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PubMed1983

An evaluation of supplementary feeding in Somali refugee camps.

Supplementary feeding programmes (SFP) that were functioning in Somali refugee camps were evaluated in March 1981 in order to describe their process of operation and to measure their effect on the refugees' nutritional status. While those children enrolled in SFPs gained weight, many malnourished children in camp had not been identified so that the programme's overall effectiveness was reduced. Even among children who attended SFPs regularly, the rate of weight gain diminished rapidly each succeeding month of attendance. This underlines that supplementary feeding is a short-term, remedial measure in disaster relief and should be quickly incorporated into a broader plan for relief assistance so that resources can be used most efficiently.

Body Height↗
PubMed1997

Assessment of a take home child supplementary feeding programme in a high density suburb of Mutare City, Zimbabwe.

OBJECTIVE: Assessment of a child supplementary feeding programme. SETTING: Mutare City Health Department has a long existing, ongoing supplementary feeding programme for undernourished children. We assessed the programme in Sakubva, Mutare's oldest, largest, poorest and most densely populated high density suburb. During the time of assessment, after the 1994/95 poor rainy season, levels of undernutrition were more that double the normal levels. DESIGN: Analysis of clinic records. Results are illustrated with findings from students on attachment who studied underlying causes of undernutrition. SUBJECTS: The supplementary feeding programme is a health service to underweight children who attend our clinics. Assessment of the programme was done on all children that regularly made use of this service between July 1995 and May 1996 in Sakubva (n = 190). RESULTS: The child supplementary feeding programme does make an impact as 83% of the children attending regularly, improve. The impact of a child supplementary feeding programme in terms of growth development in undernourished children depends on the underlying chronic diseases that the children are presenting. CONCLUSIONS: Referral of children that do not improve for check up and treatment is urgent and should be a routine procedure in Well Baby Clinics. In an environment of poverty and poor weaning practices, often aggravated by underlying illnesses, a child supplementary feeding programme can improve growth in undernourished children, within the limitations of its coverage.

Child Nutrition Disorders↗
PubMed2005

Community-based supplementary feeding for promoting the growth of young children in developing countries.

BACKGROUND: Supplementary feeding is defined as the provision of extra food to poor children or families beyond the normal ration of their home diets. The impact of food supplementation on child growth merits careful evaluation in view of the reliance of many states and NGOs on this intervention to improve child health in developing countries. OBJECTIVES: To evaluate the effectiveness of community-based supplementary feeding for promoting the physical growth of pre-school children in developing countries. SEARCH STRATEGY: Searches of CENTRAL 2005 (Issue 2), MEDLINE 1966 to 2005, EMBASE 1980 to 2005, CINAHL 1982 to 2005, LILACS 1982 to 2005, Social Science Citation Index 1956 to 2005, and Dissertation Abstracts International (late 1960s to 2005) were conducted. SELECTION CRITERIA: Randomised controlled trials evaluating supplementary feeding in children aged 0-5 years old in developing countries. DATA COLLECTION AND ANALYSIS: Data were extracted and analysed independently by two authors. MAIN RESULTS: Four trials met the inclusion criteria for this review. No meta-analysis is currently appropriate due to the clinical heterogeneity among the included studies. We group these trials into two categories: a) studies without formally assessment of malnourishment at baseline and, b) studies involving children formally assessed as malnourished.a) A cluster RCT conducted in Indonesia in 1991(20 Day Care Centres, n = 113 children), found no benefit in weight-for-age and height-for-age z-scores of the intervention group compared to the control group after three months of intervention. A study in Guatemala included four villages as unit of analysis (exact sample sizes were not provided). The length of 3-yr-old children was based on a 'before-after comparison' by village size and type of supplement. According to this analysis, the difference in net change in the large villages was 2.55 cm and in the small villages was 2.35 cm. The mean of these differences is 2.45 +- 0.10 cm (mean +- SD).b) A study conducted in Jamaica (n = 65 children) reported a positive effect on length (cm) in the supplemented group compared to controls [WMD 1.3 (0.03 to 2.57)] after 12 months of intervention. A trial from Indonesia (n = 75 children) found no benefit in growth after 12 months of supplementation. AUTHORS' CONCLUSIONS: Based on the small number of available trials, no firm conclusions of the effectiveness of supplementary feeding to the growth of pre-school children could be drawn. Issues of research design such as blinding and sample size calculation need to be addressed in future studies.

