The impact of Ready-to-Use Supplementary Food (RUSF) in targeted supplementation of children with moderate acute malnutrition (MAM) in South Africa

Abstract

Objective: To describe catch-up growth in children with moderate acute malnutrition (MAM) on targeted supplementation using Ready-to-Use Supplementary Food (RUSF).

Methods: An impact study was done to determine anthropometric changes in children aged 12–60 months who received RUSF (175 kcal/kg/day) for six weeks, managed as outpatients and followed up for 12 weeks until a final assessment.

Results: Default rates were high, with 30% of children returning to the primary healthcare facility for follow-up only once or twice. Despite significant improvement in height-for-age Z-score (HAZ), weight-for-age Z-score (WAZ), weight-for-height Z-score (WHZ) and mid-upper arm circumference (MUAC), 70.5% of the sample remained in the same malnutrition classification and only 26% recovered. The growth velocity of children with a lower initial WHZ was significantly higher (r = –0.15, p < 0.05) than those with less wasting, but only 20% grew at a rate to achieve catch-up growth. The mean growth velocity decreased as the intervention period continued.

Conclusion: All median anthropometric indicators improved with RUSF supplementation. However, catch-up growth or recovery occurred in only 20–25% of children included in the study. These findings create questions about the value of supplementation in the absence of blanket food distribution or other interventions to address food security.

Keywords:

• children
• growth velocity
• moderate acute malnutrition (MAM)
• Ready-to-Use Supplementary Food (RUSF)
• supplementation

Acknowledgements

This study would not have been possible without a Research Theme Grant from Nelson Mandela Metropolitan University, and Nadia Gous, Louise Cilliers and Craig van Wyk, all registered dietitians, who coordinated the research sites and research activities with staff from the Western Cape, Northern Cape and Free State Departments of Health. The authors also acknowledge Dr Daleen Struwig, medical writer, Faculty of Health Sciences, University of the Free State, for technical and editorial preparation of the manuscript.

Additional information

Funding

This work was supported by Nelson Mandela Metropolitan University Research Theme Grant.