Submitted to: American Journal of Clinical Nutrition
Publication Type: Peer Reviewed Journal
Publication Acceptance Date: 11/16/2004
Publication Date: 4/1/2005
Citation: Ciliberto, M.A., Sandige, H., Ndekha, M.J., Ashorn, P., Briend, A., Ciliberto, H.M., Manary, M.J. 2005. Comparison of home-based therapy with ready-to-use therapeutic food with standard therapy in the treatment of malnourished Malawian children: a controlled, clinical effectiveness trial. American Journal of Clinical Nutrition. 81(4):864-870. Interpretive Summary: Childhood malnutrition is common in Malawi, and the standard treatment, which follows international guidelines, results in poor recovery rates. Higher recovery rates have been seen in small studies with home-based therapy using ready-to-use therapeutic food. In this study, 992 severely malnourished children received treatment at home with peanut butter-based ready-to-use therapeutic food and 186 children received treatment with milk given in the hospital. Seventy-nine percent of children treated at home recovered, while only 46% of the children in hospital recovered. Children treated at home gained weight more rapidly and had less fever, cough, and diarrhea than those children treated in the hospital. Home-based therapy with ready-to-use therapeutic food was superior to standard therapy for severe childhood malnutrition.
Technical Abstract: Childhood malnutrition is common in Malawi, and the standard treatment, which follows international guidelines, results in poor recovery rates. Higher recovery rates have been seen in pilot studies of home-based therapy with ready-to-use therapeutic food (RUTF). The objective was to compare the recovery rates among children with moderate and severe wasting, kwashiorkor, or both receiving either home-based therapy with RUTF or standard inpatient therapy. A controlled, comparative, clinical effectiveness trial was conducted in southern Malawi with 1178 malnourished children. Children were systematically allocated to either standard therapy (186 children) or home-based therapy with RUTF (992 children) according to a stepped wedge design to control for bias introduced by the season of the year. Recovery, defined as reaching a weight-for-height z score > -2, and relapse or death were the primary outcomes. The rate of weight gain and the prevalence of fever, cough, and diarrhea were the secondary outcomes. Children who received home-based therapy with RUTF were more likely to achieve a weight-for-height z score > -2 than were those who received standard therapy (79% compared with 46%; P < 0.001) and were less likely to relapse or die (8.7% compared with 16.7%; P < 0.001). Children who received home-based therapy with RUTF had greater rates of weight gain (3.5 compared with 2.0 g . kg(-1) . d(-1); difference: 1.5; 95% CI: 1.0, 2.0 g . kg(-1) . d(-1)) and a lower prevalence of fever, cough, and diarrhea than did children who received standard therapy. Home-based therapy with RUTF is associated with better outcomes for childhood malnutrition than is standard therapy.