Child↗
PubMed2001

A pilot study to assess the viability of a randomised controlled trial of methods of supplementary feeding of breast-fed pre-term babies.

OBJECTIVES: to compare the impact of two methods of supplementary feeding of pre-term babies (bottle vs cup) on subsequent breast feeding and to assess the feasibility of using a randomised controlled trial (RCT) to investigate the topic. DESIGN AND METHOD: small scale prospective RCT. Data on breast feeding, as defined as the exclusive method of feeding, were collected. A range of relevant bio-data was also collected and their impact on breast feeding assessed. SETTING: a special care baby unit in a District General Hospital in the UK. PARTICIPANTS: over a three-month period, all pre-term babies (32-37 weeks' gestation) who fulfilled the inclusion criteria and has been born to mothers who had expressed a pre-partum desire to breast feed, who had consented to take part, were included (n=14). PROCEDURE: the eligible babies were randomly allocated to supplementary feeding of breast milk, via either a cup or a bottle. Whether or not the baby was being breast fed at discharge was noted. FINDINGS: the study suggested that this RCT framework is a viable method of investigating baby feeding. Because of the small-scale nature of the project, the actual database must be treated with extreme caution. No significant differences were found between the two groups in terms of breast feeding. However, the mothers reported high levels of support and also the breast-feeding rates were above the national averages. These two findings could have contributed to the non-significant results observed in this analysis. CONCLUSIONS: if the present findings could be supported by further research, then the non-significant results relating method of supplementary feeds to subsequent breast feeding could be explained by reference to three factors. Firstly, there is, in fact, no real effect of method of supplementary feeding and subsequent breast feeding; secondly, the method adopted differed from existing research and thus may be expected to produce non-corroborative results; and finally, the overall levels of breast feeding within the Unit generally were higher than the national average. The relevance of the RCT for investigating this subject is also discussed with reference to the present data set. Further experimental work to develop these ideas and to identify causal links is required.

Bottle Feeding↗
PubMed1996

Effect of supplementary feeding during the sucking period on net absorption from the small intestine of weaned pigs.

An intestinal perfusion technique was used to measure the effects of supplementary feeding (experiment 1) and temporary weaning (experiment 2) during the sucking period on the net absorption of fluid, sodium, chloride and potassium from the small intestine of pigs after weaning. The technique was also applied to control pigs which did not receive supplementary feed and were not temporarily weaned during the sucking period. Paired intestinal segments were prepared at five sites along the small intestine in each of 80 pigs in experiment 1 and 36 pigs in experiment 2. The cranial segment of each pair was infected with enterotoxigenic Escherichia coli (ETEC). In both experiments, four days after weaning, the net absorption of fluid, sodium and chloride in the uninfected segments was in general significantly less in all the pigs than at weaning or seven, 11 and 14 days after weaning and it was significantly greater in the pigs given supplementary feed than in the other pigs. Net absorption values in the infected segments of the control pigs were less four days after weaning than on the day of weaning. No differences were found between pigs that were temporarily weaned or not and those that were not fed during the sucking period. Supplementary feeding during the sucking period partially prevented the decrease of net absorption usually observed after weaning in uninfected and in ETEC-infected segments of intestine.

Animals↗
PubMed1982

Provocation of allergic response by supplementary feeds of cows' milk.

