Effectiveness of locally produced ready-to-use supplementary foods on the prevention of stunting in children aged 6-23 months: a community-based trial from Pakistan

Undernutrition is a major public health problem in developing countries. Around 40 center dot 2 % of children are stunted in Pakistan. This longitudinal study aimed to assess the effectiveness of locally produced ready-to-use supplementary foods in the prevention of stunting by detecting change in of children in intervention v. control arm against the 2006 WHO growth reference. A community-based non-randomised cluster-controlled trial was conducted from January 2018 to December 2020 in the district of Kurram, Khyber Pakhtunkhwa, Pakistan. A total of 80 clusters (each cluster comprising approximate to 250-300 households) were defined in the catchment population of twelve health facilities. Children aged 6-18 months were recruited n 1680. The intervention included a daily ration of 50 g - locally produced ready-to-use-supplementary food (Wawa-Mum). The main outcome of this study was a change in length for age z-score (LAZ) v. WHO growth standards. Comparison between the interventions was by t test and ANOVA. Cox proportional hazard models were used to assess the association between stunting occurrence and the utilisation of locally produced supplement. Out of the total 1680, fifty-one out of the total 1680, 51 center dot 1 out of the total 1680 and 51 center dot 1 % (n 859) were male. Mean age 13 center dot 9 months (sd + 859) were male. Mean age 13 center dot 9 months (sd + -4 center dot 4). At baseline, 36 center dot 9 % (n 618) were stunted. In the intervention group, mean LAZ score significantly increased from -1 center dot 13(2 center dot 2 sd) at baseline to -0 center dot 93(1 center dot 8 sd) at 6-month follow-up (P value 0 center dot 01) compared with the control group. The incidence rate of stunting in the intervention arm was 1 center dot 3 v. 3 center dot 4 per person year in the control arm. The control group had a significantly increased likelihood of stunting (Hazard Ratio (HR) 1 center dot 7, 95 % CI 1 center dot 46, 2 center dot 05, P value < 0 center dot 001) v. the intervention group. Locally produced ready-to-use supplementary food is an effective intervention for reducing stunting in children below 2 years of age. This can be provided as part of a malnutrition prevention package to overcome the alarming rates of stunting in Pakistan.