Ready to Use Supplementary Foods (RUSF) to prevent stunting among children under five years in Kurram Agency

Primary Investigator

  • Dr. Muhammad Naseem Khan, Khyber Medical University

Study Period

January 2017 - December 2020

Study Description

Objective: To evaluate the effectiveness of RUSFs in improving childhood length for age scores. 

The allocation of participants into the four groups in the intervention and control clusters is non-randomized. Clusters (each ~150 households) with a Lady Health Worker (community health workers) are assigned to intervention arm while clusters with no Lady Health Worker are assigned to the control arm. In each of the cluster (both in intervention and control arm) four groups are recruited as:
Group 1: Pregnant women between the ages of 15-49 years
Group 2: Lactating women and group 3 & 4: Children age 6-23 months and 24-59 months.

From each of the cluster an average number of 22 pregnant women, 22 lactating women, 23 six-23 months children and 23 24-59 months are enrolled for the study. Data is collected at baseline and followed up with anthropometric measurements conducted monthly from each study participant along with yearly blood and fecal sample from a sub group of study participants.

The different treatments include:
Lipid-based Nutrient Supplements (LNS) for Pregnant and Lactating Women (Local name: Maamta): These Ready to Use Supplementary Foods (RUSF) are given to pregnant and lactating women in Group 1 and Group 2. Supplementation will start from conception/earliest confirmation of pregnancy while for lactating women during the first 6 months of lactation. Active ingredients include: Roasted chickpeas, roasted yellow lentils, roasted peanuts, soybean oil, palmolein oil, hydrogenated vegetable fat as stabilizer, skimmed milk powder, sugar, maltodextrin, vitamins & minerals, emulsifier and antioxidant. The daily ration: 75 g sachet (One sachet per day is recommended for maintenance of nutritional status), throughout pregnancy and first six month of lactation. Maamta is manufactured within a quality and food safety management environment in accordance with latest version of recognized international standards and best practices and/or guidelines.

Study Arms

  • Group 1: Pregnant women between the ages of 15-49 years
  • Group 2: Lactating women and group 3 & 4: Children age 6-23 months and 24-59 months.
  • The different treatments include: Lipid-based Nutrient Supplements (LNS) for Pregnant and Lactating Women (Local name: Maamta): These Ready to Use Supplementary Foods (RUSF) are given to pregnant and lactating women in Group 1 and Group 2. Supplementation

Primary Outcomes

  • Change in Length-for-Age Z scores (LAZ) is measured using the height boards (SECA) at each month in the intervention vs control arms, compared to the baseline LAZ score against WHO 2006 growth standards.
  • Change in Weight-for-Age Z scores (WAZ) is measured using the digital weighing scales (SECA) at each month in intervention vs control arms, compared to the baseline WAZ score against WHO 2006 growth standards.
  • Change in Weight-for-Height Z scores (WHZ) is measured using the digital weighing scales (SECA) and height boards (SECA) at each month in intervention vs control arms, compared to the baseline WHZ score against WHO 2006 growth standards.

Study Interventions

  • Standard Fortified Food Blends
  • Standard Lipid-Based Nutrient Supplements (LNS)

Research Gaps

  • Effectiveness

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

Study Population

7200