The postweaning IgE and IgG antiovalbumin antibody responses were greater in rat pups which had received a cows' milk-based supplementary feed than in litter mates which had not. This effect was antigen non-specific and might be similar to that of supplementary feeds in the development of atopy in human infants. The total IgE concentration was similar in the two groups. Supplementary feeds did not increase the low values of IgE antiovalbumin in rats suckled by mothers immunised to ovalbumin.

Animal Population Groups↗
PubMed1988

Effects of supplementary feeding around lambing time on the productivity of Javanese thin-tail ewes.

The extent to which ewe reproduction could be improved by supplementary feeding around lambing time was investigated with four groups each of 16 ewes which were run continuously with fertile rams until they had lambed three times. One group was fed at a maintenance level throughout and the other three groups were given supplementary feed during the last four week of each pregnancy only, or during the last four weeks of pregnancy plus the first six weeks after each lambing, or during the last four weeks of pregnancy plus the first 12 weeks after each lambing. The average body weight of lambs weaned at 13 weeks of age increased (P less than 0.001) progressively from 6.0 to 9.1 kg with increasing duration of supplementary feeding. There were however no significant differences between treatment groups in mean interval between successive lambings (202 days), ovulation rate (2.26), litter size (1.58), lamb birth weight (1.8 kg), preweaning lamb mortality (37%) or number of lambs weaned per lambing (0.99).

Animal Feed↗
PubMed2003

Effect of supplementary feeding on the prevention of mild-to-moderate wasting in conditions of endemic malnutrition in Guatemala.

OBJECTIVE: To estimate the effect of supplementary feeding on the prevention of wasting in preschool children in a rural area of Guatemala with a high prevalence of malnutrition. METHODS: Children aged 6-48 months, with a weight-for-length exceeding 90% of that of the median NCHS/WHO/CDC reference population, received either Atole, a drink with a high protein and moderate energy content, or Fresco, a drink with no protein and a low energy content. Children consuming amounts of Atole equivalent to more than 10% of the age-adjusted recommended dietary intake for energy were termed "supplemented." A comparable group of children consuming Fresco was termed "non-supplemented". The energy intake in the supplemented group was higher than that in the non-supplemented group by 16-18% of the recommended daily intake. The corresponding difference in protein intake was 45-80% of the recommended daily intake. The children were followed up at intervals of three or six months in order to evaluate their weight-for-length development. The difference between supplemented and non-supplemented children in the proportions maintaining their weight-for-length category at the end of the study intervals represented the prevention of wasting attributable to supplementary feeding (attributable prevention). Households were used as units of analysis in order to avoid cluster effects. FINDINGS: The attributable prevention in children aged 6-24 months with weight-for-length between 90% and 99.9% of the reference population at entry ranged from 0.21 to 0.26 and was statistically significant after three and six months of supplementation. However, it was not significant in children at or above 100% weight-for-length or in older children. Children above 100% weight-for-length did not become overweight as a result of supplementation. CONCLUSION: Supplementary feeding of children aged 6-24 months in populations with inadequate dietary intakes can prevent the onset of wasting in a large proportion of children.

Body Weight↗
PubMed2004

The effect of supplementary feeding on the resilience and resistance of browsing Criollo kids against natural gastrointestinal nematode infections during the rainy season in tropical Mexico.

