Children have (MAM) which is also known as moderate acute malnutrition are often treated with fortified blended flours commonly known as (CSB) which stands for corn-soy blend. CSB is made from locally available low cost ingredients that are accepted in many settings. There is an estimated 35 million children that suffer from Mam and are left and are left with infective therapy CSB and fewer children receive a cost but effective alternative RUSF. The World Food Bank attempted to bridge the gap with a revised CSB recipe, “CSB++” and it includes dry skim milk and is more energy dense. It is designed for targeted therapy with MAM and for children feeding vulnerable aged 6 months to two years.
The World food bank attempted to bridge the gap with a revised CSB recipe, The Scientific Question is that since the World Food Bank attempted to revise the CSB is it almost as good as the RUSF. RUSF is an effective alternative but is more costly but can “CSB++” almost as effective even though it costs less.
In the trial 2 RUSF products will be tested with the CSB++ product and will determine weather, The Authors hypothesis is that CSB++ will not be > 5% worse that what is achieved by either of the RUSFs is correct.
Subjects and Methods:
Children aged 6-59 months with MAM “(WHZ <-22 and > or = 23 without bipedal edema) were in feeding clinics in Southern Malawi. Children had peanut, a chronic illness that didn’t include HIV or tuberculosis, involved in another research trial, supplementary feeding program, or received therapy for acute malnutrition with one month before presentation were excluded in the study.
The Study was a randomized, investigator-blinded, controlled trial that assessed the treatment of MAM with CSB++ for a period <=12 and use the 2 RUFS products as active comparators. “Children were defined as having recovered when they reached a WHZ !22; otherwise, they were categorized as having continued MAM despite 12 wk of therapy, had developed SAM (WHZ ,23 and/or pedal edema), were transferred to inpatient care, died, or defaulted (did not return for 3 consecu- tive visits). ” Secondary outcomes included time to recovery and rate of adverse events. The planned sample size was 900 children in each study arm. A block randomizer is also by creating a random number generalizer.
In table 3 here are the following results the plementary foods: 85.9% for CSB++ (95% CI: 83.5%, 88.1%), 87.7% for soy RUSF (95% CI:85.5%, 89.8%), and 87.9% for soy/whey RUSF (95% CI: 85.7%, 89.9%), so the recovery rates were really close and the CSB++ received a higher recovery rate. In figure 2 the mean duration of treatment required to receive was 23d, children who received CSB++ took an average of on average 2 days longer to recover. There was no significant difference in the HFAIS category at enrollment.
The conclusions that the authors came up as a result from the experiment was that fortified blended flour CSB++ was not inferior to the locally produced soy RUSF and the imported soy/whey RUSF and was effective in facilitating recovery from MAM. The recovery rate observed in CSB++ was higher than in any fortified flour blended previously.
The recovery rate for the CSB++ is n= 763 of 888, 85.9%, while the recovery rate for soy RUSF, 795 of 806, 87.7%, risk difference, 21.82%;,95% CI: 24.95%, 1.30% and soy/whey RUSF , 807 of 918, 87.9%, risk difference: 21.99%; 95% CI:,25.10%, 1.13% so they were very similar. The data seemed to support the authors hypothesis that CSB++ can be as effective as the RSF. The article mentioned that the data seemed to be pretty strong and they people giving the experiment tried very hard to get accurate results.
Fortified blenders including CSB++ has limitations they require preparation and are similar in taste and appearance to staple foods which and encourage sharing. Children treated with CSB++ have to eat 8 times as much food as Children treated with RSF. The people. . Another limitation is that if the child was a twin an additional supply of food was given to a caretaker to ensure that the child received a full ration and limit of sharing between twins, 2 children in the same household also revive the same type of food.
They can do various things in the study they and provide incentives like food or money and educate people on “CSB++” vs. RSF and tell the. There could be a bigger sample size that can include more malnutrition in multiple parts of the world for example they can run one controlled test in Ghana and one in Zimbabwe as well. They can avoid people with HIV in the study as well. I also wondered if they can repeat the study as well.