Efficacy of a Nutritional Intervention in Children with Moderate Acute Malnutrition: A Randomized Controlled Trial in Sri Lanka During the Economic Crisis in 2023

Abstract

Introduction

Undernutrition continues to be a significant public health concern, particularly among children under 5 years.

Objectives

This study evaluated the efficacy of an additional nutritional intervention in improving growth parameters, dietary diversity and hemoglobin levels in children aged 6 to 59 months with moderate acute malnutrition (MAM) during the 2023 economic crisis in Sri Lanka.

Methods

This was a randomized-controlled trial, and children with MAM were randomly allocated to either the intervention group, receiving additional food transfers and nutrition education, or the control group, receiving standard care. The outcomes were improvement in growth parameters, dietary diversity, and hemoglobin levels. Regression analysis was used to adjust for potential confounding variables. A total of 510 children were enrolled and followed for 6 months. The intervention group showed a significant proportion of children improving to normal weight-for-height Z-scores than the control group in addition to the improvement in dietary diversity. However, the 2 groups had no significant difference in stunting and underweight.

Conclusions

The nutritional intervention improved weight for height z-scores and dietary diversity in this cohort of children with MAM. The study highlights the importance of targeted nutrient-adequate food security interventions in undernourished children during crises to support their nutrition rehabilitation effectively.

Plain language summary

Undernutrition continues to be a significant public health concern in Sri Lanka despite the considerable progress the country has made in reducing maternal and child mortality. Compared to 2021, by 2023, the proportion of children under 5 with growth faltering, underweight, wasting and stunting has increased. This study focused on young children, aged 6 to 59 months, who were moderately undernourished. The main aim was to evaluate the efficacy of food-in-kind assistance and nutrition education to reach a healthier weight and height over a period of 6 months during the economic crisis in Sri Lanka in 2023. The study involved comparing 2 groups of malnourished children. The control group received standard care, which included food assistance and monthly educational sessions on topics like breastfeeding and child development. The experimental group received the same standard care plus additional support. This extra support included a food basket every 2 weeks, a recipe booklet, and cooking demonstrations to help parents prepare nutritious meals at home. We measured changes in weight, height, and various nutritional and health scores, such as weight-for-age, height-for-age, and weight-for-height ratios. Additionally, it assessed improvements in dietary diversity, which is an indicator of household food security. In total, 510 children participated and were followed for 6 months. The intervention group showed a significant improvement in weight-for-height and dietary diversity compared to the control group. However, there was no significant difference in stunting and underweight between the 2 groups. The study highlights the importance of targeted food security interventions during crises to help undernourished children recover effectively.