Submitted to: Acta Paediatrica
Publication Type: Peer Reviewed Journal
Publication Acceptance Date: 1/31/2006
Publication Date: 8/1/2006
Citation: Ciliberto, M.A., Manary, M.J., Ndekha, M.J., Briend, A., Ashorn, P. 2006. Home-based therapy for oedematous malnutrition with ready-to-use therapeutic food. Acta Paediatrica. 95(8):1012-1015. Interpretive Summary: Severe childhood malnutrition with edema (whole body swelling) is seen in the poorest parts of the world and usually treated in poor hospitals with milk. Unfortunately the outcome of hospital treatment frequently does not result in recovery. New therapies that can be given at home are needed for these children. In this study, two hundred nineteen Malawian children with severe malnutrition and edema were treated exclusively at home with a ready-to-use, peanut butter-based therapeutic food. Eighty-three percent of these children recovered and 5% died. This demonstrates that these children with severe malnutrition and edema can be successfully treated without any period of hospitalization with this specialized food.
Technical Abstract: BACKGROUND: Standard recommendations are that children with oedematous malnutrition receive inpatient therapy with a graduated feeding regimen. Aim: To investigate exclusive home-based therapy for children with oedematous malnutrition. METHODS: Children with oedematous malnutrition, good appetite, and no complications were treated at home with ready-to-use therapeutic food (RUTF) and followed up fortnightly for up to 8 wk. Setting and participants: 219 children aged 1-5 y with oedema enrolled in one of two therapeutic nutritional studies in Malawi in 2003-2004. RESULTS: The overall recovery rate was 83% (182/219), and the case-fatality rate was 5% (11/219). For children with wasting and oedematous malnutrition, 65% (55/85) recovered and 7% (6/85) died. The average weight gain was 2.8+/-3.2 g/kg/d (mean+/-SD). CONCLUSION: This preliminary observation suggests that children with oedematous malnutrition and good appetite may be successfully treated with home-based therapy; a randomized, controlled trial to evaluate this is warranted.