evidence-based blog of Filippo Dibari

Posts Tagged ‘weight-for-height’

Randomized, Double-Blind, Placebo-Controlled Trial Evaluating the Need for Routine Antibiotics as Part of the Outpatient Management of Severe Acute Malnutrition

In Under-nutrition on August 11, 2012 at 11:23 am

by Mark J. Manary, Kenneth Maleta, Indi Trehan
Food and Nutrition Technical Assistance II Project (FANTA-2) Bridge, FHI
360, March 2012

(download the entire document)

The Food and Nutrition Technical Assistance (FANTA) Project undertook a clinical trial comparing nutritional recovery and mortality outcomes in children with severe acute malnutrition (SAM) receiving 1 week of amoxicillin, cefdinir, or placebo, in addition to usual peanut-based ready-to-use therapeutic food (RUTF) therapy. This report documents the outcomes of the trial, which clearly showed the benefit of using antibiotics in the outpatient treatment of SAM without medical complications in a setting with high levels of kwashiorkor and HIV infection.

Effects of psychosocial stimulation on improving home environment and child-rearing practices: results from a community-based trial among severely malnourished children in Bangladesh

In Under-nutrition on August 9, 2012 at 12:45 pm

Nahar BHossain MIHamadani JDAhmed TGrantham-McGregor SPersson LA.

BMC Public Health. 2012 Aug 7;12(1):622. [Epub ahead of print]

 

ABSTRACT

BACKGROUND:

Parenting programmes are effective in enhancing parenting practices and child development. This study evaluated the effects of a intervention with psychosocial stimulation (PS) on the quality of the home environment and mothers’ child-rearing practices in a community-based trial with severely malnourished Bangladeshi children.

METHOD:

Severely underweight children (n = 507), 6-24 months of age, were randomly assigned to five groups: PS; food supplementation (FS); PS + FS; clinic-control (CC); and, hospital-control (CH). PS included fortnightly follow-up visits for six months at community clinics where a play leader demonstrated play activities and gave education on child development and child rearing practices. FS comprised cereal-based supplements (150-300 kcal/day) for three months. All groups received medical care, micronutrient supplements and growth monitoring. Mothers were given the Home Observation for Measurement of the Environment (HOME) inventory and a questionnaire on parenting at baseline and after six months to assess the outcome.

RESULTS:

322 children completed the study. After six months of intervention the PS + FS and PS groups benefitted in the total HOME score (depending on the comparison group, effect sizes varied from 0.66 to 0.33 SD) The PS + FS and PS groups also benefitted in two HOME subscales: maternal involvement (effect sizes: 0.8 to 0.55 SD) and play materials, (effect sizes: 0.46 to 0.6 SD), and child-rearing practices scores (effect size: 1.5 to 1.1 SD). The PS + FS group benefitted 4.0 points in total HOME score compared with CH, 4.8 points compared with CC and 4.5 points compared with FS (p < 0.001 for all). The PS group benefitted 2.4 points compared with CH (p = 0.035), 3.3 points compared with CC (p = 0.004), and 2.9 points compared with FS (p = 0.006). Child-rearing practice scores of the PS + FS group improved 7.7, 6.4 and 6.6 points and the PS group improved 8.5, 7.2 and 7.4 points more than CH, CC and FS, respectively (p < 0.001 for all).

CONCLUSIONS:

Child-rearing practices of mothers of severely malnourished children and the quality of their home environment can be improved through community-based psychosocial stimulation with or without food supplementation. This may be of importance to promote child development.

How ready-to-use therapeutic food shapes a new technological regime to treat child malnutrition

In Under-nutrition on August 1, 2012 at 6:23 pm

by José Guimón and Pablo Guimón

from Technological Forecasting and Social Change; Volume 79, Issue 7, September 2012, Pages 1319–1327

Abstract

Since the turn of the 21st century ready-to-use therapeutic food (RUTF) has emerged as the preferred solution to treat acute malnutrition without complications. RUTF is a more appropriate technology than formerly prevalent powdered milk solutions because it enables outpatient care, simpler treatment protocols and production in the field. In this paper we analyze the forces driving the diffusion of RUTF as an innovation to treat child malnutrition and discuss the main features characterizing the new technological regime that results from its wide adoption. We combine the theoretical discussion and the review of secondary sources with insights from field research in Ethiopia, encompassing personal interviews with relevant parties and direct observation of how RUTF works in practice. This technology assessment exercise enables us to suggest some opportunities for policy intervention.

