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Title: The use of home-based therapy with ready-to-use therapeutic food to treat malnutrition in a rural area during a food crisis

Author
item AMTHOR, RACHEL - Washington University
item COLE, STEPHANIE - Washington University
item MANARY, MARK - Washington University School Of Medicine

Submitted to: Journal Of The American Dietetic Association
Publication Type: Peer Reviewed Journal
Publication Acceptance Date: 6/13/2008
Publication Date: 3/1/2009
Citation: Amthor, R.E., Cole, S.M., Manary, M.J. 2009. The use of home-based therapy with ready-to-use therapeutic food to treat malnutrition in a rural area during a food crisis. Journal of The American Dietetic Association. 109(3):464-467.

Interpretive Summary: When the international community declared a famine in Malawi in January 2006, emergency food aid reached only populations with pre-existing health care services. To treat widespread childhood malnutrition in the rural Machinga district of Malawi, five outpatient therapeutic programs were implemented that utilized home-based therapy and ready-to-use therapeutic food. Children with severe malnutrition were enrolled in a program that involved biweekly visits to health aides, who collected demographic and height/weight information and distributed a 2-week supply of ready-to-use therapeutic food. Of the 826 children enrolled, 775 (93.7%) recovered. These results provide evidence that home-based therapy with ready-to-use therapeutic food administered by village health aides is an effective approach to treating malnutrition during food crises in areas lacking health services. This research may have widespread impact on the intervention approach used to treat similar areas across the globe.

Technical Abstract: When the international community declared a famine in Malawi in January 2006, emergency food aid reached only populations with pre-existing health care services. To treat the widespread childhood malnutrition in Machinga district, a rural area lacking health care facilities, in February 2006 five outpatient therapeutic programs were implemented that utilized home-based therapy and ready-to-use therapeutic food. Children with severe malnutrition, defined as the presence of edema and/or a weight-for-height less than 70% of the reference standard, were enrolled in the program. Two senior clinical nurses trained village health aides in each of the five communities. Children visited the health aides biweekly. During the visits, health aides collected demographic and anthropometric information and distributed a 2-week supply of ready-to-use therapeutic food, providing 175 kcal/kg/d. Treatment continued for 8 weeks; children were discharged before 8 weeks if they reached a weight-for-height more than 100% of the reference standard, or required admission to the hospital due to systemic infection or recurrence of edema. Of the 826 children enrolled, 775 (93.7%) recovered, 13 (1.8%) remained malnourished, 30 (3.6%) defaulted, and 8 (0.9%) died. Mean weight gained was 2.7+/-3.7 g/kg/d, height gained 0.3+/-0.9 mm/d, and mid-upper arm circumference gained 0.2+/-0.3 mm/d. Home-based therapy with ready-to-use therapeutic food administered by village health aides is an effective approach to treating malnutrition during food crises in areas lacking health services.