Peer-reviewed article
Perspective on alternative therapeutic feeds to treat severe acute malnutrition in children aged between 6 and 59 months in sub-Saharan Africa: a narrative review.
Marie-Claire Charlotte Nitschke, Martin Smollich ·
Summary
Written by AI, not yet AICS's view · claude-haiku-4-5-20251001This narrative review examines alternative therapeutic food formulas for treating severe acute malnutrition (SAM) in children aged 6-59 months in sub-Saharan Africa. The review analyzed 13 randomized controlled trials comparing alternative therapeutic foods with reduced dosages or alternative ingredients to standard treatments. While a few alternatives showed similar recovery rates to standard protocols, most were less effective, and current evidence is insufficient to change WHO guidelines. The review identifies some promising alternatives that may reduce costs while maintaining effectiveness.
Key points
- Nearly 200 million children under 5 years old suffer from stunting and wasting, with 45% of deaths in this age group associated with undernutrition
- Severe acute malnutrition affects children with weight-for-height z score < -3, mid-upper arm circumference < 115 mm, or bilateral edema
- A few alternative ready-to-use therapeutic food formulas achieved recovery rates similar to standard protocols
- Many alternative formulations were less effective than standard therapeutic foods
- Evidence is not yet strong enough to change WHO guidelines on SAM treatment
Limitations
This is a narrative review that summarizes findings from 13 randomized controlled trials but does not systematically analyze all available evidence or perform meta-analysis. The review provides an overview of current research but cannot definitively establish which alternatives are most effective or suitable for widespread implementation in resource-limited settings.
Abstract
Worldwide, nearly 200 million children younger than 5 years old suffer from stunting and wasting, 2 different types of undernutrition. Moreover, 45% of deaths among children in that age group are associated with these conditions. Severe acute malnutrition (SAM) refers to children with a weight-for-height z score < -3, a midupper arm circumference < 115 mm, or the presence of bilateral edema, and is especially prevalent in low- and middle-income countries. Undernutrition in children can have a major impact on both their physical and cognitive development. It can lead to infections and death if it remains undetected or untreated. The use of therapeutic feeds is an important component in the management of SAM, which remains a challenge in poorly resourced countries. The aim of this review was to assess the alternatives to the standard therapeutic foods used to treat SAM and to summarize their advantages and disadvantages, providing an overview of current research. A literature search was performed from September to November 2022 using PubMed, the Trip medical database, and the German Institute for Medical Documentation and Information (DIMDI). This review includes 13 randomized controlled trials testing alternatives to the standard therapeutic foods used to treat SAM by using alternative ingredients or a reduced dosage. The results show that, while a few alternative ready-to-use therapeutic food formulas lead to recovery rates similar to those seen with the standard protocol, many alternatives were less effective in the affected children. Thus, the evidence is not yet strong enough to change the World Health Organization's guidelines. The review identifies promising results of treatment alternatives related to treatment outcomes and costs. Additional research should focus on the interventions that positively impact the recovery process of severely malnourished children to facilitate the treatment and enable greater treatment coverage worldwide.
Findings the Hub has extracted
Each claim below is labelled by its type of design and links back to this report.
- Intervention
- Alternative therapeutic food formulas with reduced dosages or alternative ingredients compared to standard therapeutic foods
- Population
- Children aged 6-59 months with severe acute malnutrition in sub-Saharan Africa
Key finding
A few alternative ready-to-use therapeutic food formulas led to recovery rates similar to standard protocol
Nitschke et al. · PubMed (US National Library of Medicine) · 1 Feb 2025