Another less recent version of the same paper is available here.

Innovation to Fight Hunger: The Case of Plumpy’nut

In Under-nutrition on July 31, 2012 at 5:26 pm

by José Guimón* and Pablo Guimón** (2010)

UAM-Accenture Working Papers – ISSN: 2172-8143

(download the entire text)

Abstract 

A simple invention can at times prove extremely useful. This is the case with Plumpy‟nut, a variety of ready-to-use therapeutic food (RUTF) conceived in 1999 that  is shaping a new regime for emergency interventions to alleviate child malnutrition. This paper applies concepts from the innovation systems literature into the analysis of  Plumpy‟nut with the aim of identifying the forces driving its successful diffusion as an innovation. Special attention is paid to three features that define the diffusion process: 1) shifting from inpatient to outpatient treatment, 2) building networks through licences,  franchises and partnerships, and 3) exploring further varieties of application. We combine the theoretical discussion with insights from field research in Ethiopia, including personal interviews with relevant parties and direct observation of how Plumpy‟nut works in practice. The ultimate objectives of this technology assessment exercise are to better understand the innovation journey of Plumpy‟nut and to identify possible opportunities for policy intervention.

Keywords: food crises; malnutrition; therapeutic food; technology diffusion; technological regimes; Ethiopia

Acknowledgements: An earlier draft of this paper was presented at the Globelics International Conference 2009 organized by CRES and UNU-MERIT (Senegal, October 6-8, 2009).

* Departamento de Estructura Económica y Economía del Desarrollo. Universidad Autónoma de Madrid. Ctra. de Colmenar km. 15, 28049 Madrid. E-mail: jose.guimon@uam.es

** El País Semanal. El País. Miguel Yuste 40, 28037 Madrid. E-mail: pguimon@elpais.es

Finally! Everything, really everything, about treatment of undernutrition (CMAM). In just-one-click-away, comprehensive, interactive, open-access, website.

In Under-nutrition on July 10, 2012 at 10:42 am

A new electronic forum improves the management of acute malnutrition. Worldwide.

In this area of humanitarian intervention, CMAM is the acronym mostly used: Community-based Management of Acute Malnutrition.

The CMAM forum not only hosts e-discussions about this topic, but also collects all the key documents endorsed by the WHO, other UN agencies, national and international NGOs. Otherwise scattered around, in their web sites.

World experts in this field (Andre’ Briend, and Mark Myatt among them) support this forum. Therefore, the target consists of practitioners rather than the general public.

The main focus list of the e-forum includes:

  • malnutrition and HIV/AIDS
  • malnutrition and infants, children, adolescents and adults, whose specificities are treated separately
  • malnutrition and health systems in the individual countries
  • evidence for action aiming policy-making, advocacy, support in the area of malnutrition treatment
  • product development for malnutrition rehabilitation
  • current research and existing evidences about most of the topics mentioned above
The web site has important tools:
  • you are interested in CMAM in a specific country? Visit the country section of the CMAM web forum
  • you wish to receive notices about meetings, conferences, trainings? You want to ask questions, learn how to calculate case loads, or simply follow up other people’s questions? Create your website account (for free)
  • you are interested in the latest evidence-based documents or the current state of research? Visit the related section of the forum
  • you can also contribute sharing, with the other forum members, the lessons learnt from your community-based feeding programme

This important forum was conceived thanks to the effort of many organizations. However, the realization was led by Valid International and Action Against Hunger.

If you find the CMAM forum interesting, do not hesitate to re-blog this post, or forward the link of the forum to relevant people.

