Randomized controlled trial of the impact of offering a nutrition and health intervention to children recovered from moderate malnutrition : final report

Only a few studies have systematically followed children after recovery, and those that have been done found that relapse (defined as reverting to being acutely malnourished) and other poor outcomes are very common. In this study, we conducted a cluster randomized, controlled clinical effectiveness trial to assess the impact of a package of health and nutrition interventions on improving the proportion of children who remained well nourished for one year following recovery from MAM. We followed 1,487 children who recovered from MAM at 21 health clinics in rural Malawi. Children at 11 clinics received a package of interventions that included a lipid-based nutrient supplement (LNS), zinc supplementation, deworming medication, a bed net, and malaria prophylaxis following discharge from a supplementary feeding program (SFP). The remaining 10 sites served as controls; children at those clinics received the standard of care with no additional interventions. Children returned to the clinics for reassessment at 1, 3, 6, and 12 months following initial recovery from MAM. The proportion of children that remained well nourished was higher in the intervention group at all follow-up visits, with 53% of children remaining well nourished in the intervention group and 48% in the control group after 12 months (P = 0.076). Higher anthropometric measurements upon admission and discharge from the SFP and improved linear growth following recovery, as well as better household (HH) water, sanitation, and hygiene (WASH) factors, were found to be associated with children who remained well nourished during the entire 12-month period following recovery from MAM. An additional package of basic health and nutrition services provided to children upon discharge from the SFP improves the likelihood that recovery from MAM will be sustained. Still, additional research is needed to identify treatment protocols and other interventions that further increase the likelihood that a child will remain well nourished following MAM treatment.