Category: Treatment of severe malnutrition

A pragmatic approach to treating severe malnutrition in emergencies: is F75 always beneficial?

This article describes MSF’s experience of implementing a therapeutic feeding programme for adults in Wau, southern Sudan in 1998.

Issue 15, April 2002 (page 11)

ACC/SCN Working Group on Nutrition in Emergencies

Excerpts from Working Group Report.

Issue 10, July 2000 (page 10)

Adopting CTC from Scratch in Ethiopia (Special Supplement 2)

Save the Children USA (SC-US) implemented an emergency health and nutrition programme in Sidama zone of SNNP region of Ethiopia, in response to the 2003 food crisis.

Supplement 2, November 2004 (page 30)

Affordability of the MDG for child survival

Arecent LANCET article1 estimates the cost of delivering comprehensive child survival interventions in 42 countries where 90% of global child deaths occurred in 2000.

Issue 27, March 2006 (page 11)

Alternative RUTF formulations (Special Supplement 2)

Developing CTC programmes that use Ready to Use Therapeutic Food (RUTF) made locally, from locally available produce, and used to treat malnutrition and HIV amongst the local population, is an important vision for the future of CTC.

Supplement 2, November 2004 (page 35)

Ambulatory treatment of severe malnutrition

This article describes the experiences of an MSF-B nutritional project in Faryab that was forced by cultural and geographical constraints to treat children with severe acute malnutrition as outpatients.

Issue 19, July 2003 (page 16)

Ambulatory treatment of severe malnutrition in Afghanistan

Faryab province is in a remote and poor area in the north of Afghanistan. There is little infrastructure, a high risk of disease outbreaks such as cholera and measles, and malnutrition is endemic.

Issue 19, July 2003 (page 14)

Assessing the economic value of fortified foods

Summary of published paper.

Issue 14, November 2001 (page 6)

Capacity Building in Times of Emergency: Experiences From Malawi

In this field article, Claire demonstrates how local capacity building is possible in an emergency setting, and describes the challenges and achievements of addressing severe malnutrition in Malawi, from AAH’s perspective.

Issue 21, March 2004 (page 28)

Caring for Unaccompanied Children under Difficult Circumstances

Generally, emergency interventions are conceptualised as having an impact on nutritional status through a combination of strengthening food security, health service provision and providing or supporting caring practices.

Issue 4, June 1998 (page 4)

Case Studies (Special Supplement 2)

Case Studies.

Supplement 2, November 2004 (page 14)

Cellophane bags and clean water: A novel way of producing safe therapeutic milk and ORS?

Most people will have come across cellophane, its the packaging for many sweets, pies and other goodies.

Issue 1, May 1997 (page 10)

Challenges and Opportunities in Integrating CTC and Food Security Programmes in Malawi (Special Supplement 2)

As with the majority of famines and food crises, the 2002-3 Malawi crisis was caused by the interaction of many pre-existing factors of vulnerability that combined to over-stretch fragile coping capacities.

Supplement 2, November 2004 (page 46)

Clinical Trial of BP100 vs F100 Milk for Rehabilitation of Severe Malnutrition

This article describes the main findings of a clinical trial by ACF in Sierra Leone, which compares the use of solid RUTF (BP100) with the standard F100 treatment, during the rehabilitation phase of a TFC.

Issue 24, March 2005 (page 22)

Community based approaches to managing severe malnutrition: case study from Ethiopia

A recent published paper describes Save the Children US’s (SC US) experience of setting up a community therapeutic care (CTC) programme in the Southern Nations, Nationalities and Peoples Region (SNNPR), Ethiopia, following a drought in the lowlands of the region in 2003.

Issue 30, April 2007 (page 7)

Community care: addressing the management of severe malnutrition

Summary of published paper.

Issue 14, November 2001 (page 4)

Community Participation and Mobilisation in CTC (Special Supplement 2)

Over the last few years of CTC development, the process of community participation and mobilisation has become central to the search for more efficient and more sustainable strategies to manage malnutrition.

Supplement 2, November 2004 (page 43)

Community-based Approaches to Managing Severe Malnutrition

A three day meeting was held in Dublin hosted by Concern and Valid International between 8-10th of October, 2003 on community-based treatment1 of the severely malnourished.

Issue 21, March 2004 (page 16)

Community-based Therapeutic Care (CTC)

Summary of published research.

Issue 19, July 2003 (page 6)

Comparison of the Efficacy of a Solid Ready-to-Use Food and a Liquid, Milk- Based Diet in Treating Severe Malnutrition

Summary of published research.

Issue 20, November 2003 (page 5)

Comparison of Weight-for-Height Based Indices for Assessing the Risk of Death

Summary of Published Paper.

Issue 2, August 1997 (page 15)

Cotrimoxazole as a Prophylaxis for HIV Positive Malnourished Children

Summary of review.

Issue 25, May 2005 (page 13)

CTC Approach (Special Supplement 2)

Community Therapeutic Care (CTC) is a community-based model for delivering care to malnourished people. CTC seeks to provide fast, effective and cost efficient assistance in a manner that empowers the affected communities and creates a platform for longer-term solutions to the problems of food security and public health.

Supplement 2, November 2004 (page 6)

CTC from Scratch - Tear Fund in South Sudan (Special Supplement 2)

Tearfund has been working in Northern Bahr el Ghazal, southern Sudan, in the nutrition sector since 1998.

Supplement 2, November 2004 (page 28)

CTC in Ethiopia- Working from CTC Principles (Special Supplement 2)

In December 2002, nutrition surveys carried out by Concern Worldwide, in collaboration with Amhara Region Disasters, Preparedness and Prevention Bureau (DPPB), reported acute malnutrition levels of 17.2% global malnutrition and 3.1% severe malnutrition (based on weight for height in z scores) in Kalu and Dessie Zuria districts, South Wollo. .

Supplement 2, November 2004 (page 14)

CTC in North Darfur, North Sudan: challenges of implementation (Special Supplement 2)

North Darfur state lies 1000 km to the west of Khartoum. It is an area the size of France but is inhabited by only 1.4 million people.

Supplement 2, November 2004 (page 22)

CTC in South Sudan - A Comparison of Agency Approaches and the Dilemmas Involved (Special Supplement 2)

In 2003 both Concern Worldwide and Tearfund asked Valid International to support them in the setting-up of CTC programmes to address high rates of acute malnutrition in South Sudan.

Supplement 2, November 2004 (page 25)

Cultural integration in CTC: Practical suggestions for project implementers (Special Supplement 2)

The SPHERE guidelines touch only superficially on culture and the cultural acceptability of humanitarian assistance. However, in recent decades, the wider field of international health has produced a variety of initiatives intended to account for culture in the design and delivery of programmes.

Supplement 2, November 2004 (page 41)

Debate on the Management of Severe Malnutrition

In May 2003, a new publication, Caring for severely malnourished children, Ashworth and Burgess, 2003 1 , met with some technical criticism from Professor Mike Golden in the form of a book critique submitted to ENN, and circulated to the publishers and supporting agencies (see Field Exchange 19, pp 19).

Issue 20, November 2003 (page 16)

Debate on the Management of Severe Malnutrition : A Response

Many individuals and organisations, including NGOs, have contributed to the improved treatment of children with severe malnutrition, but case-management remains very poor in most hospitals in developing countries and many children die as a result.

Issue 20, November 2003 (page 17)

Decentralisation of out-patient management of severe malnutrition in Ethiopia

This article describes the large-scale rollout of outpatient therapeutic care in Ethiopia in response to the 2008 escalation in severe acute malnutrition.

Issue 36, July 2009 (page 12)

Delivering Supplementary and Therapeutic Feeding in Darfur: coping with Insecurity

This article describes the ongoing challenges that insecurity poses to the GOAL nutrition programme in Dafur and the strategies they have responded with.

Issue 28, July 2006 (page 10)

Dietary Treatment of Severe Malnutrition in Adults

A recently published paper reports the results of a study conducted by Concern Worldwide on severely malnourished adults in Baidoa, Somalia, a town at the epicentre of the 1992 famine.

Issue 6, February 1999 (page 11)

Effectiveness of Integrated Outpatient Care of Severe Acute Malnutrition in Ethiopia

Community-based management of acute malnutrition (CMAM) has been implemented in Ethiopia by various non-governmental organisations (NGOs) in response to emergencies.

Issue 34, October 2008 (page 8)

ENN/GIFA project

Summary of presentation.

Issue 19, July 2003 (page 28)

Ethics of use of ready-to-use-therapeutic foods

I have been following the debate on the ethics surrounding the research on Community Therapeutic Care (CTC) and Ready to Use Therapeutic Foods (RUTFs), and was wondering whether the issue of ethics in the current use of RUTF’s in the field is also being discussed, as this also could have effects on the quality of the research and effectiveness of future CTC programmes.

Issue 17, November 2002 (page 23)

Evaluation of the Impact of the ACF Therapeutic Feeding Programme in Burundi

ACF and ECHO (European Commission Humanitarian Office) undertook a joint evaluation of the ACF therapeutic feeding programme in Burundi in November 1998.

Issue 8, November 1999 (page 27)

Factors associated with defaulting in MSF ambulatory programme

Summary of meeting abstract.

Issue 34, October 2008 (page 9)

Feeding without fear

This is a story to illustrate that however experienced you are, there is always the chance that you will find yourself in a situation that you are not prepared for, and that you do not feel qualified to deal with.

Issue 10, July 2000 (page 8)

Foods for the Treatment of Malnutrition

Summary of Conference Presentation.

Issue 2, August 1997 (page 14)

Fortified spreads v CSB in supplementary feeding in Malawi

Summary of published research.

Issue 37, November 2009 (page 10)

Home Based Treatment of Severe Malnutrition in Kabul

Action Contre la Faim (ACF) has been working in Afghanistan since 1995. The nutrition programme in Kabul includes three therapeutic feeding centres (TFC) within paediatric hospitals in the city, and a network of smaller TFCs providing care close to the population.

Issue 24, March 2005 (page 18)

Home treatment for severe malnutrition in South Sudan

This article details the largely positive experiences of ACF-USA in using home treatment as an integral part of their programme to manage severe malnutrition in South Sudan.

Issue 28, July 2006 (page 18)

Home-Based Therapy With RUTF In Malawi

This article describes the positive experiences of the St Louis Nutrition Project using Ready to Use Therapeutic Food (RUTF) in Malawi, and how this approach was integrated into the existing national network for managing severe and moderate malnutrition.

Issue 21, March 2004 (page 12)

Impact of community mobilisation activities in Uganda

In July 2006, ACF-USA implemented an out-patient programme for the treatment of severely malnourished children in the main internally displaced people (IDP) camps of the districts of Lira and Apac, Northern Uganda.

Issue 34, October 2008 (page 15)

Impact of HIV/Aids on Acute Malnutrition in Malawi

In Malawi, chronic malnutrition (stunting) is estimated at around 50%, although recent studies suggest this has increased substantially and, in some districts, is now around 65%. Rates of underweight are at 25% and acute wasting around 6%.

Issue 25, May 2005 (page 18)

Impact of non-admission on CTC Programme Coverage

This article presents the fi ndings of a preliminary analysis by Valid International of questionnaires and Centric Systematic Area Sampling (CSAS) surveys implemented in seven countries by a variety of agencies and organisations, with a view to investigating the impact of non-admission on estimates of CTC programme coverage.

Issue 31, September 2007 (page 29)

Implementation of WHO Guidelines on the Management of Severe Malnutrition in South Africa and Ghana

Summary of published research.

Issue 20, November 2003 (page 12)

Implications of a Coverage Survey in Ethiopia

This article presents the results of a survey that took place in December 2006 to assess the coverage of a community-based programme and discusses the implications of the fi ndings.

Issue 31, September 2007 (page 11)

Infant feeding in a TFP

MSc Thesis.

Issue 9, March 2000 (page 7)

Infant feeding strategies and PMTCT - Mashi trial from Botswana

Summary of published research.

Issue 29, December 2006 (page 26)

Institutional Integration of CTC with existing clinical health systems (Special Supplement 2)

Therapeutic Feeding Centres (TFCs) are often highly effective in treating individual cases of severe malnutrition. Their exacting requirements for hygiene, and delivery of the medical and nutritional protocols means that they are often set up as 'parallel structures,' with little room for local Ministry of Health (MoH) involvement.

