Comparison of Different Feeding Protocols for the Treatment of Acute Malnutrition
Condition: Malnutrition, Child
MeSH terms: Malnutrition; Child Nutrition Disorders
Study type: Interventional

Summary: 
      Though malnutrition is prevalent worldwide but its situation is alarming in low- and
      middle-income countries. Pakistan has also been facing an alarming situation of prevailing
      severe malnutrition. Malnutrition in its any form costs a huge intolerable burden not only on
      national health care system, but also on social and economic fabric of the nation. The
      current management of severe malnutrition is based on World Health Organization (WHO)
      guidelines and protocols which has been evolved from expert opinions and observational
      studies. The principles of these protocols have emerged from emergency settings and
      converting these protocols for developing countries where severe malnutrition, a routine
      burden is a critical challenge. In the absence of standard protocols for the treatment of
      uncomplicated severe malnutrition in non-emergency settings it is important to test and
      optimize different approaches to treat severely acute malnutrition (SAM). It is hypothesized
      that by optimizing, adapting and implementing time oriented and resource intensive
      approaches, a huge burden of high cost of RUTF may be reduced. While RUTF may be utilized to
      treat SAM children in emergency settings, it is not a substitute of local household foods.
      Therefore, a pilot study has been conducted to compare the various treatment protocols for
      malnourished children. We specifically hypothesized that a reduced dose of RUTF for reduced
      duration, combined with age-appropriate food intake from locally available resources can
      treat uncomplicated SAM children cost effectively as compared to standard national Community
      Management of Acute Malnutrition (CMAM) protocol currently implemented in Punjab, Pakistan.
    

Detailed description: 
      Malnutrition signifies to inadequacies, immoderations or imbalances in an individual's
      consumption of nutrients or energy. The word malnutrition covers both under and
      over-nutrition. Undernutrition manifest in two different ways acute and chronic malnutrition.
      The acute malnutrition includes wasting while chronic malnutrition includes stunting. The
      situation of malnutrition has been perplexed in Pakistan in recent years and according to
      National Nutrition Survey (2018) rates of wasting are alarmingly high. Also, Pakistan ranks
      at 2nd position for infant and child mortality. The standard treatment of uncomplicated SAM
      in Pakistan often utilizes prolonged use of therapeutic food (RUTF), and after discharge
      results in high rates of relapse(official data from department of Health doesn't support this
      statement, according to them there is low rate of relapse). The present pilot study was
      conducted with the objective to find cost effective treatment protocols for treatment of
      uncomplicated SAM children. The study was conducted at The Children's Hospital and Institute
      of Child Health, Lahore in Out Patient Therapeutic Program (OTP) of Preventive Pediatrics
      Department. The children diagnosed with SAM aged 6-59 months without any specific gender
      preference were recruited. Weight, height and MUAC were measured at the time of enrolment in
      the study and Weight for Height (WHZ), Weight for Age (WAZ), Height for Age (HAZ) standard
      deviation (SD) Z scores and weight velocity was calculated for baseline. For current pilot
      study SAM children were grouped into 3 clusters. First, 30 children were grouped in 1st
      cluster, next 30 in 2nd cluster and further next 30 in 3rd cluster. Children in 1st cluster
      were treated as per standard CMAM protocols. Children in this cluster were provided RUTF as
      per admission weight of child until they attain 11.5cm MUAC or >-3SD WHZ. The children in the
      2nd group (1st intervention group) were initially provided RUTF until they attain MUAC 11cm.
      After this, children were provided 50% of their required daily calories intake by RUTF and
      50% of the calories were provided by the home-based food. The children in the 3rd group (2nd
      intervention group) were initially provided RUTF until they attain MUAC 11 cm. After this,
      children were provided their 100% caloric requirement from home-based food along with
      micronutrients sachets (MMS). The discharge criteria for control group was according to the
      existing CMAM guidelines that is MUAC > 11.5 cm. The discharge criteria for 2nd & 3rd group
      was MUAC > 12.5 cm and WHZ > -2SD score. Follow-up home visits of all children were done
      according to a predefined protocol. During follow-up the control and intervention groups
      underwent weekly anthropometric measurements. Follow up of the study participants of each
      group was continued for one month. Growth rate, recovery rate, mortality rate, relapse
      frequency and duration of recovery were calculated for each group.
    

Intervention name(s): Home based food
Intervention type(s): Dietary Supplement
Intervention description(s): Home based food is compare able to RUTF
Allocation: Randomized
Intervention model: Parallel Assignment
Intervention model description: Study involved 3 arms; 1st arm was treated as per standard protocol. 2nd arm was provided half calories from RUTF and half from home based food, 3rd arm was provided home based food along with MMS
Masking: None (Open Label)
Primary purpose: Treatment
Keywords: Malnutrition; RUTF; Children; Home base food