Isanaka Sheila, Kodish Stephen R, Berthé Fatou, Alley Ian, Nackers Fabienne, Hanson Kerstin E, Grais Rebecca F
Departments of Nutrition and
Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA; and.
Am J Clin Nutr. 2017 May;105(5):1191-1197. doi: 10.3945/ajcn.116.148064. Epub 2017 Apr 12.
Community-based management of severe acute malnutrition (SAM) has been shown to be safe and cost-effective, but program coverage remains low. Treatment models that maintain high levels of clinical effectiveness but allow for increased coverage are still needed. A reduced schedule of follow-up, in which children receive clinical follow-up and therapeutic foods on a monthly rather than weekly basis, may be one alternative. We aimed to describe the safety and feasibility of a monthly distribution of ready-to-use therapeutic food (RUTF) in the treatment of uncomplicated SAM, in terms of clinical response to treatment and household RUTF use. We conducted a nonrandomized pilot intervention study in which 115 children eligible for outpatient treatment of SAM were provided a monthly ration of RUTF. Anthropometric measurements were taken weekly for 4 wk to monitor treatment response. Unannounced household spot checks were conducted over 4 wk to assess household use of RUTF and storage practices. Adequate weight and midupper arm circumference (MUAC) gain were found throughout the 4-wk follow-up period. Observed mean ± SD weight gain from admission was 9.8 ± 6.8 g · kg · d in week 1 and 4.2 ± 2.1 g · kg · d by week 4. Unplanned household spot checks found an average surplus of RUTF sachets compared with the number expected based on the date of distribution and recommended dosing throughout the 4 wk of follow-up. The frequency at which more than the recommended dose was used (i.e., deviance of >2 sachets between available and expected stocks) was 4% and 22% of households visited in week 1 and week 4, respectively. Adequate treatment response and RUTF use in the outpatient treatment of SAM was maintained over 4 wk of follow-up with a monthly schedule of RUTF distribution. This study was registered at clinicaltrials.gov as NCT02994212.
基于社区的重度急性营养不良（SAM）管理已被证明是安全且具有成本效益的，但项目覆盖范围仍然较低。仍需要维持高临床疗效但能扩大覆盖范围的治疗模式。减少随访安排，即儿童每月而非每周接受临床随访和治疗性食品，可能是一种选择。我们旨在描述每月分发即用型治疗性食品（RUTF）在治疗非复杂性SAM方面的安全性和可行性，包括对治疗的临床反应和家庭对RUTF的使用情况。我们进行了一项非随机试点干预研究，为115名符合SAM门诊治疗条件的儿童提供每月定量的RUTF。每周进行4周的人体测量以监测治疗反应。在4周内进行了不预先通知的家庭抽查，以评估家庭对RUTF的使用和储存做法。在整个4周的随访期内发现体重和上臂中部周长（MUAC）有足够增加。观察到入院后第1周的平均体重增加±标准差为9.8±6.8 g·kg·d，到第4周为4.2±2.1 g·kg·d。计划外的家庭抽查发现，与根据分发日期和整个4周随访期的推荐剂量预期的数量相比，RUTF包平均有剩余。使用超过推荐剂量的频率（即可用库存和预期库存之间偏差>2包）在第1周和第4周分别为受访家庭的4%和22%。在每月一次RUTF分发计划的4周随访中，SAM门诊治疗中维持了足够的治疗反应和RUTF使用。本研究在clinicaltrials.gov上注册为NCT02994212。