If you have some constructive criticism or ideas to improve this new important tool, I encourage you to contact its coordinators: Nicky Dent and Rebecca Brown (contacts): I promise that they will be extremely happy to hear from you…

WFP: foods and food supplements for preventing and treating malnutrition in children

In Under-nutrition on June 4, 2012 at 2:23 pm

Original title: “Current and potential role of   specially formulated foods and food supplements for   preventing malnutrition among 6-23 months old and   treating moderate malnutrition among 6-59 months old children”

by Saskia de Pee and Martin W Bloem (2008) – WFP

(download)

Abstract

Reducing child malnutrition requires nutritious food, breastfeeding, improved hygiene, health services, and (prenatal) care. Poverty and food insecurity seriously constrain accessibility of nutritious diets, including high protein quality, adequate micronutrient content and bioavailability, macro-minerals and essential fatty acids, low anti-nutrient content, and high nutrient density. Largely plant-source-based diets with few animal source and fortified foods do not meet these requirements and need to be improved by processing (dehulling, germinating, fermenting), fortification, and adding animal source foods, e.g. milk, or other specific nutrients. Options include using specially formulated foods: fortified blended foods (FBFs), commercial infant cereals, ready-to-use foods i.e. pastes/compressed bars/biscuits, or complementary food supplements (CFS): micronutrient powders (MNP); powdered CFS containing (micro)nutrients, protein, amino acids and/or enzymes; or lipid-based nutrient supplements (LNS), 120-500 kcal/d, typically containing milk powder, high-quality vegetable oil, peanut-paste, sugar, (micro)nutrients. Most supplementary feeding programs for moderately malnourished children supply FBFs, such as corn soy blend, with oil and sugar, which has shortcomings: too many anti-nutrients, no milk (important for growth), suboptimal micronutrient content, high bulk and viscosity. Thus, for feeding young or malnourished children, FBFs need to be improved or replaced. Based on success with ready-to-use therapeutic foods (RUTF) for treating severe acute malnutrition, modifying that recipe is also considered. Commodities for reducing child malnutrition should be chosen based on nutritional needs, program circumstances, availability of commodities, and likelihood of impact. Data are urgently required to compare impact of new or modified commodities to current (FBFs) and to RUTF developed for treating severe acute malnutrition.

Use of Lipid-Based Nutrient Supplements by HIV-Infected Malawian Women during Lactation Has No Effect on Infant Growth from 0 to 24 Weeks

In Under-nutrition on May 31, 2012 at 6:23 am

by Valerie L. Flax5, Margaret E. Bentley, Charles S. Chasela, Dumbani Kayira, Michael G. Hudgens, Rodney J. Knight, Alice Soko, Denise J. Jamieson, Charles M. van der Horst, and Linda S. Adair

J. Nutr. July 1, 2012

Abstract

The Breastfeeding, Antiretrovirals, and Nutrition study evaluated the effect of daily consumption of lipid-based nutrient supplements (LNS) by 2121 lactating, HIV-infected mothers on the growth of their exclusively breast-fed, HIV-uninfected infants from 0 to 24 wk. The study had a 2 × 3 factorial design. Malawian mothers with CD4+ ≥250 cells/mm3, hemoglobin ≥70 g/L, and BMI ≥17 kg/m2 were randomized within 36 h of delivery to receive either no LNS or 140 g/d of LNS to meet lactation energy and protein needs, and mother-infant pairs were assigned to maternal antiretroviral drugs (ARV), infant ARV, or no ARV. Sex-stratified, longitudinal, random effects models were used to estimate the effect of the 6 study arms on infant weight, length, and BMI. Logistic regression models were used to calculate the odds of growth faltering [decline in weight-for-age Z-score (WAZ) or length-for-age Z-score (LAZ) >0.67] using the control arm as the reference. Although some differences between study arms emerged with increasing infant age in boys, there were no consistent effects of the maternal supplement across the 3 growth outcomes in longitudinal models. At the ages where differences were observed, the effects on weight and BMI were quite small (≤200 g and ≤0.4 kg/m2) and unlikely to be of clinical importance. Overall, 21 and 34% of infants faltered in WAZ and LAZ, respectively. Maternal supplementation did not reduce the odds of infant weight or length faltering from 0 to 24 wk in any arm. These results indicate that blanket supplementation of HIV-infected lactating women may have little impact on infant growth.

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For more information on LNS products you can browse in this blog. 

