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BMJ 2009; 338 doi: (Published 28 January 2009) Cite this as: BMJ 2009;338:b303

High calorie supplement prevents wasting in vulnerable children

Food is scarce during the three months before the harvest in Niger, and children are at risk of malnutrition and the morbidity and mortality that goes with it. Food supplements can help tide them over, according to a trial in one of the poorest and most vulnerable areas. A measure of weight for height fell more slowly among children in six villages that received the supplement for three months, compared with children in six control villages. The difference was significant and clinically relevant—the supplement cut the risk of wasting by 36% (95% CI 17% to 50%; 140 events/841 child years (0.17 events per child year) v 233/895 (0.26)). The high calorie paste containing peanuts, oil, sugar, milk powder, and essential micronutrients was also associated with a 58% (43% to 68%) fall in the incidence of severe wasting.

The supplement is already used to treat malnourished children in Niger, and these findings show it can also be a useful preventive measure during seasonal food insecurity, say the researchers. None of the children in this trial was malnourished at recruitment.

Twenty five children died during the eight months of follow-up, and death rates were lower in the villages given the supplement (7/986 v 18/1099 child years; hazard ratio 0.51, 0.25 to 1.05). The difference wasn’t significant, but the trial wasn’t powerful (big) enough to be conclusive.

Babies get better faster after laparoscopic surgery for pyloric stenosis

It is never easy to design head to head trials comparing laparoscopic and open surgery, not least because the different scars make blinding such a challenge. Surgeons comparing laparoscopic and open surgery for infantile pyloric stenosis got over this by designing three dressings that went on all babies and stayed on until discharge, so parents, nurses, and researchers were unaware of the assigned technique. Overall, the results favoured laparoscopy, which was associated …

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