Peer-reviewed article
Acceptability of a reduced dose of therapeutic food in the management of severely acutely malnourished children aged 6-59 months in Mbuji-Mayi, Democratic Republic of Congo.
Ntaongo Alendi J, Muyer MC, Salpeteur C, Botomba S, Mayavanga JB et al. ·
Summary
Written by AI, not yet AICS's view · claude-haiku-4-5-20251001This qualitative study in the Democratic Republic of Congo examined whether caregivers, health workers, and community members would accept a reduced dose of therapeutic food (RUTF) for treating severely malnourished children aged 6-59 months. The reduction in dose would free up resources to treat more children. Most respondents accepted the reduced dose if the savings were used to treat other malnourished children and if additional support was provided for food insecurity, water access, and gender-based violence. However, some caregivers and health workers worried about negative effects on children's health and their own livelihoods.
Key points
- Reduced RUTF dose was acceptable to the majority of respondents if savings enabled treatment of more children with SAM
- Acceptability was conditional on accompanying measures to address food insecurity, lack of safe water, and gender-based violence
- Some health workers feared the reduced dose would increase workload by lengthening treatment duration or increasing patient numbers
- Some caregivers expressed concerns that dose reduction would harm children's health and reduce household food sources or income
- Study conducted in Mbuji-Mayi, Kasaï Oriental, eastern DRC, a region with high vulnerability to food insecurity and limited access to services
Limitations
This qualitative study captured perceptions and acceptability rather than clinical outcomes or actual adherence rates. The findings reflect views in one specific context (DRC) and may not generalise to other settings with different health systems, economic conditions, or community characteristics.
Abstract
BACKGROUND: Despite a higher prevalence of Severe Acute Malnutrition (SAM) in children living in Sub Saharan Africa, access to outpatient treatment remains limited. In relation to this, the 2023 WHO guidelines proposed reducing the dose of Ready to Use Therapeutic Food (RUTF) distributed on the basis of recent evidence. One of the positive consequence is that savings made by reducing RUTF prescription per child can then be reinvested to admit more children and hence increase treatment coverage. But this RUTF reduction may not be acceptable in all contexts and more evidence is needed to ascertain this strategy is acceptable by main actors of SAM management. METHODS: This qualitative study assessed the acceptability of the reduced dose as part of a nutritional intervention programme in Mbuji-Mayi, Democratic Republic of Congo (DRC). The present qualitative study, a sub-study of the EfRAMAS clinical trial, assessed the acceptability of the reduced dose in the context of a nutritional intervention programme run by Action Against Hunger (AAH) in Mbuji-Mayi, DRC. Information was gathered through 54 semi-structured interviews, 10 focus groups and 6 in situ observations. Deductive analysis (from pre-established hypotheses) and inductive analysis (using themes that emerged in the field) were based on a triangulation of different sources of information. The hypothetico-deductive analysis was based on a triangulation of the different sources of information. RESULTS: The acceptability of the reduced dose of RUTF during the treatment of children 06 to 59 months with SAM was confirmed provided that two conditions were met: firstly, that the savings made are used to treat other children suffering from SAM, but who do not have access to treatment, and secondly, that accompanying measures are put in place to address food insecurity, lack of access to drinking water, and gender-based violence. The reduced dose was deemed acceptable by the majority of health workers. Others, on the contrary, feared that it would increase their workload by lengthening the duration of children’s treatment or increasing the number of children treated. Some caregivers showed a high degree of acceptance of the idea of reducing the dose to enable more children with SAM to have access to the treatment. Other caregivers felt that this would affect the children’s health and reduce household income or food sources. CONCLUSIONS: Overall, the reduction in RUTF doses seems relatively acceptable to the majority of those interviewed, considering the benefit of more children accessing treatment, in that aligned with recent WHO recommendations. However, the caregivers, health care personnel and local authorities recommend paying attention to their vulnerable situation prone to food insecurity, low access to drinking water, lack of income-generating activities, and gender-based violence in Kasaï Oriental, eastern DRC.
Findings the Hub has extracted
Each claim below is labelled by its type of design and links back to this report.
- Intervention
- Reduction of the dose of Ready to Use Therapeutic Food (RUTF) distributed to children with SAM, with accompanying measures to address food insecurity, water access, and gender-based violence
- Population
- Children aged 6-59 months with severe acute malnutrition in Mbuji-Mayi, DRC; caregivers, health workers, and local authorities involved in their management
Key finding
Reduced dose was acceptable to the majority on condition that savings enable treatment of other untreated SAM children