutrition (SAM) and their correction during nutritional rehabilitation are not well documented. This study assessed serum iron and serum retinol levels, effect of ready-to-use therapeutic foods (RUTF) and home based treatment on levels of serum iron and serum retinol level in SAM children.Methods: This was a simple randomised controlled trial in 6-59 months old children with SAM. Two groups of 70 each were divided, one was given RUTF and other home based food comparable to RUTF. Serum retinol and serum iron were measured on day 1 and 6 weeks of therapy.Results: Home based food was found better in terms of increase in serum iron than RUTF while there was no difference in rise of serum retinol in both the groups. There was no significant difference between day 1 value of serum iron in both the groups as p value was 0.82 but the level of serum iron at 6 weeks has shown significant difference in both the groups as p value was 0.0014 so there was significant increase in serum iron in group B in comparison to group A; the serum retinol value in both the groups has not shown any significant improvement.Conclusions: It was concluded home based food is better in correcting iron deficiency in SAM children as it is cheap, easily available, palatable, and acceptable than RUTF.

scholarly journals Malaria and malnutrition co-existence among under-five children of tribal dense regions of Odisha: a community based study

2018 ◽  
Vol 5 (7) ◽  
pp. 3024
Author(s):  
Ashish Mahapatra ◽  
Sabyasachi Mohapatra ◽  
Niloy Mitter ◽  
Sushree Swagata Dash ◽  
Rudra Prasanna Mishra ◽  
...  
Keyword(s):  
Rainy Season ◽  
Malaria Infection ◽  
Nutritional Assessment ◽  
Severe Acute Malnutrition ◽  
Acute Malnutrition ◽  
Age Group ◽  
Community Based ◽  
Malnourished Children ◽  
Significant Difference ◽  
Estimate Prevalence

Background: “Malaria and malnutrition are closely related in the months of hunger gap when malnutrition is at its peak often coincides with rainy season when the number of malaria cases shoot up. The disease combines in a vicious circle. Children sick with malaria are more likely to become dangerously malnourished”. Severely malnourished children with malaria infection may have no fever, or be hypothermic. Proactive screening for malaria in severely malnourished children is needed even if the child has no symptoms of malaria. The objectives of the study were to estimate prevalence of “malaria and malnutrition” co-existence in under 5 children of tribal dense regions and to determine if any significant difference between this co-existent condition against the disease alone.Methods: Eight villages were selected based on their inaccessibility and demography spread across Bamnipal and Sukinda region. Malaria testing using antigen based RDK and nutritional assessment using MUAC tapes were conducted in of 6 months to <5 yrs children.Results: A total of 224 children of under 5 yrs age group were screened. 50.4% of them were suffering from malaria, 38% of the children were at risk or suffering from severe acute malnutrition. Of the 113 children with malaria, 45% were having malnutrition. Out of 86 malnourished children 59% were diagnosed with malaria. 22.7% of children were found to have malaria and malnutrition together.Conclusions: Malaria and Malnutrition are co-existent and synergistic to each other.

Time To Relapse of Severe Acute Malnutrition And Its Determinants Among Children Treated In The Health Posts of Hadiya Zone, Southern Ethiopia.

2021 ◽  
Author(s):  
Abera Lambebo ◽  
Desselegn Temiru ◽  
Tefera Belachew
Keyword(s):  
Severe Acute Malnutrition ◽  
Statistical Significance ◽  
Acute Malnutrition ◽  
Southern Ethiopia ◽  
Under Five ◽  
Back Ground ◽  
Relapse Time ◽  
The Mean ◽  
Time To Relapse ◽  
Hadiya Zone

Abstract Back ground: In developing countries including Ethiopia, children under five years old are likely to suffer from repeated bouts of SAM. There is lack of study that documented time to relapse of SAM and its determinants. Objective: This study aimed to identify time of relapse and its determinants among children discharged after treatment for SAM in health facilities of Hadiya Zone, South, Ethiopia Methods: An institution based retrospective cohort study was carried out from data spanning from 2014/2015 to 2019/2020. After checking all the assumptions, multivariable CPH model was fitted to isolate independent determinants of time to relapse. All tests were two sided and statistical significance at P values <0.05. Result: The mean(±SD) time for relapse of SAM among under five children was 22(±9.9) weeks from discharge to relapse time. On multivariable CPH model, the hazard of relapse for SAM was significantly higher for children who had edema (AHR =2.02 ,95%, CI: 1.17-3.50), age of 6-11 months (AHR = 5.2, 95%, CI:1.95-13.87), had discharge low MUAC (AHR = 12,95%, CI: 7.90-19.52)Concussion: The finding showed that children discharged from SAM are likely to have relapse in 3 weeks.

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