Effectiveness and cost-effectiveness of 4 supplementary foods for treating moderate acute malnutrition: Results from a cluster-randomized intervention trial in Sierra Leone

Authors: GRISWOLD, STACY - Friedman School Of Nutrition; LANGLOIS, BREANNE - Friedman School Of Nutrition; SHEN, YE - Friedman School Of Nutrition; CLIFFER, ILANA - Friedman School Of Nutrition; SURI, DEVIKA - University Of Wisconsin; WALTON, SHELLEY - Friedman School Of Nutrition; CHUI, KEN - Tufts University; ROSENBERG, IRWIN - Friedman School Of Nutrition; KOROMA, AMINATA - Ministry Of Health & Sanitation; WEGNER, DONNA - Washington University; HASSAN, AMIR - Washington University; MANARY, MARK - Washington University; VOSTI, STEPHEN - University Of California, Davis; WEBB, PATRICK - Friedman School Of Nutrition; ROGERS, BEATRICE - Friedman School Of Nutrition

Submitted to: The American Journal of Clinical Nutrition
Publication Type: Peer Reviewed Journal
Publication Acceptance Date: 4/5/2021
Publication Date: 5/21/2021
Citation: Griswold, S.P., Langlois, B.K., Shen, Y., Cliffer, I.R., Suri, D.J., Walton, S., Chui, K., Rosenberg, I.H., Koroma, A.S., Wegner, D., Hassan, A., Manary, M.J., Vosti, S.A., Webb, P., Rogers, B.L. 2021. Effectiveness and cost-effectiveness of 4 supplementary foods for treating moderate acute malnutrition: Results from a cluster-randomized intervention trial in Sierra Leone. American Journal of Clinical Nutrition. https://doi.org/10.1093/ajcn/nqab140.
DOI: https://doi.org/10.1093/ajcn/nqab140

Interpretive Summary: Globally 33 million children are affected with moderate acute malnutrition (MAM) and to maximize the impact of scarce resources for this vulnerable group of children, governments and donors must consider the cost, in addition to the effectiveness, of different treatment options. This study compared 4 different specialized foods to treat MAM to see which one would be most effective for treatment, 2643 MAM children for Sierra Leone were treated with one of these foods. All 4 foods compared performed similarly and are equally good choices.

Technical Abstract: Moderate acute malnutrition (MAM) affects 33 mil-lion children annually. Investments in formulations of corn-soy blended flours and lipid-based nutrient supplements have effec-tively improved MAM recovery rates. Information costs and cost-effectiveness differences are still needed. We assessed recovery and sustained recovery rates of MAM children receiving a supplementary food: ready-to-use supplementary food (RUSF), corn soy whey blend with fortified vegetable oil (CSWB w/oil), or Super Cereal Plus with amylase (SC + A) compared to Corn Soy Blend Plus with fortified vegetable oil (CSB+ w/oil). We also estimated differences in costs and cost effectiveness of each supplement. In Sierra Leone, we randomly assigned 29 health centers to provide a supplement containing 550 kcal/d for ~12 wk to 2691 children with MAM aged 6–59 mo. We calculated cost per enrollee, cost per child who recovered, and cost per child who sustained recovery each from 2 perspectives: program perspective and caregiver perspective, combined. Of 2653 MAM children (98.6%) with complete data, 1676 children (63%) recovered. There were no significant differences in the odds of recovery compared to CSB+ w/oil [0.83 (95% CI: 0.64–1.08) for CSWB w/oil, 1.01 (95% CI: 0.78–1.3) for SC + A, 1.05 (95% CI: 0.82–1.34) for RUSF]. The odds of sustaining recovery were significantly lower for RUSF (0.7; 95% CI 0.49–0.99) but not CSWB w/oil or SC + A [1.08 (95% CI: 0.73–1.6) and 0.96 (95% CI: 0.67–1.4), respectively] when compared to CSB+ w/oil. Costs per enrollee [US dollars (USD)/child] ranged from $105/child in RUSF to $112/child in SC + A and costs per recovered child (USD/child) ranged from $163/child in RUSF to $179/child in CSWB w/oil, with overlapping uncertainty ranges. Costs were highest per sustained recovery (USD/child), ranging from $214/child with the CSB+ w/oil to $226/child with the SC + A, with overlapping uncertainty ranges. The 4 supplements performed similarly across recov-ery (but not sustained recovery) and costed measures. Analyses of posttreatment outcomes are necessary to estimate the full cost of MAM treatment.