Supplementary Feeding of Moderately Wasted Children in Sierra Leone Reduces Severe Acute Malnutrition and Death When Compared to Nutrition Counseling: a Retrospective Cohort Study

Abstract

Abstract Background There is uncertainty about whether children with moderate wasting should receive supplementary feeding. Objectives We examined whether supplementary feeding compared to counseling alone in children with moderate wasting prevented progression to severe acute malnutrition (SAM) or death. Methods This was a retrospective, dual cohort study in which 1,791 children with moderate wasting were drawn from two prior randomized controlled trials that took place in the same location in rural Sierra Leone. 1,077 children received supplementary feeding, while 714 children received counseling alone. Children in both cohorts were followed for at least 24 weeks from enrollment. The primary outcome was time to SAM or death using Kaplan-Meier analysis. Secondary outcomes included time to death as well as proportions of children with healthy mid-upper arm circumference (MUAC), moderate wasting, SAM, or death at 6, 12, and 24 weeks from enrollment. Results Children who received supplementary feeding were less likely to develop SAM or die across the entire follow-up period (HR 0.53, 95% CI 0.44, 0.65, P < 0.001). Time to event for death alone also revealed a lower risk for children who received supplementary feeding (HR 0.52, 95% CI 0.28, 0.94, P = 0.03). Children who received supplementary feeding were more likely to have a healthy MUAC at 6 weeks (RR 2.0, 95% CI 1.7, 2.2) and 12 weeks (RR 1.3, 95% CI 1.2, 1.5), were less likely to develop SAM at 6 (RR 0.7, 95% CI 0.6, 0.9), 12 (RR 0.5, 95% CI 0.3, 0.8), and 24 weeks (RR 0.2, 95% CI 0.1, 0.5), and had higher rates of gain in weight and MUAC at 6 and 12 weeks. Conclusions Supplementary feeding of children with moderate wasting reduces risk of SAM and death across 24 weeks of follow-up.