From the Institut de Recherche en Sciences de la Santé, Ministry of Scientific Research and Innovation, Ouagadougou, Burkina Faso (LN, HL, ST, SK, and BS); the Child Health and Nutrition Unit, Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium (DR, LH, and PK); and the Department of Food Safety and Food Quality, Ghent University, Ghent, Belgium (LH, KB, and PK).
Am J Clin Nutr. 2014 Jul;100(1):241-9. doi: 10.3945/ajcn.113.072538. Epub 2014 May 7.
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.
This study compared the effectiveness of weekly context-appropriate child-centered counseling (CCC), with an improved corn-soy 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.
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.
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.
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.
目前，中度急性营养不良（MAM）的管理侧重于食物补充方法。然而，这些策略在中低收入国家的可持续性仍然较弱。在粮食有保障的环境中，教育/行为干预可能是改善 MAM 管理的一种替代方法。
本研究比较了每周根据具体情况进行以儿童为中心的咨询（CCC），使用添加了微量营养素的改良玉米-大豆混合物（CSB++）或当地生产的即食补充食品（RUSF）治疗 MAM 的效果，这些治疗方法均通过一线农村卫生服务进行。
我们采用了 3 臂的群组随机对照试验设计，涉及 18 个农村卫生中心（每组 6 个）和 6-24 月龄患有非复杂性 MAM 的儿童。在第一臂（CCC）中，经过培训的卫生工作者每周向照顾者提供个性化咨询。在另外 2 个臂中，儿童每周接受 455 克 CSB++或 350 克当地生产的基于大豆的 RUSF。这两种食物补充剂均提供约 250 千卡/天。
治疗 3 个月后的康复率，采用 CCC 治疗的儿童为 57.8%，明显低于 CSB++（74.5%）和 RUSF（74.2%）（P<0.0001）。在 CCC 组中，母亲到卫生机构就诊的比例也显著降低（P<0.0001）；该组的失访率很高（P<0.003）。当对就诊情况进行分析调整后，我们发现 3 个组之间没有显著差异，CSB++和 RUSF 组的发病率比分别为 1.14（95%CI：0.99，1.31）和 1.13（95%CI：0.98，1.30），与 CCC 组相比。
虽然基于补充剂的 MAM 治疗被发现比提供 CCC 更有效，但我们假设，通过初级卫生保健机构，以儿童需求为中心，提供适当和具体的营养咨询，可能是粮食有保障的农村地区治疗 MAM 的替代策略，前提是确保照顾者参加咨询会议。该试验在 clinicaltrials.gov 注册，编号为 NCT01115647。
