Comparison of home-based therapy with ready-to-use therapeutic food with standard therapy in the treatment of malnourished Malawian children: a controlled, clinical effectiveness trial
Comparison of home-based therapy with ready-to-use therapeutic food with standard therapy in the treatment of malnourished Malawian children: a controlled, clinical effectiveness trial
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DOI：
10.1093/ajcn/81.4.864
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发表时间：
2005-04-01
影响因子：
7.1
通讯作者：
Manary, MJ
中科院分区：
文献类型：
--
作者：
Ciliberto, MA;Sandige, H;Manary, MJ
背景：儿童营养不良在马拉维很常见，遵循国际指南的标准治疗导致康复率很低。在使用即食治疗食品 (RUTF) 进行家庭治疗的试点研究中，康复率较高。目的：目的是比较中度和重度消瘦、恶性营养不良或两者均接受 RUTF 家庭治疗或标准住院治疗的儿童的康复率。设计：在马拉维南部对 1178 名营养不良儿童进行了一项对照、比较、临床效果试验。根据阶梯楔形设计，将儿童系统地分配到标准治疗（186 名儿童）或 RUTF 家庭治疗（992 名儿童），以控制一年中季节引入的偏差。康复（定义为达到身高体重 z 评分 > -2）以及复发或死亡是主要结局。体重增加率以及发烧、咳嗽和腹泻的发生率是次要结果。 结果：接受 RUTF 家庭治疗的儿童比接受标准治疗的儿童更有可能达到体重身高 z 评分 > -2（79% 与 46%；P < 0.001），并且复发或死亡的可能性较小（8.7% 与 16.7%；P < 0.001）。与接受标准治疗的儿童相比，接受 RUTF 家庭治疗的儿童体重增加率较高（3.5 与 2.0 g (.) kg(-1) (.) d(-1) 相比；差异：1.5；95% CI：1.0、2.0 g (.) kg(-1) d(-1)），发烧、咳嗽和腹泻的患病率较低。结论：RUTF 家庭治疗与更好的结果相关对于儿童营养不良，比标准疗法更有效。
Background: Childhood malnutrition is common in Malawi, and the standard treatment, which follows international guidelines, results in poor recovery rates. Higher recovery rates have been seen in pilot studies of home-based therapy with ready-to-use therapeutic food (RUTF). Objective: The objective was to compare the recovery rates among children with moderate and severe wasting, kwashiorkor, or both receiving either home-based therapy with RUTF or standard inpatient therapy.Design: A controlled, comparative, clinical effectiveness trial was conducted in southern Malawi with 1178 malnourished children. Children were systematically allocated to either standard therapy (186 children) or home-based therapy with RUTF (992 children) according to a stepped wedge design to control for bias introduced by the season of the year. Recovery, defined as reaching a weight-for-height z score > -2, and relapse or death were the primary outcomes. The rate of weight gain and the prevalence of fever, cough, and diarrhea were the secondary outcomes.Results: Children who received home-based therapy with RUTF were more likely to achieve a weight-for-height z score > -2 than were those who received standard therapy (79% compared with 46%; P < 0.001) and were less likely to relapse or die (8.7% compared with 16.7%; P < 0.001). Children who received home-based therapy with RUTF had greater rates of weight gain (3.5 compared with 2.0 g (.) kg(-1) (.) d(-1); difference: 1.5; 95% CI: 1.0, 2.0 g (.) kg(-1) d(-1)) and a lower prevalence of fever, cough, and diarrhea than did children who received standard therapy.Conclusion: Home-based therapy with RUTF is associated with better outcomes for childhood malnutrition than is standard therapy.