Low-dose RUTF protocol and improved service delivery lead to good programme outcomes in the treatment of uncomplicated SAM: a programme report from Myanmar

Philip T James, Natalie Van den Briel, Aurélie Rozet, Anne-Dominique Israël, Bridget Fenn, Carlos Navarro-Colorado, Philip T James, Natalie Van den Briel, Aurélie Rozet, Anne-Dominique Israël, Bridget Fenn, Carlos Navarro-Colorado

Abstract

The treatment of uncomplicated severe acute malnutrition (SAM) requires substantial amounts of ready-to-use therapeutic food (RUTF). In 2009, Action Contre la Faim anticipated a shortfall of RUTF for their nutrition programme in Myanmar. A low-dose RUTF protocol to treat children with uncomplicated SAM was adopted. In this protocol, RUTF was dosed according to beneficiary's body weight, until the child reached a Weight-for-Height z-score of ≥-3 and mid-upper arm circumference ≥110 mm. From this point, the child received a fixed quantity of RUTF per day, independent of body weight until discharge. Specific measures were implemented as part of this low-dose RUTF protocol in order to improve service quality and beneficiary support. We analysed individual records of 3083 children treated from July 2009 to January 2010. Up to 90.2% of children recovered, 2.0% defaulted and 0.9% were classified as non-responders. No deaths were recorded. Among children who recovered, median [IQR] length of stay and weight gain were 42 days [28; 56] and 4.0 g kg(-1) day(-1) [3.0; 5.7], respectively. Multivariable logistic regression showed that children older than 48 months had higher odds of non-response to treatment than younger children (adjusted odds ratio: 3.51, 95% CI: 1.67-7.42). Our results indicate that a low-dose RUTF protocol, combined with specific measures to ensure good service quality and beneficiary support, was successful in treating uncomplicated SAM in this setting. This programmatic experience should be validated by randomised studies aiming to test, quantify and attribute the effect of the protocol adaptation and programme improvements presented here.

Keywords: community-based; health service delivery; programme evaluation; severe acute malnutrition; therapeutic feeding; undernutrition.

Conflict of interest statement

The authors declare that they have no conflicts of interest. The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.

© 2015 The Authors. Maternal & Child Nutrition published by John Wiley & Sons Ltd.

Figures

Figure 1
Figure 1
Flowchart of data inclusion and exclusion criteria. HAZ, height‐for‐age z‐score; MUAC, mid‐upper arm circumference; OTP, outpatient therapeutic programme; SAM, severe acute malnutrition; WAZ, weight‐for‐age z‐score; WHZ, weight‐for‐height z‐score.

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