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Background

Treatment for severe acute malnutrition (SAM) significantly improved from protein rich diets (‘50s) to F-75 and F-100 formula in hospital based treatment to Ready-to-Use Therapeutic Foods (RUTF) for the Community-based Management of Acute Malnutrition (CMAM). Despite these significant changes in treatment formulation and service delivery, the dose of RUTF for SAM treatment has not been revised since. Today, RUTF is dosed according to body weight and does not take into account possible reduced needs as the child is recovering.

In 2009, due to RUTF pipeline problems and increased caseload, SAM children in Myanmar were successfully treated through an alternative protocol (recovery rate 90.2%). Children admitted with SAM who were already partly recovered (i.e. WHZ >-3 and MUAC>110mm) were treated with a single dose of RUTF (1 sachet) for the end of the treatment until discharge. This treatment change was delivered through enhanced quality of services, which could have contributed to the success and high recovery rate.

Research objectives

• To compare speed of recovery (i.e. weight gain velocity) between SAM children 6-59 months of age receiving the standard treatment dosage and those receiving the optimized one
• To assess the cost effectiveness of this optimized RUTF dosage versus the standard one
• To assess the effects of both the standard and optimized RUTF dosage on vitamin A and iron status in SAM children under 5
• To assess the food intake of SAM children during treatment
• To compare the body composition in SAM children enrolled in the 2 groups particularly the increase of lean body mass