Effect of Community-Based Directly Observed Supplemental Feeding (Home Cooked Meals Vs Improvised Ready-to-Use Therapeutic Food) on Nutritional Status of Children with Acute Moderate or Acute Severe Uncomplicated Malnutrition: A Randomized Controlled Tria
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Background: Undernutrition is a widespread phenomenon across the Philippines, which contributes significantly to childhood morbidity and mortality. This study assessed the ef ect of community-based home-cooked meals versus improvised ready-to-use therapeutic food (RUTF) over three months on the nutritional status of undernourished children, as measured by weight gain plotted against Weight-forLength/Body Mass Index (WFL/BMI) z-scores. Method: A community-based non-blinded randomised controlled trial was conducted in twenty-one (21) children with either acute moderate or severe uncomplicated malnutrition. Undernourished children were randomised by lot to either homecooked meals or improvised RUTF, with two groups receiving both powdered cow milk and multivitamins for 20 days/month for 3 months. Monthly measurements of child weight gain with an increase in WFL/BMI z score 1 SD above their previous score. Results: Baseline characteristics were comparable between the two groups (p>0.05). There was a significant increase in weight from baseline to the 1st-, 2nd-, and 3rd-month of the intervention for both home-cooked meals (p=.001) and improvised RUTF (p=.000). When comparing the two interventions, there was no significant difference between the two groups (RR 4.55, 95% CI 0.63-32.56). Improvements in the nutritional status and behaviour of children, such as increased utensil utilisation and decreased sugar-sweetened beverage intake, were also observed through nutritional counselling. Conclusions: Both home-cooked meals and improvised RUTF provide nutritional rehabilitation for children after 3 months, with average weight gains of 2kg (improvised RUTF) and 1.8kg (home-cooked meal) and a BMI increase of 1.1 in both groups. Improvised RUTF may be given as an adjunct for additional calories. Nutritional counselling is essential for children’s nutritional values and behaviour.
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References
World Health Organization Nutrition Division. (2018). Fill the nutrition gap Philippines summary report. World Food Programme, November 2018.
https://reliefweb.int/report/philippines/philippines-fill-nutrient-gap-summary-report-november-2018
World Health Organization. (2019). The State of Food Security and Nutrition in the World.
United Nations Children’s Fund. (2017). DOH delivers Ready-to-Use Therapeutic Food for severely malnourished children to priority provinces. https://www.unicef.org/philippines/press-releases/doh-delivers-ready-use-therapeutic-food-severely-malnourished-children-priority
Barroga, A., Directo, O., Abaya, D. et al. (2016). Supplemental feeding program: A nutrition intervention to promote health in school children. Advanced Science Letters, Volume 22, Numbers 5-6, May 2016, pp. 1582-1584(3). DOI: https://doi.org/10.1166/asl.2016.6691
The Mother and Child Health and Education Trust. (2019). Management of moderate acute malnutrition in children under five years. https://mchetrust.org/nutrition/malnutrition
World Health Organization. (2019). Malnutrition. Maternal, newborn, child and adolescent health.
https://www.who.int/maternal_child_adolescent/topics/child/malnutrition/en/
Chatterjee, N., & Saumitra, M. (2016). Developmental outcome in children with malnutrition. Journal of Nepal Pediatric Society. 2016; 36(2): 170-177. DOI: https://doi.org/10.3126/jnps.v36i2.14619
Black, RE., Laxminarayan, R., Temmerman M. et al. (2016). Reproductive, maternal, newborn, and child health: Disease control priorities, Third Edition (Volume 2). Washington (DC): The International Bank for Reconstruction and Development / The World Bank; 2016 Apr 5. https://hdl.handle.net/10986/23833
Garg, A., Calibo, A., Galera, R. et al. (2016). Management of SAM in the Philippines: from emergency-focused modelling to national policy and government scale-up. UNICEF NewYork, May 2016.
Jimoh, A., Anyiam, J., & Yakubu, A. (2018). Relationship between child development and the nutritional status of Nigerian children under 5. South African Journal of Clinical Nutrition, 31:3, 50-54, DOI: https://doi.org/10.1080/16070658.2017.1387434
Dabar, D., Das, R., Nagesh, S. et al. (2016). A Community-based study on growth and development of under-five children in an urbanized village of South Delhi. Journal of Tropical Paediatrics, Volume 62, Issue 6, December 2016, Pages 446–456.
DOI: https://doi.org/10.1093/tropej/fmw026
Rivera, L. (2017). The implementation of the school-based feeding program (SBFP) in the Tarlac province school division. DLSU Research Congress, 2017. https://www.researchgate.net/publication/362225271_The_Implementation_of_the_School-Based_Feeding_Program_SBFP_in_the_Schools_Division_of_Tarlac_Province
Kristjansson, E., Francis, D., Welch, V. et al. (2016). Supplementary feeding for improving the health of disadvantaged infants and children: what works and why? 3ie Systematic Review Summary 5. London: International Initiative for Impact Evaluation (3ie).
https://www.3ieimpact.org/sites/default/files/2019-01/srs5-supplementary-feeding.pdf
World Health Organization. (2019). Application for inclusion of ready-to-use therapeutic food (RUTF) on the WHO Model List of Essential Medicines (EML) and Model List of Essential Medicines for Children (EMLc).
Singhal, S., Baker, R., & Baker, S. (2017). A comparison of the nutritional value of cow's milk and nondairy beverages. Journal of Pediatric Gastroenterology and Nutrition: May 2017Volume64Issue5 -p 799-805. DOI: https://doi.org/10.1097/MPG.0000000000001380
Food and Nutrition Technical Assistance III Project (FANTA). (2016). Nutrition assessment, counselling, and support (NACS): A User’s Guide—Module 3: Nutrition Education and Counselling, Version 2. Washington, DC: FHI 360/FANTA.
https://www.fantaproject.org/sites/default/files/resources/NACS-Module-3-Counseling-May2016.pdf
Schoonees, A., Lombard, M. J., Musekiwa, A. et al. (2019). Ready-to-use therapeutic food (RUTF) for home-based nutritional rehabilitation of severe acute malnutrition in children from six months to five years of age. Cochrane Database of Systematic Reviews.
DOI: https://doi.org/10.1002/14651858.CD009000.pub3
Capanzana, M.V., Aguila, D.V., Gironella, M.P. et al. (2018). Nutritional status of children aged 0-5 and 5-10 years in households headed by fisherfolk in the Philippines. Archives of Public Health, 76, 24. DOI: https://doi.org/10.1186/s13690-018-0267-3
Black, A.P., D’Onise, K., McDermott, R. et al. (2017). How effective are family-based and institutional nutrition interventions in improving children’s diet and health? A systematic review. BMC Public Health. 2017 Oct 17;17(1):818. DOI: https://doi.org/10.1186/s12889-017-479