The Alliance for International Medical Action (ALIMA), Dakar, Senegal.
PRISME-CI ANRS|MIE Research Programme, University Hospital of Treichville, Abidjan, Côte d'Ivoire.
Front Public Health. 2023 Jul 5;11:1199036. doi: 10.3389/fpubh.2023.1199036. eCollection 2023.
Globally, access to treatment for severe and moderate acute malnutrition is very low, in part because different protocols and products are used in separate programs. New approaches, defining acute malnutrition (AM) as mid-upper arm circumference (MUAC) < 125 mm or oedema, are being investigated to compare effectiveness to current programs. Optimizing Malnutrition treatment (OptiMA) is one such strategy that treats AM with one product - ready-to-use therapeutic food, or RUTF - at reduced dosage as the child improves.
This study aimed to determine whether OptiMA achieved effectiveness benchmarks established in the Nigerien National Nutrition protocol. A prospective cohort study of children in the rural Mirriah district evaluated outcomes among children 6-59 months with uncomplicated AM treated under OptiMA. In a parallel, unconnected program in one of the two trial sites, all non-malnourished children 6-23 months of age were provided small quantity lipid-based nutritional supplements (SQ-LNS). A multivariate logistic regression identified factors associated with hospitalization.
From July-December 2019, 1,105 children were included for analysis. Prior to treatment, 39.3% of children received SQ-LNS. Recovery, non-response, and mortality rates were 82.3%, 12.6%, and 0.7%, respectively, and the hospitalization rate was 15.1%. Children who received SQ-LNS before an episode of AM were 43% less likely to be hospitalized (ORa=0.57; 0.39-0.85, = 0.004).
OptiMA had acceptable recovery compared to the Nigerien reference but non-response was high. Children who received SQ-LNS before treatment under OptiMA were less likely to be hospitalized, showing potential health benefits of combining simplified treatment protocols with food-based prevention in an area with a high burden of malnutrition such as rural Niger.
在全球范围内，严重和中度急性营养不良的治疗方法非常有限，部分原因是不同的方案和产品在不同的项目中使用。目前正在研究新的方法，将急性营养不良定义为中上臂围（MAC）<125 毫米或水肿，以比较其与当前方案的有效性。优化营养不良治疗（OptiMA）就是这样一种策略，它用一种产品——即食用即治疗食品或 RUTF——以较低的剂量治疗 MAC，随着儿童病情的改善逐渐增加剂量。
本研究旨在确定 OptiMA 是否达到尼日尔国家营养方案中规定的有效性标准。对 Mirriah 农村地区的 6-59 个月患有非复杂性 MAC 的儿童进行前瞻性队列研究，评估 OptiMA 治疗下儿童的结局。在两个试验点之一的一个平行、不相关的方案中，为所有 6-23 个月的非营养不良儿童提供小剂量的基于脂质的营养补充剂（SQ-LNS）。多变量逻辑回归确定了与住院相关的因素。
2019 年 7 月至 12 月，共有 1105 名儿童纳入分析。治疗前，39.3%的儿童接受 SQ-LNS。恢复、无反应和死亡率分别为 82.3%、12.6%和 0.7%，住院率为 15.1%。在出现 AM 之前接受 SQ-LNS 的儿童住院的可能性降低了 43%（ORa=0.57；0.39-0.85，p=0.004）。
OptiMA 的恢复率与尼日尔参考标准相比可以接受，但无反应率很高。在接受 OptiMA 治疗之前接受 SQ-LNS 的儿童住院的可能性较低，这表明在营养不良负担较重的农村尼日尔等地区，将简化的治疗方案与基于食物的预防措施相结合，具有潜在的健康益处。