Randomized, Double-Blind, Placebo-Controlled Trial Evaluating the Need for Routine Antibiotics as Part of the Outpatient Management of Severe Acute Malnutrition (2012)

In Under-nutrition on May 25, 2012 at 9:07 am

from FANTA:

“Severe acute malnutrition (SAM) in children contributes to the deaths of 1 million children every year. Until recently, children with SAM were treated as inpatients in crowded hospital wards with milk-based therapy and routine antibiotics for all children. With the advent and widespread acceptance of peanut-based ready-to-use-therapeutic food (RUTF), standard therapy for SAM without medical complications is to treat these children at home.

Even in the home setting, international guidelines recommend that children receive a course of oral antibiotics at the start of their RUTF therapy. Because this places an additional burden on already taxed health systems and caregivers, because clinical experience has shown good recovery rates without antibiotics, and because the bacteria most likely to cause severe infections in these children are unlikely to be susceptible to most options for routine antibiotics, their routine use has been called into question. Thus, FANTA undertook a clinical trial comparing nutritional recovery and mortality outcomes in children with SAM receiving 1 week of amoxicillin, cefdinir, or placebo, in addition to usual RUTF therapy. This report documents the outcomes of the trial, which clearly showed the benefit of using antibiotics in the outpatient treatment of SAM without medical complications”.

Download the document

Wasting Is Associated with Stunting in Early Childhood

In Under-nutrition on May 24, 2012 at 7:33 am

by Stephanie A. Richard, Robert E. Black, Robert H. Gilman, Richard L. Guerrant, Gagandeep Kang, Claudio F. Lanata, Kåre Mølbak, Zeba A. Rasmussen, R. Bradley Sack, Palle Valentiner-Branth9, William Checkley, and Childhood Infection and Malnutrition Network

Journal of Nutrition – May 2012. Ahead of print.

Abstract

“The longitudinal relationship between stunting and wasting in children is poorly characterized. Instances of wasting or poor weight gain may precede linear growth retardation. We analyzed longitudinal anthropometric data for 1599 children from 8 cohort studies to determine the effect of wasting [weight-for-length Z-score (WLZ) < −2] and variability in WLZ in the first 17 mo on length-for-age Z-score (LAZ) at 18–24 mo of age. In addition, we considered the effects of change in WLZ during the previous 6-mo period on length at 18 and 24 mo. Wasting at 6–11 or 12–17 mo was associated with decreased LAZ; however, children who experienced wasting only at 0–5 mo did not suffer any long-term growth deficits compared with children with no wasting during any period. Children with greater WLZ variability (≥0.5 SD) in the first 17 mo of life were shorter [LAZ = −0.51 SD (95% CI: −0.67, −0.36 SD)] at 18–24 mo of age than children with WLZ variability <0.5. Change in WLZ in the previous 6-mo period was directly associated with greater attained length at 18 mo [0.33 cm (95% CI: 0.11, 0.54 cm)] and 24 mo [0.72 cm (95% CI: 0.52, 0.92 cm)]. Children with wasting, highly variable WLZ, or negative changes in WLZ are at a higher risk for linear growth retardation, although instances of wasting may not be the primary cause of stunting in developing countries.”

How ready-to-use therapeutic food shapes a new technological regime to treat child malnutrition

In Under-nutrition on May 13, 2012 at 7:19 am

José GuimónPablo Guimón

on Technological Forecasting and Social Change, 2012 – Elsevier

Abstract

“Since the turn of the 21st century ready-to-use therapeuticfood (RUTF) has emerged as the preferred solution to treat acute malnutrition without complications. RUTF is a more appropriate technology than formerly prevalent powdered milk solutions because it enables outpatient care, simpler treatment protocols and production in the field. In this paper we analyze the forces driving the diffusion of RUTF as an innovation to treat child malnutrition and discuss the main features characterizing the new technological regime that results from its wide adoption. We combine the theoretical discussion and the review of secondary sources with insights from field research in Ethiopia, encompassing personal interviews with relevant parties and direct observation of how RUTF works in practice. This technology assessment exercise enables us to suggest some opportunities for policy intervention.”

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