The Effectiveness of RUTF for Catch up Growth After an Episode of P
The effectiveness of ready-to-use therapeutic food (RUTF) for catch-up growth after an episode of P. falciparum malaria
Saskia van der Kam
MSF, Amsterdam, Holland
Contact:
Background
Malnutrition in most tropical countries involves recurrent infections as well as inadequate diet. Young children areat high risk ofacute infectious diseases such as diarrhoea, respiratory infections, and malaria. If increased nutritional needs are not met by increased consumption during and after a disease episode,children can suffer permanent weight loss and susceptibility to further infections that in turn reduce nutritional status.MSF has supported health-care services in Dubie,Katanga, in the southeast of the Democratic Republic of Congo (DRC)since 2005 when conflict resulted in food scarcityand population displacement. This study aimed to determine whether ready-to-use therapeutic food (RUTF) promoted catch-up growth in children following an acute, uncomplicated episode of P.falciparum malaria.
Methods
Children aged 6-59 months visiting the clinic attached to the hospital in Dubie with confirmed falciparum malaria were enrolled in this randomised, controlled study between January 6 and February 16 2009.Randomisation was through simple fixed random allocation. All children received a clinical examination and malaria treatment. The intervention (RUTF)groupreceived daily Plumpynut® (92 g, 500 kcal) for 14 days in addition to their normal diet; controls received no food supplement.Initial malaria screening was by Paracheck®with microscopy confirmation (parasite count). Children were weighed during each visiton days 1, 14, and 28. The primary outcome was weight gain.
Results
93 children were enrolled in the RUTF groupand 87 in the control group;final analysis included 88 and 86 children, respectively.Groupsdid not significantly differ in most baseline characteristics.However, the RUTF group was less likely to be breastfeeding (22% [n=19] vs 37% [n=32], p=0.035) and, though not statistically significant, reported lower appetite. At 14 days the RUTF group had greater mean (SD) weight gain than controls: 0.353 g (0.377) vs 0.189 (0.386), respectively,(p=0.004); theyalsohadfastermean (SD) weight gain at2.36 g/kg/day (2.40) vs 1.29 (2.54) (p=0.005). However, at 28 days there was no significant difference:0.539g (0.429) vs 0.414 (0.407) (p=0.053) at 1.87 g/kg/day (1.47) vs 1.48 (1.35), respectively, (p=0.076).
Conclusions
RUTF supplementation promotedgreater weight gain in the 2 weeks following adequate malaria treatmentcompared withchildren not receiving such supplementation. However, 4 weeks after the malaria episode both groupshad achieved similar weight gain. This might have been a consequence of the relatively good food available in Katanga–between the planning and implementation of the study the displaced population returned home and the situation improved considerably. These results and further planned studies will assist MSF in deciding whether or not to includeroutine nutritional support as supportive therapy for serious infections as part of a strategy to promote catch-up growth and prevent malnutrition.