This intent-to-treat study was designed to compare the relative effectiveness and costeffectiveness
of four food aid products for the treatment of moderate acute malnutrition
(MAM) in Sierra Leone. While several products exist to treat MAM, including various
formulations of fortified blended foods (FBFs) and ready-to-use supplementary foods (RUSFs),
studies to date have provided mixed evidence on effectiveness, and few studies have addressed
the question of cost-effectiveness in any depth.
A cluster randomized effectiveness trial was started in Sierra Leone in January 2014. Inclusion
criteria for the study were: age six months up to five years; mid-upper arm circumference
(MUAC) ≥ 11.5 cm and < 12.5 cm; and receiving food from only one supplementary feeding
program (SFP). The study site was Kenema District, where participants received one of four
supplementary foods designed to treat MAM from a SFP based in a clinic setting. Three of these
foods—Super Cereal (SC), Super Cereal Plus (SC+), and a RUSF—are commonly used. The
fourth food, Corn Soy Blend 14 (CSB14)1
, was developed based on nutritional
recommendations of the Food Aid Quality Review Phase I (FAQR) [1].
SFP clinic sites were cluster randomized to receive one of the four foods. From January to July
2014, a total of1,327 children with MAM were eligible for enrollment. Participating children
received a ration every two weeks, for up to 10 weeks or until one of the following outcomes
was reached: recovered from MAM; developed severe acute malnutrition (SAM); transferred to
inpatient care; default2
; or death. The study foods were similar in energy and protein with the
exception of RUSF, which provided roughly half as much energy and protein. The foods were
not isocaloric, but were consistent with normal programmatic standards of WFP. WFP
provides larger quantities of foods that require preparation, as the foods are expected to be
shared more than foods that do not require preparation.
The study originally planned to enroll participants until March 2015. However, due to an Ebola
virus outbreak in the research area, the study was terminated in July 2014. Early termination of
the study meant the target sample size of 5,000 was not reached, leaving 1,135 children who
completed the study. Additionally, much of the planned data collection was truncated.