Stobaugh Heather C, Bollinger Lucy B, Adams Sara E, Crocker Audrey H, Grise Jennifer B, Kennedy Julie A, Thakwalakwa Chrissie, Maleta Kenneth M, Dietzen Dennis J, Manary Mark J, Trehan Indi
Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA.
Department of Pediatrics, Washington University in St. Louis, St. Louis, MO.
Am J Clin Nutr. 2017 Aug;106(2):657-666. doi: 10.3945/ajcn.116.149799. Epub 2017 Jun 14.
Children who recover from moderate acute malnutrition (MAM) have high rates of relapse in the year after nutritional recovery. Interventions to decrease these adverse outcomes are needed to maximize the overall effectiveness of supplemental feeding programs (SFPs). We evaluated the effectiveness of a package of health and nutrition interventions on improving the proportion of children who sustained recovery for 1 y after MAM treatment. We further explored factors related to sustained recovery. We conducted a cluster-randomized clinical effectiveness trial involving rural Malawian children aged 6-62 mo who were enrolled on discharge from an SFP for MAM. We enrolled 718 children at 10 control sites and 769 children at 11 intervention sites. In addition to routine health and nutrition counseling, the intervention group received a package of health and nutrition interventions that consisted of a lipid nutrient supplement, deworming medication, zinc supplementation, a bed net, and malaria chemoprophylaxis. A survival analysis was used to determine the effectiveness of the intervention as well as to identify factors associated with sustained recovery. Of 1383 children who returned for the full 12-mo follow-up period, 407 children (56%) and 347 children (53%) sustained recovery in the intervention and control groups, respectively. There was no significant difference in relapse-free survival curves between the treatment and control groups ( = 0.380; log-rank test). The risk factors for relapse or death after initial recovery were a smaller midupper arm circumference on SFP admission ( = 0.01) and discharge ( < 0.001), a lower weight-for-height score on discharge ( < 0.01), and the receipt of ready-to-use supplementary food as opposed to ready-to-use therapeutic food during treatment ( < 0.05). The provision of a package of health and nutrition services in addition to traditional SFP treatment has no significant effect on improving sustained recovery in children after treatment of MAM. This trial was registered at clinicaltrials.gov as NCT02351687.
从中度急性营养不良（MAM）中康复的儿童在营养恢复后的一年内复发率很高。需要采取干预措施来减少这些不良后果，以最大限度地提高补充喂养计划（SFP）的整体效果。我们评估了一套健康和营养干预措施对提高MAM治疗后持续康复1年的儿童比例的有效性。我们进一步探讨了与持续康复相关的因素。我们进行了一项整群随机临床有效性试验，纳入了马拉维农村地区6至62个月大的儿童，这些儿童在从MAM的SFP出院时被纳入研究。我们在10个对照点招募了718名儿童，在11个干预点招募了769名儿童。除了常规的健康和营养咨询外，干预组还接受了一套健康和营养干预措施，包括脂质营养补充剂、驱虫药物、锌补充剂、蚊帐和疟疾化学预防。采用生存分析来确定干预措施的有效性，并识别与持续康复相关的因素。在1383名返回进行完整12个月随访期的儿童中，干预组和对照组分别有407名儿童（56%）和347名儿童（53%）持续康复。治疗组和对照组的无复发生存曲线没有显著差异（ = 0.380；对数秩检验）。初始康复后复发或死亡的风险因素包括SFP入院时（ = 0.01）和出院时（ < 0.001）较小的上臂中部周长、出院时较低的身高别体重Z评分（ < 0.01）以及治疗期间接受即食补充食品而非即食治疗食品（ < 0.05）。除了传统的SFP治疗外，提供一套健康和营养服务对改善MAM治疗后儿童的持续康复没有显著效果。该试验在clinicaltrials.gov上注册，注册号为NCT02351687。
