Bangladesh 2021
© Fabeha Monir pour Action contre la Faim

MAM – CHiFT Project

A Cluster RCT comparing the effectiveness of Improved Nutrition Counseling and Home Food Fortification with Micronutrient Powder vs. Nutritional Supplementation with a Specially Formulated Food in the Management of Moderate Acute Malnutrition in Children, Teknaf, Bangladesh.

THE RESEARCH PROJECT 

BACKGROUND AND OBJECTIVES 

Management of severe (SAM) and moderate acute malnutrition (MAM) in children aged 6-59 months is an acknowledged public health priority in low- and middle- income countries. Yet it mostly relies on the administration of large quantities of costly nutritional supplements, also called specially formulated foods (SFFs), a range of WHO-endorsed products, which have to be transported over long distances to reach the remote communities and Community Clinics where they are required. In practice, the supplements are not available at scale, and do not represent a sustainable option for supporting nutritional recovery. While the WHO now recommends limiting the use of SFFs to specific high-risk individuals or contexts, the effectiveness of MAM management strategies that do not rely on SFFs has rarely been evaluated. 

The main objective of the project was thus to assess the effectiveness, feasibility and scalability of administering 15-micronutrient powder (15-MNP) with an improved nutrition counselling (INC) – for improving access to and consumption of nutritious home food – for the management of MAM in the host communities in Teknaf sub-district of Cox’s Bazar, Bangladesh. 

METHODS 

We conducted a two-arm cluster comparison study (Randomized Controlled Trial – RCT) in 20 community clinics and union sub centers in Teknaf sub-district, rural Bangladesh, with 280 MAM children by arm. In the intervention arm, families received improved nutritional counseling, cooking demonstration using traditional recipes and 15-micronutrients powder sachets every two weeks. In the control arm, they received a standard SFF (Supercereal Plus) every two weeks. The duration of MAM management was 4 months, followed by a 6-month follow-up. Anthropometric measures, morbidity and adherence to treatment were recorded at each visit. Primary outcomes included weight gain and nutritional status. Intervention effects were estimated using regression models adjusted for clustering and baseline characteristics. 

FINDINGS 

Field data collection was completed in March 2025. Data analysis is currently underway to compare responses to MAM management between the two study arms, based on recovery and sustained recovery outcomes. 

DISCUSSION AND RECOMMENDATIONS 

This study is expected to significantly strengthen the evidence base regarding the effectiveness and cost-effectiveness of a non-SFF-based approach, compared to traditional SFF-based programs. It will provide insights into both short-term nutritional rehabilitation and sustained recovery among children with MAM. 

This study was co-promoted by the Government of Bangladesh, with the explicit objective of informing the revision of the country’s current guidelines on acute malnutrition management. It also aims to contribute evidence that may inform future international recommendations on acute malnutrition, beyond the Bangladeshi context. 

PROJECT-RELATED PUBLICATIONS 

Thanks to the data collected at baseline, ahead of the trial, two papers have been published in the Maternal & Child Nutrition journal: