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Preventive Nutrition Intervention Program Yields More Than Traditional Recuperative Model
When preventing undernutrition, it is more effective to focus on
children who are at risk earlier than to attempt recuperative programs
on children already affected. A preventive nutrition
intervention program was analyzed in the February 16, 2008 issue of The
Lancet, in a follow up of the recent Lancet
Series on Maternal and Child Undernutrition.
Dr. Marie Ruel, of the Food Consumption and Nutrition Division, part of
the International Food Policy Research Institute in Washington, DC,
USA, worked with colleagues to perform a cluster randomized trial of
both of these methods of intervention in Haiti. In the preventive
model, all children from 6-23 months old were addressed, while the
recuperative model targeted only underweight children aged 6-60 months.
The models also addressed pregnant and lactating women.
Communities were paired together based on the accessibility to various
services and several other factors. Then, models were randomly assigned
to each cluster. Through two cross-sectional surveys, taken at a
baseline and then after three years, differences in undernutrition were
measured in children aged 12-41 months. At these points, several
indications of undernutrition were observed.
No differences were found between the program groups at the baseline.
After follow up, stunting, being underweight, and wasting were
approximately 5 percentage points lower in the preventative rather than
recuperative communities. Mean anthropometric indicators were higher in
the preventive group as well: weight for age and weight for height by
0.24 Z scores. Height for age was higher by 0.14 Z scores in the
preventive group, but this is not statistically significant. The
preventive program showed greater effects for children given the full
span of 6-23 months than children who were delivered therapy for a
shorter period of time. The quality of each of the programs was not
different, and the use of services for maternal and child health and
nutrition were comparable.
In conclusion, the authors believe that the preventive program can
yield more effective results: "This study shows, using a
cluster-randomized trial, that an age-based preventive model for
delivering a package of food assistance and maternal and child health
and nutrition interventions was more effective at reducing childhood
undernutrition than the traditional, recuperative model based on
targeting underweight children."
Howard White, Independent Evaluation Group, World Bank, Washington, DC,
USA, wrote a Comment accompanying the article. He states that the study
showed that a universal approach could be superior to a targeted one,
and that randomized trials can be used for social programs in
developing countries. That said, he also raises concerns about the
experimental design of the study, specifically in the lack of a control
group and that the researchers did not examine whether implementation
differences explain the relative underperformance of the recuperative
model.
Age-based preventive targeting of food assistance and
behaviour change and communication for reduction of childhood
undernutrition in Haiti: a cluster randomised trial
Marie T Ruel, Purnima Menon, Jean-Pierre Habicht, Cornelia Loechl,
Gilles Bergeron, Gretel Pelto, Mary Arimond, John Maluccio, Lesly
Michaud, Bekele Hankebo
The Lancet, Vol. 371, Issue 9612, 16 February 2008,
Pages 588-595
Click
Here For Abstract
Written by Anna Sophia McKenney
Copyright: Start Sanatate
Not to be reproduced without permission of Start Sanatate
Programul de prevenire hrana randamentelor mai mult de modelul tradiþional regenerativ - Preventive Nutrition Intervention Program Yields More Than Traditional Recuperative Model - articole medicale engleza - startsanatate