Greco L et al. (2006) Effect of a low-cost food on the recovery and death rate of malnourished children. J Pediatr Gastroenterol Nutr 43: 512–517

A new study has highlighted the importance of using locally available ingredients to develop nutritious foods that prevent and treat malnutrition. Current WHO guidelines recommend that severely malnourished children initially receive F75 milk (of moderate energy and protein content), followed by F100 milk (once they can tolerate its increased energy and protein levels). Over 90% of Africans carry a polymorphism that causes lactose intolerance, however, and malnourished children often respond poorly to milk-based feeding alone. An imported supplemental food (a spread) is available, but is expensive, unavailable outside hospitals, and unacceptable to patients because of local food preferences.

Greco et al. retrospectively reviewed medical records of three cohorts of 100 children aged 6 months to 6 years, randomly selected from those treated for malnourishment in October–December of successive years. The 2001 cohort received milk-based feeding according to WHO guidelines only, whereas the 2002 and 2003 cohorts additionally received two daily 150 g servings of a local food-supplement porridge, consisting of carbohydrate (maize, corn or millet flour), protein (powdered fish, chicken, beef or beans), and fat (peanut butter and vegetable oil). The porridge was acceptable to both children and their mothers, and mothers participated in making it before their children were discharged.

Children who received the porridge did better than those given only milk-based feeding: their edema disappeared more rapidly, and they put on more weight daily. Crucially, the treatment-failure rate (deaths and withdrawals from treatment) declined by >50% after the porridge was introduced.