Effect of ready-to-use foods for preventing child undernutrition in Niger: analysis of a prospective intervention study over 15months of follow-up

摘要

Strategies for preventing undernutrition comprise a range of interventions, including education, provision of complementary food and cash transfer. Here, we compared monthly distributions of two different lipid-based nutrient supplements (LNS), large-quantity LNS (LNS-LQ) and medium-quantity LNS (LNS-MQ) for 15months on prevention of undernutrition among children 6 to 23months. Both groups also received cash transfer for the first 5months of the intervention. We conducted a prospective intervention study in Maradi, Niger, between August 2011 and October 2012. Six and 11 villages were randomly allocated to LNS-LQ/Cash and LNS-MQ/Cash, respectively. Children measuring 60-80cm were enrolled in the respective groups and followed up monthly. Poisson regression was used to assess differences between interventions and adjust for baseline characteristics, intervention periods and child-feeding practices. The analysis included 2586 children (1081 in the LNS-LQ/Cash group and 1505 in the LNS-MQ/Cash group). This study suggests that provision of LNS-LQ (reference) or LNS-MQ had, overall, similar effect on incidence of severe acute malnutrition (RR=0.97; 95% CI: 0.67-1.40; P=0.88), moderate acute malnutrition (RR=1.20; 95% CI: 0.97-1.48; P=0.08), severe stunting (RR=0.94; 95% CI: 0.70-1.26; P=0.69), moderate stunting (RR=0.95; 95% CI: 0.76-1.19; P=0.67) and mortality (RR=0.83; 95% CI: 0.41-1.65; P=0.59). Compared with LNS-LQ, LNS-MQ showed a greater protective effect on moderate acute malnutrition among children with good dietary adequacy: RR=0.72; 95% CI: 0.56-0.94; P=0.01. These results highlight the need to design context-specific programmes. Provision of LNS-LQ might be more appropriate when food insecurity is high, while when food security is better, distribution of LNS-MQ might be more appropriate.