Supplement 2, November 2004 (page 51)

Integrating CTC and HIV/AIDS Support in Malawi

This article describes the research findings1 of the first phase of a two-part study in Malawi by Valid International, which is exploring how existing CTC programmes can be adapted in the context of HIV/AIDS.

Issue 25, May 2005 (page 7)

Integrating CTC in health care delivery systems in Malawi (Special Supplement 2)

In February 2002, the Malawi government declared a national nutritional emergency and the UN launched an international appeal for emergency assistance.

Supplement 2, November 2004 (page 19)

Integration of CTC with strategies to address HIV/AIDS (Special Supplement 2)

Home-Based Care (HBC) is now seen as the way forward for caring and supporting People Living With HIV/AIDS (PLWHA) and HIV affected households (30;31).

Supplement 2, November 2004 (page 49)

Introduction (Special Supplement 2)

This supplement presents a collection of articles written by people who have been involved in Community-based Therapeutic Care (CTC) programmes.

Supplement 2, November 2004 (page 4)

Is extrusion cooking of blended foods really advantageous?

Published Paper.

Issue 10, July 2000 (page 4)

Lessons From SC UK Evaluation in DRC

Save the Children UK (SC UK) began implementing emergency health and nutrition interventions in eastern Democratic Republic of the Congo (DRC) in 1998, with initial activities in North and South Kivu and North Katanga.

Issue 22, July 2004 (page 22)

Letter on background to 1999 WHO guidelines on malnutrition, by Mike Golden

Further to your article on the technical debate regarding the management of severe malnutrition, I wish to offer some contextual information to the development of the World Health Organisation (WHO) guidelines, and agency field protocols.

Issue 20, November 2003 (page 18)

Letter on commercial production of RUTF, by Michel Lescanne

Letters.

Issue 24, March 2005 (page 17)

Letter on community mobilisation in outpatient management of severe malnutrition, by Saul Guerrero and Steve Collins

Letters.

Issue 29, December 2006 (page 37)

Letter on inadequate coverage of SAM in Lancet Undernutrition Series, by Susan Shepherd

Letter.

Issue 33, June 2008 (page 24)

Letter on local v imported therapeutic milk, by Rebecca Norton and Jean-Pierre Papart (with responses by Mike Golden, Ann Ashworth, Mary Lung'aho and David Sanders)

Letter from the Nutrition/health advisors of Fondation Tdh.

Issue 31, September 2007 (page 18)

Letter on MSF guidelines on using F75, Saskia van der Kam, Aranka Anema, Sophie Baquet and Marc Gastellu

MSF would like to thank Schofield et al for their constructive criticism in the letter section of the previous edition of Field Exchange.

Issue 15, April 2002 (page 9)

Letter on nomenclature in CTC programmes, by Steve Collins

Letters.

Issue 24, March 2005 (page 16)

Letter on nomenclature used in malnutrition programmes, by Mike Golden

Letters.

Issue 24, March 2005 (page 15)

Letter on revised MSF Nutrition Guidelines draft, by E.C. Schofield, Ann Ashworth, Mike Golden and Y. Grellety

Revised MSF nutrition guidelines.

Issue 14, November 2001 (page 21)

Letter on standards for severe malnutrition mangement, by Kiross Tefera, with response by Saskia van der Kam

First my gratefulness goes to Professor Michael Golden and Yvonne Grellety for their detailed and scientific article based on the research outcome of about 8500 children comparing the observed to expected mortality rate done in different therapeutic feeding institutions (Field exchange, issue 15, April 15, pp. 12-13).

Issue 16, August 2002 (page 20)

Local and centralised therapeutic food production

Summary of editorial.

Issue 37, November 2009 (page 8)

Local Production of Plumpy’Nut

The French company, Nutriset, has been involved in projects aimed at establishing local production of Plumpy’nut - a ready-to-use food product (RTUF) employed in feeding programmes for the management of severe malnutrition.

Issue 20, November 2003 (page 14)

Local Production of RUTF (Special Supplement 2)

The development of RUTF has been an important factor facilitating the development of CTC. However at the moment, most RUTF is made in France, is marketed at a high cost and incurs considerable transport overheads to move it to the point of use.