The objective was to determine the effect of supplementary feeding on the resilience and resistance of Criollo kids against natural gastrointestinal nematode (GIN) infections, when browsing native vegetation during the wet season in tropical Mexico. Thirty-four 2-month old Criollo kids, raised nematode free, were included at weaning in a 22-week trial. The kids were placed into four groups. Two groups of 8 kids were offered 100g/day soybean and sorghum meal (26%:74%, respectively fresh basis) (treated/supplemented (T-S) and infected/supplemented (I-S)). Two groups remained with no supplement for the duration of the trial (infected/non-supplemented (I-NS) (n = 10) and treated/non-supplemented (T-NS) (n = 8)). Kids in groups T-S and T-NS were drenched with 0.2mg of moxidectin/kg body weight orally (Cydectin, Fort Dodge) every 28 days. Groups I-S and I-NS were naturally infected with GIN. The animals browsed native vegetation (for an average of 7h/day) together with a herd of 120 naturally infected adult goats. Cumulative live weight gain (CLWG), packed cell volume (PCV), haemoglobin (Hb), total plasma protein and plasma albumin were recorded every 14 days as measurements of resilience. Resistance parameters (faecal egg counts (FEC) and peripheral eosinophil counts (PEC)) were also measured. Bulk faecal cultures were made for each group every 28 days. Every month a new pair of tracer kids assessed the infectivity of the vegetation browsed by the animals. The T-S group had the highest CLWG, PCV and Hb compared to the other three groups (P < 0.001). The I-S and T-NS group had similar mean CLWG and PCV (P > 0.05), while the I-NS group had the poorest CLWG, PCV and Hb (P < 0.001). The PEC of supplemented kids (I-S and T-S) was higher than in the I-NS and T-NS kids (P < 0.05). No effect of supplementary feeding was found in the FEC. Tracer kids and faecal cultures showed that kids suffered mixed infections with Haemonchus contortus, Trichostrongylus colubriformis and Oesophagostomum columbianum. Supplementary feeding improved resilience of browsing Criollo kids against natural GIN infections and was economically feasible. Improved resistance was also suggested by the PEC but was not confirmed in the FEC.

Animal Feed↗
PubMed2004

Malnourished children and supplementary feeding during the war emergency in Guinea-Bissau in 1998-1999.

BACKGROUND: Supplementary feeding programs (SFPs) are intended to mitigate the deterioration of nutritional status and the increase in mortality among malnourished children. OBJECTIVE: We investigated the effect of an SFP on malnourished children in Guinea-Bissau who were returning to their homes after having been displaced within the country because of war in 1998-1999. DESIGN: The effect of the war on the nutritional status of children aged 6-59 mo who were present in Bissau sometime from September 1998 to June 1999 was evaluated by comparing the mortality and the prevalence of malnutrition with the values expected had the war not occurred and by comparing the severity of malnutrition in malnourished children before and during the war. The quality of the SFP was also evaluated. Children with midupper arm circumference < 130 mm were provided weekly medical consultations and supplementary feeding until recovery. RESULTS: The degree of malnutrition did not increase during the war. The prevalence of malnutrition increased with the start of the war but then decreased. The mortality of malnourished children did not increase during the war. Seventy-four percent of the referred children received treatment; of those, 1% died, 67% recovered, and 32% abandoned treatment. Compliance was 89%. The recovery rate was 13.1. 1000(-1). d(-1), and the median time to recovery was 48 d. Better compliance was associated with shorter time to recovery. CONCLUSIONS: Our findings may be biased by changes in the cultural and socioeconomic background of the malnourished children. However, 3 different analyses indicated a beneficial effect of the SFP. Thus, the home-based SFP probably prevented nutritional deterioration during the war in Guinea-Bissau.

Child Nutrition Disorders↗
PubMed1990

The effects on weight and attendance of a supplementary feeding programme operating in two under-5 clinics in Lesotho.

The routinely collected weight data of 2202 pre-school children who visited two under-5 clinics in Lesotho between 1978 and 1983 were used to calculate growth curves and to assess the effects of supplementary feeding. Up to the age of 5 months growth curves were above the NCHS reference. Growth started to decrease at the age of 3 months and stabilized at 11-13 months at the 10th percentile of the reference. The decrease of growth might have been due to environmental factors such as under-nutrition and disease. If this was the case, supplementary feeding might have had a positive impact on weight, but such an effect was not observed in this study. Supplementary feeding had, however, a positive effect on attendance rates and hence contributed to higher coverage of other under-5 clinic activities, such as immunization, health and nutrition education, and growth monitoring. Whether this positive effect warrants its extra cost remains open to question.

Ambulatory Care Facilities↗
PubMed1994

Effect of the levels of N fertilizer, grass and supplementary feeds on nitrogen composition and renneting properties of milk from cows at pasture.

In a 2 x 2 x 3 factorial design grazing experiment we investigated the effect of fertilizer (none or 240 kg N/ha), amounts of clover grass available (low or high) and type and level of daily supplementary feed for each cow (3.5 kg barley, 3.5 kg concentrate mixture rich in protein and fat, or both, 7 kg) on the protein composition and renneting properties of their milk. The experiment was carried out in two successive grazing seasons (years) and included a total of 79 Danish Holstein cows. The effect on milk protein composition was determined in both years whereas the effect on renneting properties was determined only in the second year. Fertilization of the clover grass significantly decreased total milk protein concentration (-1.4 g/kg; P < 0.01) and tended also to decrease the relative proportion of whey protein N. Fertilization had no effect on renneting properties. Increased availability of clover grass significantly increased milk protein concentration (1 g/kg; P < 0.05) and resulted in significantly poorer renneting properties, that is increased clotting time (P < 0.01) and decreased coagulum development. These effects seemed to be mediated through an effect on the pH of the milk (+0.05; P < 0.05) as the effect was markedly reduced when statistical correction was made for the actual pH. Use of the protein- and fat-rich concentrate mix (3.5 kg) significantly reduced the total protein content of the milk (P < 0.05) and increased the proportion of non-protein N (NPN) in total N compared with use of the other supplementary feeds (P < 0.05). We found no effect on renneting properties of the different supplementary feeds. Throughout the grazing season and independent of the main treatments, the NPN proportion of milk N increased at the expense of casein N. At the same time, renneting properties became poorer, especially with high clover grass availability.

Animal Feed↗
PubMed1991

Developmental effects of short-term supplementary feeding in nutritionally-at-risk Indonesian infants.

This study assessed the developmental effects of supplementary feeding over 90 consecutive days on infants aged 6-20 mo at six tea plantations in West Java, Indonesia. Every day except Sunday, the infants attended day-care centers distributed throughout the plantations. Twenty centers and 113 infants were selected; the infants in 9 centers received a dietary supplement, while the infants in 11 centers served as control subjects. Supplements were given twice a day providing, on average, 10.66 kJ (400 kcal) and 5 g protein/d. Measurements of body growth, dietary intake, and mental and motor development were made on all infants. Supplementary feeding had significant effects on weight gain and on motor development. Changes in caloric intake were independently associated with changes in weight and in motor test scores. The data suggest that the effects of the supplement may not have followed a simple mechanistic relationship from intake to weight change to motor development, but, rather, intake may have affected both growth and development domains simultaneously.

Anthropometry↗
PubMed2002

Zimbabwe's Child Supplementary Feeding Programme: a re-assessment using household survey data.

In 1992-3 and 1995-6, Zimbabwe used a Child Supplementary Feeding Programme (CSFP) to combat child malnutrition during drought-induced emergencies. Previous evaluations of the CSFP relied on routine administrative data and key informant interviews and made only cursory use of available household survey data. These evaluations concluded that the CSFP was effective in preventing an increase in malnutrition among children under five, especially in 1992-3. The more-detailed analysis of household surveys provided in this article suggests that CSFP coverage was generally patchy and disappointingly low, especially in 1995-6. There is little evidence that children from poor or nutritionally vulnerable households got preferential access to supplementary feeding. The CSFP failed to feed many malnourished and nutritionally vulnerable children even in areas where the programme was operating. Household survey evidence suggests that the CSFP's impact on nutritional status was likely marginal, especially in 1995-6.

Child↗
PubMed1999

Supplementary feeding in maternity hospitals and the risk of cow's milk allergy: A prospective study of 6209 infants.

BACKGROUND: Early feeding with cow's milk (CM) may increase the risk of cow's milk allergy (CMA). OBJECTIVE: We sought to examine prospectively whether supplementary feeding of CM at the maternity hospital would increase the risk when compared with feeding with pasteurized human milk or hydrolyzed formula. METHODS: We studied 6209 unselected healthy, full-term infants, of whom 5385 (87%) required supplementary milk while in the hospital. The infants were randomly assigned to receive CM formula (1789 infants), pasteurized human milk (1859 infants), or whey hydrolysate formula (1737 infants). The comparison group (824 infants) was composed of infants who were exclusively breast-fed. The infants were followed for 18 to 34 months for symptoms suggestive of CMA. The primary endpoint was a challenge-proven adverse reaction to CM after a successful CM elimination diet. RESULTS: The cumulative incidence of CMA in the infants fed CM was 2.4% compared with 1.7% in the pasteurized human milk group (odds ratio [OR], 0.70; 95% confidence interval [CI], 0. 44-1.12) and 1.5% in the whey hydrolysate group (OR, 0.61; 95% CI, 0. 38-1.00). In the comparison group, CMA developed in 2.1% of the infants. Among the infants who required supplementary feeding at hospital, both exposure to CM while in the hospital (OR, 1.54; 95% CI, 1.04-2.30; P =.03) and obvious parental atopy (OR, 2.32; 95% CI, 1.53-3.52; P <.001) increased the risk of CMA. CONCLUSIONS: Our data indicate that feeding of CM at maternity hospitals increases the risk of CMA when compared with feeding of other supplements, but exclusive breast-feeding does not eliminate the risk.

Animals↗
PubMed1994

Supplementary feeding in the maternity ward shortens the duration of breast feeding.

In a prospective study, feeding routines of a maternity unit and the subsequent feeding patterns of 521 newborns were analysed. During the stay in the maternity unit, 69% of newborns were exclusively breast fed and 1% received only donor's milk from the milk bank and/or formula. Nine percent received their mothers' milk by bottle at least once and 21% received one or more supplementary feedings with donor's milk from the milk bank. One-quarter of the children received supplementary feeds on the third day of life, the indications for this being birth weight less than 3.0 kg, maternal diabetes or gestational diabetes, "insufficient amounts" of milk or fussiness. At three months, 65% were being exclusively breast fed and 15% partially breast fed. In a multiple logistic regression analysis, the potential determinants (neonatal feeding, maternal characteristics, characteristics of the delivery and the child) for the duration of breast feeding were included. The adjusted relative risk (estimated as odds ratios, OR) of not being breast fed at three months was associated with maternal age (< 25 years, OR 4.2), maternal smoking (OR 4.0), neonatal feeding (supplements given, OR 3.9) and initial weight loss (10% or more, OR 2.8). Thus the administration of supplementary donor's milk or formula during the early neonatal period was associated with an increased risk of a short duration for breast feeding, even after adjustment for a number of potential confounders.

Bottle Feeding↗
PubMed1995

Prolonged breastfeeding without the introduction of supplementary feeding.

A study on the determinants of nutritional marasmus (NM) and kwashiorkor (K) was conducted using Sudanese children aged 6-36 months. The hypotheses tested were related to the specific circumstances leading to the development of NM and K. Subjects consisted of 55 children with NM and 55 with K, admitted to the Children's Emergency Hospital in Khartoum. This paper presents the results of the association between NM and prolonged breastfeeding without introduction of supplementary feeding between the ages of 6 and 24 months. Mothers were interviewed in hospital, and information on duration of breastfeeding, age at introduction of supplementary foods, and weaning foods was obtained. Observations were made in 20 per cent of homes of study children. The results suggest a positive association between prolonged breastfeeding without introduction of supplementary feeding between the ages of 6 and 24 months, and NM. Using multivariate analysis the data show that late introduction of supplementary foods produces an increase of 1.4-fold the odds of developing nutritional marasmus, rather than kwashiorkor. In contrast the odds ratio is 1.9 for the two conditions in terms of age of cessation of breastfeeding, the kwashiorkor children breastfeeding for fewer months. Results suggest strategies to reduce the prevalence of NM and K, plus mild and moderate PEM.

Breast Feeding↗