Abstract
BackgroundWorld Health Organization now recommends the transition from F-75 to ready-to-use therapeutic foods (RUTF) in the management of severe acute malnutrition (SAM). We described the transition from F-75 to RUTF and identified correlates of failed transition.MethodsWe conducted an observational study among children aged 6–59 months treated for SAM at Mulago hospital, Kampala, Uganda. Therapeutic feeding during transition phase was provided by first offering half of the energy requirements from RUTF and the other half from F-75 and then increasing gradually to RUTF as only energy source. The child was considered to have successfully transitioned to RUTF if child was able to gradually consume up to 135 kcal/kg/day of RUTF in the transition phase on first attempt. Failed transition to RUTF included children who failed the acceptance test or those who had progressively reduced RUTF intake during the subsequent days. Failure also included those who developed profuse diarrhoea or vomiting when RUTF was ingested.ResultsAmong 341 of 400 children that reached the transition period, 65% successfully transitioned from F-75 to RUTF on first attempt while 35% failed. The median (IQR) duration of the transition period was 4 (3–8) days. The age of the child, mid-upper arm circumference, weight-for-height z-score and weight at transition negatively predicted failure. Each month increase in age reflected a 4% lower likelihood of failure (OR 0.96 (95% CI 0.93; 0.99). Children with HIV (OR 2.73, 95% CI 1.27; 5.85) and those rated as severely ill by caregiver (OR 1.16, 95% CI: 1.02; 1.32) were more likely to fail. At the beginning of the rehabilitation phase, the majority (95%) of the children eventually accepted RUTF while only 5% completed rehabilitation in hospital on F-100.ConclusionTransition from F-75 to RUTF for hospitalized children with SAM by gradual increase of RUTF was possible on first attempt in 65% of cases. Younger children, severely wasted, HIV infected and those with severe illness as rated by the caregiver were more likely to fail to transit from F-75 to RUTF on first attempt.
Highlights
World Health Organization recommends the transition from F-75 to ready-to-use therapeutic foods (RUTF) in the management of severe acute malnutrition (SAM)
We do not know the proportion of the children are mostly likely to fail to transit from F-75 to RUTF on first attempt
This study provides evidence that supports the direct transition from F-75 to RUTF and subsequently these children are managed in the out-patient therapeutic programmes
Summary
World Health Organization recommends the transition from F-75 to ready-to-use therapeutic foods (RUTF) in the management of severe acute malnutrition (SAM). Patients with severe acute malnutrition (SAM) are classified into those with and without medical complications depending on the presence of medical illness and/or integrated management of childhood illness (IMCI) danger signs. Transition phase feeding refers to the feeding regimen offered to children during the transition phase [4] During this phase, the therapeutic feed is gradually changed from F-75 to F-100 or RUTF. WHO suggests a slow and gradual transition phase feeding in which F-100 or ready-to-use therapeutic food (RUTF) is introduced in an equal volume as F-75 for 2– 3 days before offering larger volumes intended for catchup growth in the rehabilitation phase [3]
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