Résumé
Across Africa, Severe Acute Malnutrition (SAM) affects approximately 3% of children under five at any time and is associated with several hundred thousand child deaths each year. Since the 1950s, efforts to treat these children as inpatients in hospitals or clinics have failed to lower mortality rates and have achieved very poor coverage. During the past 10 years new community-based management approaches treating over 85% of SAM cases solely as outpatients using nutrient dense, lipid-based Ready to Use Therapeutic Foods have dramatically reduced mortality and increased coverage rates. In 2005, this new model was endorsed by the UN under the name Community-based Management of Acute Malnutrition (CMAM) and has now been adopted by over 25 National governments and all major relief agencies. By 2009, approximately 1 million cases of SAM were being treated annually, with programs expanding by approximately 30% year on year.
Sujets)
Convalescence , Toux/épidémiologie , Diarrhée/épidémiologie , Compléments alimentaires/statistiques et données numériques , Consommation alimentaire , Fièvre/épidémiologie , État de santé , Humains , Nourrisson , Phénomènes physiologiques nutritionnels chez le nourrisson , Lipides/usage thérapeutique , Études longitudinales , Malawi/épidémiologie , Malnutrition/prévention et contrôle , État nutritionnel , Satisfaction des patients , Enquêtes et questionnaires , Maigreur/traitement médicamenteuxRésumé
The study was a controlled, comparative clinical effectiveness trial of two supplementary feeding regimens in children at risk of malnutrition from seven centres in rural Malawi. Being at risk of malnutrition was defined as weight-for-height <85%, but >80% of the international standard. A stepped-wedge design with systematic allocation was used for assigning children to receive either ready-to-use therapeutic food (RUTF) (n=331) or micronutrient-fortified corn/soy-blend (n=41) for up to eight weeks. The primary outcomes were recovery, defined as weight-for-height >90%, and the rate of weight gain. Children receiving RUTF were more likely to recover (58% vs 22%; difference 36%; 95% confidence interval [CI] 20-52) and had greater rates of weight gain (3.1 g/kg.d vs 1.4 g/kg x d; difference 1.7; 95% CI 0.8-2.6) than children receiving corn/soy-blend. The results of this preliminary work suggest that supplementary feeding with RUTF promotes better growth in children at risk of malnutrition than the standard fortified cereal/legume-blended food.