MANGO Project
Testing the effectiveness of a reduced dose of ready-to-use therapeutic food (RUTF) for the treatment of severely acute malnourished children (SAM)
Burkina Faso, Fada N’Gourma District
2015-2021
Academic Partners: U.S. Centers for Disease Control and Prevention (CDC), University of Copenhagen (Denmark), University of Abomey-Calavi (Benin).
The research project
The MANGO project is a non-inferiority randomized controlled trial. 801 children aged 6-59 months suffering from severe acute malnutrition were individually allocated into two groups:
- 402 children in the intervention group treated with a reduced dose of RUTF
- 399 children in the control group treated with a standard dose of RUTF
Apart from the change in the amount of therapeutic food, both groups received the same care throughout the treatment.
The main objective of this project is to prove, under ideal conditions, the efficacy of a reduced dose of RUTF compared to a standard dose in the treatment of uncomplicated Severe Acute Malnutrition in children aged 6-59 months.
The results
The first results are encouraging. Treatment of SAM with a reduced dose is as effective as with a standard one in terms of:
- Weight gain velocity;
- Rate of recovery, death, referral to health centers, default, non-respondent and relapse after 3 months;
- Gain of fat and fat-free mass (bone, muscle);
- Decrease of initial vitamin A and iron deficiencies;
- Recommended daily nutrient intake covered;
- Average probability of micronutrient adequacy ;
- Savings (16.8%) on treatment costs.
But the reduced dose is insufficient compared to the standard dose in terms of :
- Height gain velocity in children under 12 months;
- Iron, vitamin A, thiamine, riboflavin, folate and vitamin B12 intakes;
- Hemoglobin concentration and prevalence of anemia at the end of treatment.
Finally, the results show that the treatment of severe acute malnutrition can still be improved:
- Insufficient recovery of fat mass after treatment, compared to healthy children;
- Partial correction of vitamin A and iron deficiencies compared to healthy children at the end of treatment;
- Discovery of the considerable part played by family and supplementary foods in the daily energy intake.
The results in one page
Published articles
Origins of the MANGO project
The treatment of severe acute malnutrition uses a nutrition product called Ready-to-use Therapeutic Food (RUTF) jointly with medical treatment (amoxicillin as routine and other treatments according to individual needs). Its lipid-based nutritional formula is derived from F100 therapeutic milk one used in hospitals, and allows it to be consumed at the child’s home without strict hygiene and conservation conditions. Its dosage (quantity, duration) stemmed from that used in hospitals. It is used since the early 2000s in humanitarian programs. However, it is observed that weight gain occurs very quickly in few weeks for children treated with RUTF, reaching a plateau afterwards, while the dosage remains high and identical throughout the treatment. We hypothesize that too much was given in relation to the physiological needs for recovery from the malnutrition episode.
The treatment of severe acute malnutrition is also subject to persistent implementation problems with frequent shortages in the supply of RUTF. This product represents the largest part of the cost of treating a severely malnourished child.
A program in Myanmar showed in 2009 that the dose of RUTF could be reduced to treat a child, but this required more solid confirmation with a control group of children receiving a standard dose.
The question then arose: Can the same level of recovery be achieved with less than the standard dose of RUTF?
Reducing the dose would save money on the cost of nutritional programs. These savings could be reinvested to treat more children and thereby increase the coverage of malnourished children in need of treatment.
Acknowledgements
We would like to warmly thank the parents and children who participated in this research, their representatives, the health authorities, the donors, the academic partners (Univ. of Ouagadougou, UCL, and UAC Benin) and the entire AAH team. This study would not have been possible without the trust of the participants, the scientific expertise of our partners, the support of donors and the excellent work of the teams.
Donors : Humanitarian Innovation Fund (HIF) by ELHRA, ECHO, Children’s Investment Fund Foundation (CIFF), ECHO ERC, Fondation ACF – Institut de France