1University Of Saskatchewan, Saskatoon, Canada, 2Ministerio de Salud, San Salvador, El Salvador
Introduction. Acute malnutrition affects 45.4 children under five globally, which is caused by a deficiency in energy or nutrient intake that negatively impacts immune and physical development. Resulting rapid weight loss contributes to wasting, described as a Weight-for-Height Z-score (WHZ) ≤-2 SDs of the WHO child growth standards. In Central America, wasting prevalence is low (0.9%), but El Salvador currently holds double the burden (2.1%). Present treatments for wasting involve energy-and-nutrient-dense foods including Ready-touse Therapeutic Foods (RUTF). In El Salvador, a cereal blend named Biofortik, made of maize and sorghum fortified with micronutrients was formulated to replicate the local porridge drink, Atole. Objective. To determine the bioequivalence between the RUTF and Biofortik for co-deployment to treat acute malnutrition in children aged 6-59 months. Methods. A quasi-experimental design was undertaken in 2021 among 108 children in metropolitan San Salvador. Health clinics were randomly assigned to provide acutely malnourished children the RUTF or Biofortik and monitor their weight gain through regular check-ups. Once a child achieved a WHZ greater than -2 SD, they were discharged from the trial. Differences in wasting recoveries by treatment group and variations in WHZ score were compared. Results. Our findings demonstrated significant increases to WHZ scores in both the Biofortik and RUTF groups (p<0.05). At enrollment, children receiving Biofortik displayed a lower mean WHZ score of -2.86, compared to -2.44 in the RUTF group (p<0.001). However, no differences in WHZ scores at discharge were shown with mean scores of -1.87 and -1.65 for children who received the RUTF or Biofortik respectively (p=0.75). Both treatments contributed to similar weight gain rates and length of stay in the program (p>0.05). When considering contextual group differences, those living in a rural setting were more likely to receive Biofortik compared to the RUTF (p<0.05). Nevertheless, this was not shown to contribute to final recovery status among this sample (p=0.33). Conclusions. Our findings support the hypothesis that Biofortik demonstrated nutritional equivalency to the RUTF in treating children with acute malnutrition. These preliminary results were limited by a small sample size, indicating the potential for an expanded intervention.
Keywords: child, malnutrition, outpatient, effectiveness