Evaluation of the Effectiveness of Cost-free Nutrition Programme on Children in Reo Health District, Burkina Faso

Background: The community management for acute malnutrition (CMAM) was started in 2012 with the aim toimpact the lives of a large number of children suffering from acute malnutrition without any cost. Objective: Thestudy aimed at evaluating the effectiveness of the CMAM program on severe acute malnutrition (SAM) andmoderate acute malnutrition (MAM) treatment. Methods: Children aged 6 to 59 months were screened formalnutrition in a complementary compulsory screening program. Acutely malnourished children underwent freemedical and nutritional treatment. Evaluation of the CMAM program implementation was performed bycomparison with paid services by collecting data from malnourished children’s parents. Results: From the 64458screened children, 835 were diagnosed as new acutely malnourished cases and referred to health centers fortreatment. The anthropometric parameters (MUAC, weight, height) have significantly improved from the time ofadmission to the end of treatment. Performance indicators using the Sphere standards were above the expectedlevel for outpatient treatment but for inpatient treatment, it failed to meet the expected standard. Poverty and theuse of traditional medicine to treat malnutrition, distance, availability, and cost of transportation to the healthcenter were significant barriers to the continuation of healthcare services. Conclusion: The CMAM program iseffective. It covered and allowed the treatment of several children presenting the number of pathologies reducingchildren's morbidity and mortality. In order to increase children’s nutritional status, it will be helpful to workwith traditional healers.

Nutrition rehabilitation of children with severe acute malnutrition: Revisiting studies undertaken by the National Institute of Nutrition

Severe acute malnutrition (SAM) in children under five years is an important public health problem due to associated high mortality and long-term health consequences. Research on the dietary causes of SAM, especially the role and relative importance of dietary protein, in the aetiology of oedematous malnutrition, has led to considerable debates and controversies. The present article revisits some of the debates in this field, where the researchers at the National Institute of Nutrition (NIN), Hyderabad, India, with their pioneering work, have contributed to the global literature on the various facets of the disease. Highlighting the importance of energy as a bigger problem than protein malnutrition is a noteworthy contribution of NIN's research. It is, however, important to examine the protein quality of the diets in light of the new information on the lysine requirements. The article argues that the currently dominating hypothesis of free radical theory requires a critical review of the supporting evidence. Over the past few decades, the research has focused on low-cost diets using locally available foods. The article also argues that solutions based on local foods, being acceptable and sustainable, need to be strengthened for their effective delivery through the existing nutrition programmes. Recent evidence shows that the use of ready-to-use therapeutic foods (RUTF) with high micronutrient density may be linked with higher mortality possibly due to the high iron content, which could be counterproductive. There are several unaddressed concerns regarding the potential long-term impact of consumption of RUTF in children with SAM. More evidence and a cautious approach are, therefore, needed before implementing these solutions.

Formulation and Evaluation of Ready-To-Use Therapeutic Foods Using Locally Available Ingredients in Bauchi, Nigeria

Globally, severe acute malnutrition (SAM) is reported to affect 19 million children 0-5 years of age, and is associated with 1 to 2 million preventable child deaths every year. 60-90% of children with SAM without medical complications can be treated without being admitted to health facilities using Ready-to-use Therapeutic Food (RUTF). Shipping costs, delays & donor fatigue lead to periodical unavailability of RUTF in Nigeria, undermining its effectiveness in combating malnutrition. The aim of this study was to produce RUTF from locally available ingredients, and to determine the proximate composition and evaluate the acceptability of the RUTF. The study produced and evaluated eight samples of RUTF from locally available ingredients such as soybean, acha, (fonio), guinea corn, crayfish, peanuts, cashew nut, milk, sugar, vegetable oil and date palm, but discarded five of the samples based on costs and acceptability. Sensory evaluation of the three selected samples of RUTF (AOB, BOC and PCO) was carried out. The energy content (523kcal) of PCO, AOB (555kcal) and BOC (573kcal) were comparable to the recommendation of 520-550 kcal by the WHO. The fat contents (45.11g and 43.04g) of BOC and AOB respectively were higher, while that of PCO (32.14g) was within the recommendation of 45-60% for fat. The protein contents of AOB, BOC and PCO (22.7g, 24.11g and 21.70g respectively) were higher than the recommendation of 10-12% of energy. The ash contents (3.5g and 4.38g) of AOB and BOC were similar to that of Plumpy’Nut. BOC was the most acceptable in terms of flavour, colour and consistency. There was no significant difference in flavour and colour (p>0.05) but there were significant differences in consistency and taste (p=0.025 and 0.008 respectively) between the samples.

Consensus Statement: National Consensus Workshop on Management of SAM Children through Medical Nutrition Therapy.

Justification: Severe acute malnutrition (SAM) is an important preventable and treatable cause of morbidity and mortality in children below five years of age in India. The concerned stakeholders are not in agreement about the role of product based medical nutrition therapy in the management of this condition. Process: In November 2009, a National Consensus Workshop was organized by the Department of Human Nutrition, All India Institute of Medical Sciences, New Delhi in collaboration with the Department of Pediatrics and Clinical Epidemiology, Sitaram Bhartia Institute of Science and Research, New Delhi, and the Sub-specialty Chapter on Nutrition, Indian Academy of Pediatrics. Presentations by eminent national and international scientists, the ensuing discussions, and opinions expressed by the participants provided the basic framework for drafting the consensus statement. The draft of the consensus statement was circulated to all the participants; it underwent two revisions after consideration of their comments. Objectives: (i) Critically appraise the current global evidence on the utility of “Medical Nutrition Therapy” (MNT) for the management of SAM in under five children; (ii) Formulate a consensus amongst stakeholders regarding the need to introduce product based MNT for the management of SAM in under five children in India; (iii) Identify research priorities for MNT for the management of SAM in under five children in India; and (iv) Ascertain potential challenges for introducing product based MNT in India, if consensus opinion identifies such a need. Recommendations: Guidelines related to the role of MNT in management of children suffering from SAM are presented. Global and regional data document the effectiveness of MNT using ready-to-use therapeutic foods (RUTF) and locally formulated products. Adequate caution should be exercised to ensure that MNT for SAM does not interfere with measures for the holistic prevention of childhood undernutrition. Indian manufacture of RUTF is feasible, and can be scaled up. Product-based nutrition therapy including RUTF can be introduced on a pilot basis when a delivery design and plan of action is developed and is in place as a part of the larger system to deal with childhood undernutrition. RUTF should be used only as therapeutic and not supplementary feeding, above six months of age, and for a limited time period (4-8 weeks) until the child recovers from SAM, which should be defined in explicit treatment protocols. An urgent research issue is comparison of RUTF with home-based and locally-formulated products.