Supplement 2, November 2004 (page 33)

Local versus industrially produced therapeutic milks in managing severe malnutrition

For the past eight years, Fondation Terre des hommes (Fondation Tdh) have been working in Mauritania, opening a nutritional unit for managing acute malnutrition in 2000.

Issue 34, October 2008 (page 13)

Locally produced RUTF in a hospital setting in Uganda

This article describes some of the preliminary findings of a recent study that introduced locally produced Ready to Use Therapeutic Food (RUTF) into a hospital setting in Uganda, comparing its use to F100 during the rehabilitation phase. This article focuses particularly on the experiences producing local RUTF in a hospital setting, including cost comparisons with the routinely used F100.

Issue 28, July 2006 (page 22)

Malaria Treatment in Severe Malnutrition in Angola

This field article outlines the results of a preliminary study carried out by ACH in Angola, which showed poor response rates to standard TFC protocols for managing malaria.

Issue 21, March 2004 (page 3)

Malaria: The Iron and Folate Debate.

Marion Kelly summarised recent deliberations among NGOnut contributors in relation to the administration of iron (and folate) in malaria endemic areas. Below is her summary in point format. .

Issue 4, June 1998 (page 30)

Management of moderate acute malnutrition with RUTF in Niger

Between 2001 and 2005, the Médecins Sans Frontières (MSF) therapeutic feeding programme in Maradi.

Issue 31, September 2007 (page 3)

Managing severe acute malnutrition in high HIV prevalence areas

Summary of research.

Issue 34, October 2008 (page 7)

New Method for Estimating Programme Coverage

This article gives an overview of the coverage estimation method developed for the Community Therapeutic Care (CTC) Research Programme in Malawi.

Issue 21, March 2004 (page 11)

Nutrition in the DPRK - a field view

This article, provides an 'experience based' sequel to Field Exchange's analysis of the DPRK crisis (see issue 3). It casts doubt on claims of widespread malnutrition, focuses on the appalling state of care available to chronically malnourished children, and highlights the considerable operational difficulties in running nutritional programmes in DPRK.

Issue 5, October 1998 (page 21)

Nutrition Programming in the Southern Africa Emergency

Summary of unpublished report.

Issue 23, November 2004 (page 6)

Nutritional Status of HIV+ Pre-School Children in South Africa

Summary of unpublished research.

Issue 22, July 2004 (page 10)

Operational study on SAM management in high HIV prevalence area

Summary of published research.

Issue 34, October 2008 (page 12)

Outpatient therapeutic programme (OTP): an evaluation of a new SC UK venture in North Darfur, Sudan (2001)

Summary of internal evaluation by Anna Taylor (headquarters nutrition advisor for SC UK).

Issue 16, August 2002 (page 26)

Postscript on local capacity building for treatment of severe malnutrition

International NGOs usually provide better treatment for children with severe malnutrition in their feeding centres than is provided by local hospitals.

Issue 17, November 2002 (page 22)

Postscript to 'The risks of wet feeding programmes'

This is a very interesting and clear analysis of a nutrition intervention which experienced an unanticipated cholera epidemic.

Issue 3, January 1998 (page 5)

Postscript to: 'A pragmatic approach to managing severe malnutrition: Is F75 always beneficial?'

It is quite wrong to consider the advantage of F75 as “theoretical”.

Issue 15, April 2002 (page 12)

Practical experiences and lessons learned in using supplemental suckling technique

Following on from the article on infant feeding in emergencies, which appeared in the March 2000 issue of Field Exchange, we wish to add our thoughts on the use of the supplemental suckling technique, drawing on our experience from the therapeutic feeding centre in Kabaya district hospital, in Gisenyi, Rwanda, which Save the Children (UK) was supporting.

Issue 13, August 2001 (page 23)

Probiotics and prebiotics for SAM in Malawi

Summary of research.

Issue 37, November 2009 (page 10)

Ready to use therapeutic food for treatment of marasmus

Summary of published letter.

Issue 8, November 1999 (page 8)

Reducing the price of Plumpy’nut

The August edition of Field Exchange (Issue 16, p28) published an article by Anna Taylor (headquarters nutrition advisor for SC UK), summarising the evaluation of the Outpatient Therapeutic Programme (OTP) project by Save the Children UK in North Darfur, Sudan in 2001.

