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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
medicine
Treating moderate acute malnutrition in first-line health services: An effectiveness cluster-randomized trial in Burkina Faso
American Journal of Clinical Nutrition, Volume 100, No. 1, Year 2014
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Description
Background: Management of moderate acute malnutrition (MAM) is, currently, focused on food supplementation approaches. However, the sustainability of these strategies remains weak in low- and middle-income countries. In food-secure settings, an educational/behavioral intervention could be an alternative for improving MAM management. Objective: This study compared the effectiveness of weekly contextappropriate child-centered counseling (CCC), with an improved cornsoy blend [corn-soy blend with added micronutrients (CSB++)] or a locally produced ready-to-use supplementary food (RUSF), in treating MAM through first-line rural health services. Design: We used a cluster randomized controlled trial design with 3 arms, involving 18 rural health centers (6 by arm) and children aged 6-24 mo with uncomplicated MAM. In the first arm (CCC), trained health workers provided weekly personalized counseling to caretakers. In the 2 other arms, children received weekly either 455 g CSB++ or 350 g locally produced soy-based RUSF. Both food supplements provided-250 kcal/d. Results: The recovery rate after 3 mo of treatment was significantly lower with CCC (57.8%) than with CSB++ (74.5%) and RUSF (74.2%) (P < 0001). Mothers' attendance at health facilities was also substantially lower in the CCC arm (P < 0001); this arm had a high defaulter rate (P < 0.003). When the analysis was adjusted for attendance, we did not find a significant difference between the 3 arms, with incidence rate ratios of 1.14 (95% CI: 0.99, 1.31) and 1.13 (95% CI: 0.98, 1.30) for the CSB++ and RUSF arms, respectively, compared with the CCC arm. Conclusion: Whereas supplement-based treatment of MAM was found to be more effective than the provision of CCC, we hypothesize that appropriate and specific nutrition counseling centered on children's needs, through primary health facilities, might be an alternative strategy for MAM treatment in rural food-secure areas, provided that attendance at counseling sessions by the caregiver is ensured. This trial was registered at clinicaltrials.gov as NCT01115647. © 2014 American Society for Nutrition.
Authors & Co-Authors
Nikièma, Laetitia Ouedraogo
Burkina Faso, Ouagadougou
Institut de Recherche en Sciences de la Santé
Huybregts, Lieven Fernand
Burkina Faso, Ouagadougou
Institut de Recherche en Sciences de la Santé
Kolsteren, Patrick Wilfried V.J.
Belgium, Antwerpen
Prins Leopold Instituut Voor Tropische Geneeskunde
Belgium, Ghent
Universiteit Gent
Lanou, Hermann Biénou
Belgium, Antwerpen
Prins Leopold Instituut Voor Tropische Geneeskunde
Belgium, Ghent
Universiteit Gent
Tiendrébéogo, Simon
Burkina Faso, Ouagadougou
Institut de Recherche en Sciences de la Santé
Bouckaert, Kimberley P.
Belgium, Ghent
Universiteit Gent
Kouanda, Sèni
Burkina Faso, Ouagadougou
Institut de Recherche en Sciences de la Santé
Sondo, Blaise K.
Burkina Faso, Ouagadougou
Institut de Recherche en Sciences de la Santé
Roberfroid, Dominique Albert
Belgium, Antwerpen
Prins Leopold Instituut Voor Tropische Geneeskunde
Statistics
Citations: 60
Authors: 9
Affiliations: 3
Identifiers
Doi:
10.3945/ajcn.113.072538
ISSN:
00029165
e-ISSN:
19383207
Research Areas
Food Security
Health System And Policy
Maternal And Child Health
Study Design
Randomised Control Trial
Cohort Study
Study Approach
Quantitative
Study Locations
Burkina Faso