Treating moderate acute malnutrition in first-line health services: an effectiveness cluster-randomized trial in Burkina Faso.

BACKGROUND: Management of moderate acute malnutrition (MAM) is currently focused on food supplementation approaches. However the sustainability of these strategies remains weak in low- and middle-income countries. In food-secure settings an educational/behavioral intervention could be an alternative for improving MAM management. OBJECTIVE: This study compared the effectiveness of weekly context-appropriate child-centered counseling (CCC) with an improved corn-soy blend [corn-soy blend with added micronutrients (CSB++)] or a locally produced ready-to-use supplementary food (RUSF) in treating MAM through first-line rural health services. DESIGN: We used a cluster randomized controlled trial design with 3 arms involving 18 rural health centers (6 by arm) and children aged 6-24 mo with uncomplicated MAM. In the first arm (CCC) trained health workers provided weekly personalized counseling to caretakers. In the 2 other arms children received weekly either 455 g CSB++ or 350 g locally produced soy-based RUSF. Both food supplements provided approximately 250 kcal/d. RESULTS: The recovery rate after 3 mo of treatment was significantly lower with CCC (57.8%) than with CSB++ (74.5%) and RUSF (74.2%) (P < 0001). Mothers attendance at health facilities was also substantially lower in the CCC arm (P < 0001); this arm had a high defaulter rate (P < 0.003). When the analysis was adjusted for attendance we did not find a significant difference between the 3 arms with incidence rate ratios of 1.14 (95% CI: 0.99 1.31) and 1.13 (95% CI: 0.98 1.30) for the CSB++ and RUSF arms respectively compared with the CCC arm. CONCLUSION: Whereas supplement-based treatment of MAM was found to be more effective than the provision of CCC we hypothesize that appropriate and specific nutrition counseling centered on childrens needs through primary health facilities might be an alternative strategy for MAM treatment in rural food-secure areas provided that attendance at counseling sessions by the caregiver is ensured. This trial was registered at clinicaltrials.gov as NCT01115647. (c) 2014 American Society for Nutrition.