National University of Rwanda Family and Community Medicine

Efficacy of Home Based Management of Malnutrition Using Ready to Use Therapeutic Food in Rwanda
Muhanga District
Dr KABERA Ren Supervisor Prof Munyanshongore Cyprien

Kigali,11 July 2012

Plan
Introduction Objective Justification Methodology Results Conclusion and Recommendations Acknowledgement

Introduction
The Management of severe and moderate malnutrition in emergencies includes setting up Therapeutic Feeding Centers (TFCs) in Hospitals. Recovery and clinical outcomes in TFCs managed by experienced agencies has been positive. TFCs are difficult to establish, expensive to operate, and they often have very limited coverage.

Introduction
Community Therapeutic Care (CTC) is a new approach to manage acute malnutrition in emergencies and beyond, CTC aims at treating the majority of the severely malnourished children at home, Build local capacity to better manage care of acutely malnourished children and uses ready to use therapeutic food (RUTF).

Objective
To evaluate the efficacy of the home based therapy with RUTF for children with malnutrition in Muhanga District.

Justification
Malnutrition is among the most common disease condition in our daily medical practice. Many Health Centers have been using the classic F-75 and F-100 (liquid) for treating malnutrition. Input from the new management with RUTF has brought to our system.

Methodology
Study design The study is a controlled, comparative clinical effectiveness trial Comparing a group of children (12-60 months) treated with RUTF versus the standard management of malnutrition in TFCs without medical complications. From May to October 2011

Methodology
Sample size Alain Bouchard formula No = t2(p)(1-p)/d2 n is the sample size, N is the size of the population, No is the sample size of a defined population, d is the error term that is estimated 5%, p is the estimated frequency of the sample with size n, while t is the figure obtained from the t-student's table. Our population is 125 children

Table of Alain Bouchard

Population infinie Marge derreur 10% 5% 90% 1% 10% 5% Prcision 95% 1% 10% 5% 99% 1%

1000000 500000 100 000 50 000 10 000 5 000 1 000 5 00 100 50

68 68 68 68 67 67 63 60 41 29

271 271 270 269 263 257 313 176 73 42

6.765 6.720 6.336 5.999 4.035 2.875 871 281 99 50

96 96 96 95 95 94 88 94 49 33

384 384 383 381 370 357 278 357 80 40

9.604 9.513 8.763 8.057 4.899 3.288 906 328 99 50

166 166 166 165 165 161 142 161 63 39

661 663 659 655 622 586 399 586 87 47

16.589 16.589 14.229 12.459 6.239 3.442 943 344 99 50

Methodology
Materials A Questionnaire Data entry with Epi-Data 3.1 software Microsoft Word 2010 for texts Microsoft Excel 2010 for tables. SPSS 20 for analysis WHO Anthro II software for Z Scores The difference is statistically significant if p<0.05 for the Pearson test.

Methodology
Utilization of expected findings Figures from the study will show a clear image of the Home based management of malnutrition in Muhanga District. Stakeholders can utilize our study as tool in making some decisions for improving the system and prepare a study including many sites in Rwanda.

Results

Variables Group F100 RTUF Total

Frequency

Percent

58 67 125

46.4 53.6 100

Results

Age group (months ) % 12-24 25-36 37-48 64 33 23

N 51.2 26.4 18.4

49-60
Total

5
125

4
100

Results

Sex Male Female Total

N 70 55 125

% 56 44 100

Results

Breastfeeding N Breastfed Not breastfed Total 64 61 125

%
51.2 48.8 100

Results

Malnutrition N
Moderate 62

% 49.6

Severe
Total

63
125

50.4
100

Results
Outcome Outcome Group population Group population F100 F100 % % Recovered Recovered Failed Failed 77.5 (45) 77.5 (45) 12 (7) 12 (7) RUTF RUTF % % 88 88(59) (59) 0 (0) 8782 8782 0.032 0.032 Pearson ChiP Chi- square square P value P value

0 (0) 4.5 (3) 7.5 (5)

100%(125)

Referred
Dropped out

Referred

5.1 (3)
5.1 (3)

5.1 (3)

4.5 (3) 7.5 (5)

Dropped out
Total

5.1 (3)

100 (58)

100 (67)

Total

100 (58)

100 (67)

100 (125)

Results
Gp population P Chi-Square

P value

F100 Rehab. pd(days) <15 3 15-30

>30 Total

RTUF
1 17.269 0.001

37
12 52

58
0 59 111

Results

Weight gain (g/kg.d) RUTF

F100

P Chi square 3
29 20 0 52

P value 0.001

No weight gain
0.10-5.00 5.10-10.00 10.10-15.00 Total

0
11 41 7 59

21.946

111

Results
Group F100 Mean N Std. Deviation Minimum Maximum Range Mean N Std. Deviation Minimum Maximum Range Weight at entry Weight at exit Weight Gain 8019.231 8876.923 4.3544 52 52 52 f 38.842 sign 0.001

RUTF

1439.232 5400 11300 5900 8579.661 59

1490.751 6000 12200 6200

1534.009 6300 12100 5800 9710.17 59

1512.898 7600 13200 5600

2.07504 0 9 9 6.9675 59
2.31189 3.1 12.8 9.7

Results

Group

Rehabilit per.Mean (days) 25.8462

Std. Deviation Minimum Maximum

Sig.

F100

52

7.65784

15.00

45.00

33.788

0.001

RTUF

19.5763

59

2.97810

15.00

25.00

Total

22.5135

111

6.46088

15.00

45.00

Conclusion
The RUTF is more efficient than the standard management of malnutrition RUTF are facing stock out periods

Recommendations
Use RUTF in countrywide as a home based management Make RUTF available in all different health centers. Conduct a national survey. Implementation of Home based treatment of malnutrition policy. Teaching and sensitization about food preparation are needed.

Acknowledgement
Government of Rwanda Family and Community Medicine Program Prof Munyanshongore Cyprien

Thank you