Modelling an alternative nutrition protocol generalizable for outpatient (MANGO)

Primary Investigator

  • Suvi Kangas

Study Period

January 2015 - January 2019

Study Description

Severe acute malnutrition in children under 5 is defined by being too thin for a given height and/or having the left arm circumference less than a given threshold (i.e. measuring how fat or thin the arm is), and/or having swollen feet (malnutrition oedema). It affects 19 million children under five at any point in time, and is likely to result in death if left untreated. Children can be treated in the hospital as in inpatient (hospitalized, for example, due to medical complications) or as outpatients, coming once a week to the closest health centre for monitoring and to receive treatment that they take at home. A very effective ambulatory (outpatient) treatment has been in place for several years and involves giving each patient an antibiotic and a therapeutic food made of peanut paste, vegetable oil, powdered milk, sugar, vitamins and minerals. The amount given to each child is matched to their individual nutritional needs. The treatment does work, however the children do gain less weight than expected. There have been reports that this may be partly due to the therapeutic food being shared with the family and it being sold on the market. It is also possible that malnourished children in the process of recovery may need less therapeutic food than currently provided. This study will test out this theory by giving children treated as outpatients a lesser amount of the therapeutic food to see whether they still gain the weight. Other effects of the treatment from admission to discharge will also be measured, including duration of the treatment, the recovery, how many stick with the treatment, how many are admitted to hospital, death and relapse rates from the nutritional programme, the changes in anthropometry (weight, height, arm circumference, leg length), average energy intake after 4 weeks of treatment, micronutrient blood status changes (that is, levels of nutrients in the blood), hair changes, body fat and lean masses changes. The cost of treatment will also be calculated and compared with costs for children given the more standard amount of therapeutic food. 

Study Arms

  • Intervention: Week 1-2: normal dose RUTF; week 3 to discharge: reduced dose RUTF
  • Control: Week 1 to discharge: normal dose RUTF

Primary Outcomes

  • Children's rate of weight gain (g/kg/d) during treatment, measured at admission, upon weekly visits, and at discharge

Study Intervention

  • Standard Lipid-Based Nutrient Supplements (LNS)

Research Gaps

  • Cost

    What are the relative costs and outcomes of different food aid products or programs?

  • Effectiveness

    How well do different food compositions and interventions prevent or treat undernutrition, when implemented "on the ground"?

Study Population