Effectiveness and cost-effectiveness of 4 supplementary foods for treating moderate acute malnutrition: results from a cluster-randomized intervention trial in Sierra Leone.

Autor:	Griswold SP; Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA., Langlois BK; Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA., Shen Y; Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA., Cliffer IR; Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA., Suri DJ; Department of Nutritional Sciences, University of Wisconsin-Madison, Madison, WI, USA., Walton S; Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA., Chui K; Department of Public Health and Community Medicine, School of Medicine, Tufts University, Boston, MA, USA., Rosenberg IH; Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA., Koroma AS; Ministry of Health and Sanitation, Directorate of Food and Nutrition, Freetown, Sierra Leone., Wegner D; Department of Pediatrics, Washington University in St. Louis, St. Louis, MO, USA., Hassan A; Department of Pediatrics, Washington University in St. Louis, St. Louis, MO, USA., Manary MJ; Department of Pediatrics, Washington University in St. Louis, St. Louis, MO, USA., Vosti SA; Department of Agricultural and Resource Economics, University of California-Davis, Davis, CA, USA., Webb P; Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA., Rogers BL; Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA.
Jazyk:	angličtina
Zdroj:	The American journal of clinical nutrition [Am J Clin Nutr] 2021 Sep 01; Vol. 114 (3), pp. 973-985.
DOI:	10.1093/ajcn/nqab140
Abstrakt:	Background: Moderate acute malnutrition (MAM) affects 33 million children annually. Investments in formulations of corn-soy blended flours and lipid-based nutrient supplements have effectively improved MAM recovery rates. Information costs and cost-effectiveness differences are still needed. Objectives: We assessed recovery and sustained recovery rates of MAM children receiving a supplementary food: ready-to-use supplementary food (RUSF), corn soy whey blend with fortified vegetable oil (CSWB w/oil), or Super Cereal Plus with amylase (SC + A) compared to Corn Soy Blend Plus with fortified vegetable oil (CSB+ w/oil). We also estimated differences in costs and cost effectiveness of each supplement. Methods: In Sierra Leone, we randomly assigned 29 health centers to provide a supplement containing 550 kcal/d for ∼12 wk to 2691 children with MAM aged 6-59 mo. We calculated cost per enrollee, cost per child who recovered, and cost per child who sustained recovery each from 2 perspectives: program perspective and caregiver perspective, combined. Results: Of 2653 MAM children (98.6%) with complete data, 1676 children (63%) recovered. There were no significant differences in the odds of recovery compared to CSB+ w/oil [0.83 (95% CI: 0.64-1.08) for CSWB w/oil, 1.01 (95% CI: 0.78-1.3) for SC + A, 1.05 (95% CI: 0.82-1.34) for RUSF]. The odds of sustaining recovery were significantly lower for RUSF (0.7; 95% CI 0.49-0.99) but not CSWB w/oil or SC + A [1.08 (95% CI: 0.73-1.6) and 0.96 (95% CI: 0.67-1.4), respectively] when compared to CSB+ w/oil. Costs per enrollee [US dollars (USD)/child] ranged from $105/child in RUSF to $112/child in SC + A and costs per recovered child (USD/child) ranged from $163/child in RUSF to $179/child in CSWB w/oil, with overlapping uncertainty ranges. Costs were highest per sustained recovery (USD/child), ranging from $214/child with the CSB+ w/oil to $226/child with the SC + A, with overlapping uncertainty ranges. Conclusions: The 4 supplements performed similarly across recovery (but not sustained recovery) and costed measures. Analyses of posttreatment outcomes are necessary to estimate the full cost of MAM treatment. This trial was registered at clinicaltrials.gov as NCT03146897. (© The Author(s) 2021. Published by Oxford University Press on behalf of the American Society for Nutrition.)
Databáze:	MEDLINE
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