Location: Children's Nutrition Research CenterTitle: Supplementary feeding of moderately wasted children in Sierra Leone reduces severe acute malnutrition and death when compared with nutrition counseling: A retrospective cohort study
|RAJABI, TANNAZ - The Republic Of Sierra Leone|
|SCHELL, SAM - The Republic Of Sierra Leone|
|AGAPOVA, SOPHIA - Washington University|
|HASSA, AMIR - Washington University|
|ZALTA, MA - Washington University|
|WEGNER, DONNA - Washington University|
|CALLAGHAN-GILLESPIE, MEGHAN - Washington University|
|KOROMA, AMINATA - Ministry Of Health & Sanitation|
|KAMARA, MOHAMED - The Republic Of Sierra Leone|
|MANARY, MARK - Children'S Nutrition Research Center (CNRC)|
|STEPHENSON, KEVIN - Washington University School Of Medicine|
Submitted to: Journal of Nutrition
Publication Type: Peer Reviewed Journal
Publication Acceptance Date: 12/28/2021
Publication Date: 4/2/2022
Citation: Rajabi, T., Schell, S.K., Agapova, S.E., Hassa, A., Zalta, M., Wegner, D.R., Callaghan-Gillespie, M., Koroma, A., Kamara, M.T., Manary, M.J., Stephenson, K.B. 2022. Supplementary feeding of moderately wasted children in Sierra Leone reduces severe acute malnutrition and death when compared with nutrition counseling: A retrospective cohort study. Journal of Nutrition. 152(4):1149-1158. https://doi.org/10.1093/jn/nxab451.
Interpretive Summary: There is uncertainty about whether children with moderate, not severe, malnutrition should receive additional nutrient dense food in order to recover. Data from two clinical trials in Sierra Leone were analyzed to answer this question, accounting for multiple individual child characteristics such as age and household wealth. Children who received specialized food were less likely to develop severe malnutrition or die up to six months after becoming malnourished.
Technical Abstract: There is uncertainty about whether children with moderate wasting should receive supplementary feeding. This was a retrospective, dual-cohort study in which 1791 children with moderate wasting were drawn from 2 prior randomized controlled trials that took place in the same location in rural Sierra Leone. A total of 1077 children received supplementary feeding, whereas 714 children received counseling alone. Children in both cohorts were followed for =24 wk from enrollment. The primary outcome was time to SAM or death using Kaplan–Meier analysis. Secondary outcomes included time to death as well as proportions of children with healthy midupper arm circumference (MUAC), moderate wasting, SAM, or death at 6, 12, and 24 wk from enrollment. Children who received supplementary feeding were less likely to develop SAM or die across the entire follow-up period (HR: 0.53; 95% CI: 0.44, 0.65; P < 0.001). Time to event for death alone also revealed a lower risk for children who received supplementary feeding (HR: 0.52; 95% CI: 0.28, 0.94; P = 0.03). Children who received supplementary feeding were more likely to have a healthy MUAC at 6 wk (RR: 2.0; 95% CI: 1.7, 2.2) and 12 wk (RR: 1.3; 95% CI: 1.2, 1.5), were less likely to develop SAM at 6 (RR: 0.7; 95% CI: 0.6, 0.9), 12 (RR: 0.5; 95% CI: 0.3, 0.8), and 24 wk (RR: 0.2; 95% CI: 0.1, 0.5), and had higher rates of gain in weight and MUAC at 6 and 12 wk. Supplementary feeding of children with moderate wasting reduces risk of SAM and death across 24 wk of follow-up.