Issue 17, November 2002 (page 23)

Response on F-75 and use of measuring scoops

Since 1986, Nutriset has been very involved in seeking practical solutions for the development of quality nutritional products.

Issue 32, January 2008 (page 14)

Review of CMAM in Ethiopia, Malawi and Niger

Summary of research.

Issue 33, June 2008 (page 11)

RUTF use in adults in Kenya

Summary of meeting abstract.

Issue 34, October 2008 (page 10)

Scaling up the treatment of acute childhood malnutrition in Niger

This article presents a strong case from Niger that managing severe malnutrition on a large scale through outpatient treatment is a real possibility.

Issue 28, July 2006 (page 3)

Socio-Anthropological Aspects of Home Recovery from Severe Manutrition

This article shares the experiences of a programme- based field study in Makeni, Sierra Leone, which looked at how home based rehabilitation of severe malnutrition was perceived, and whether it was more acceptable and beneficial than centre-based management in this context.

Issue 21, March 2004 (page 24)

SQUEAC: Low resource method to evaluate access and coverage of programmes

Centric Systematic Area Sampling (CSAS) was developed to estimate coverage of selective feeding programmes.

Issue 33, June 2008 (page 3)

Supplementary feeding using RUTF in Malawi

Summary of published research.

Issue 29, December 2006 (page 13)

Taking forward research on adult malnutrition

Adult malnutrition was initially put on the agenda of the United Nations Standing Committee on Nutrition (UNSCN) Working Group on Nutrition in Emergencies meeting in April 1999.

Issue 22, July 2004 (page 11)

Temporal Integration - Demand driven CTC (Special Supplement 2)

Early CTC programmes prioritised the timely provision of an appropriate level of care to a large proportion of the target population and monitored this using the standard SPHERE indicators plus assessments of coverage.

Supplement 2, November 2004 (page 53)

The application of minimum standards during crisis - A practitioner ’s perspective, southern Sudan 1998/9

The Sphere Project was launched in 1997 to develop a set of universal minimum standards in core areas of humanitarian assistance.

Issue 11, December 2000 (page 15)

The Cost of Selective Feeding (Special Supplement 2)

The aim of this paper is to present the cost per beneficiary of CTC and discuss aspects of these costs, underlying assumptions and other factors and issues affecting cost.

Supplement 2, November 2004 (page 39)

The CTC Advisory Service: Supporting the Countrywide Scale-up of CTC in Malawi

In response to a food shortage in 2002, Concern Worldwide and Valid International piloted a Community-based Therapeutic Care (CTC) project in two districts in Malawi.

Issue 35, March 2009 (page 18)

The Management of Persistent Diarrhoea and Malnutrition:

Peter Sullivan from the Department of Paediatrics, University of Oxford presented a paper on 'the Management of Persistent Diarrhoea and Malnutrition (PDM) at the International Child Health Group Meeting on Managing Childhood Malnutrition: in Birmingham. .

Issue 4, June 1998 (page 10)

Therapeutic feeding centres - Routine Antibiotics ?

Routine prescription of antibiotics to all TFC admissions regardless of clinical presentation (as recommended by WHO protocol ) seems rather extreme. What are the benefits and risks involved?.

Issue 4, June 1998 (page 23)

Therapeutic Feeding in an Insecure Area

Liberia has a history of virtually continuous civil war since 1989. Some say that 75% of the population of 2 million are or have been displaced during that time. The most recent agreement between the warring factions (Abuja Accord 2, signed in August 1996) allowed for disarmament (Nov. 22 '96 to Jan. 31 '97) followed by elections which resulted in the election of Charles Taylor as President.

Issue 2, August 1997 (page 17)

Therapeutic Feeding: Imported Versus Local Foods

Steve Collins recently drew attention to a situation in Haiti where the only food being used (i.e.,F100) in the treatment of severe malnutrition became unavailable. Health staff subsequently adopted dangerous treatment approaches (i.e., dextrose-saline drips) which resulted in higher mortality rates (>70%) amongst kwashiorkor patients.

Issue 4, June 1998 (page 30)