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Abstract Severe acute malnutrition (SAM) remains a major global public health problem. SAM cases are treated using ready‐to‐use therapeutic food (RUTF) at a dosage of ∼200 kcal/kg/day per the standard treatment protocol (STD). Emerging evidence on simplifications to the standard protocol, which among other adaptations, includes reducing the daily RUTF dosage, indicates that it is effective and safe for treating children with SAM. In response to a foreseen stock shortage of RUTF, the government of Afghanistan endorsed the temporary use of a modified treatment protocol in which the daily RUTF dosage was prescribed at 1000 kcal/day (irrespective of body weight) until the child achieved moderate acute malnutrition status (weight‐for‐height z ‐score ≥ −3 or mid‐upper arm circumference MUAC ≥ 115 mm), at which point 500 kcal/day was prescribed until cured (modified treatment protocol MTP). In this paper, we report the results of this nonweight‐based daily RUTF dosage experience. Data of 2042 children with SAM, treated using either the STD protocol ( n = 269) or the MTP protocol ( n = 1773) from August 2019 to March 2021 in five provinces, were analyzed. The per‐protocol analyses confirmed noninferiority of MTP protocol when compared to STD protocol for recovery rate 93.3% vs. 90.2%; ∆ (95% confidence interval, CI) = 3.1 (−0.9; 7.2) % and length‐of‐stay 82.6 vs. 75.6 days; ∆ (95% CI) = 6.9 (3.3; 10.5) days, considering the margin of noninferiority of −10% and +14 days, respectively. Weight gain velocity was smaller in the MTP protocol group than in the STD protocol group 3.7 (1.7) vs. 5.2 (2.9) g/kg/day; ∆ (95% CI) = −1.5 (−1.8, −1.2); p < 0.001. The STD group had a significantly higher mean than the MTP group for absolute MUAC gain ∆ (95% CI) = 1.7 (1.0; 2.3) mm; p < 0.001 and the MUAC velocity ∆ (95% CI) = 0.29 (0.20; 0.37) mm/week; p < 0.001. Our results confirm the noninferiority of a nonweight‐based daily dosage and support the endorsement of this modification as an alternative to the standard protocol in resource‐constrained contexts.
Bahwere et al. (Tue,) studied this question.