human
***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: OBJECTIVES To compare the effectiveness of locally adapted Institute of Child and Mother Health ( ICMH ) protocol with the WHO protocol for the management of severely malnourished children in Bangladesh . DESIGN Quasi-experimental non-r and omized clinical trial . SETTING Hospital based . PARTICIPANTS Severely malnourished children ( 2 - 59 mo ) with weight for height<70 % ( n=60 ) . INTERVENTION Children treated with either WHO protocol ( Group I , n=30 ) or ICMH protocol ( Group II , n=30 ) . OUTCOME VARIABLES Clinical improvement , weight gain , time taken to achieve target weight gain , and mortality among the study subjects . RESULTS Mean ( SD ) weight related to gain in Group I and Group II was 11.2 ( 4.1 ) and 11.1 ( 3.9 ) g/kg/day , respectively . The weight gain was not related to the age group or type of malnutrition . The time taken for edema to subside ( 7.3 d vs 8 d ) and for improvement of appetite ( 6.5 d to 7.3 d vs 6.7 d to 8.4 d ) was similar between the groups . The target weight gain was achieved in 28.3 ( 11.5 ) days in Group I against 27.9 ( 6.2 ) days in Group II ( P=0.88 ) . The mortality rate was 6.7 % in each group . CONCLUSION Treatment of severe malnutrition with locally adapted ICMH protocol using locally available foods is as efficacious as the WHO protocol Over 1300 severely malnourished children ( < 60 % of US National Center for Health Statistics weight-for-height , with edema , or both ) are admitted each year to the Children 's Nutrition Unit in Dhaka . Fatality during treatment is low and recovery is rapid . Our aim was to determine whether this initial success is sustained when children return home . A previous attempt to address this question was frustrated by the difficulty in tracing children after discharge because most are from slum settlements and families move frequently . This prospect i ve study with fortnightly monitoring was therefore undertaken . The main outcomes of interest were anthropometric status , relapse , morbidity , and mortality .  Children ( n = 437 ) who had been treated for severe malnutrition when aged 12 - 59 mo and had reached the discharge criterion of 80 % of weight-for-height , were followed for the next 12 mo . During follow-up , 7.5 % were lost without trace , 0.6 % relapsed , and 2.3 % died . Morbidity was high , with a mean of seven episodes of diarrhea during the year . Outpatient visits for diarrhea occurred for 67 % of children , and 58 % had pneumonia ( 10 % had pneumonia three times ) . After 12 mo , mean weight-for-height was 91 % ( -0.92 z score ) but mean height-for-age remained at 84 % ( -4.14 z score ) . Weight gain , but not height gain , tended to be lower in children who experienced more diarrhea . Fever and cough were not associated with either weight or height gain . The high prevalence of illness highlights the need for continued accessible health care and for interventions to reduce disease acquisition BACKGROUND Childhood malnutrition is common in Malawi , and the st and ard treatment , which follows international guidelines , results in poor recovery rates . Higher recovery rates have been seen in pilot studies of home-based therapy with ready-to-use therapeutic food ( RUTF ) . OBJECTIVE The objective was to compare the recovery rates among children with moderate and severe wasting , kwashiorkor , or both receiving either home-based therapy with RUTF or st and ard inpatient therapy .  DESIGN A controlled , comparative , clinical effectiveness trial was conducted in southern Malawi with 1178 malnourished children . Children were systematic ally allocated to either st and ard therapy ( 186 children ) or home-based therapy with RUTF ( 992 children ) according to a stepped wedge design to control for bias introduced by the season of the year . Recovery , defined as reaching a weight-for-height z score > -2 , and relapse or death were the primary outcomes . The rate of weight gain and the prevalence of fever , cough , and diarrhea were the secondary outcomes . RESULTS Children who received home-based therapy with RUTF were more likely to achieve a weight-for-height z score > -2 than were those who received st and ard therapy ( 79 % compared with 46 % ; P < 0.001 ) and were less likely to relapse or die ( 8.7 % compared with 16.7 % ; P < 0.001 ) . Children who received home-based therapy with RUTF had greater rates of weight gain ( 3.5 compared with 2.0 g . kg(-1 ) . d(-1 ) ; difference : 1.5 ; 95 % CI : 1.0 , 2.0 g . kg(-1 ) . d(-1 ) ) and a lower prevalence of fever , cough , and diarrhea than did children who received st and ard therapy . CONCLUSION Home-based therapy with RUTF is associated with better outcomes for childhood malnutrition than is st and ard therapy The effect of different energy densities of complementary foods on breast milk consumption is not well understood . In this study , we tested the hypothesis that provision of fortified spread ( FS ) , a micronutrient fortified , energy-dense ( 22 kJ/g ) , ready-to-use food , to Malawian infants would not decrease their breast milk intake more than a traditional corn + soy blended flour ( CSB ) .  Forty-four healthy 6-mo-old infant and mother pairs were enrolled in a prospect i ve , parallel group , investigator-blinded , r and omized controlled complementary feeding trial . Infants were r and omized to receive 25 g/d of FS , 50 g/d of FS , or 72 g/d of CSB . The primary outcome was the difference in breast milk intake after 1 mo of complementary feeding as measured by the dose-to-mother deuterium oxide dilution technique . Outcomes were compared using repeated measures ANOVA . A total of 41 mother-infant pairs completed the study . At enrollment , 88 % of the infants had received corn porridge .  At baseline , the infants consumed 129 + /- 18 g.kg body wt(-1 ) x d(-1 ) ( mean + /- SD ) of breast milk . After 1 mo of complementary feeding with 25 g/d FS , 50 g/d FS , or 72 g/d CSB , their breast milk consumption was 115 + /- 18 g.kg body wt(-1 ) x d(-1 ) , a significant reduction ; however , the effects of the complementary foods did not differ from one another ( F-value model = 4.33 , P = 0.0008 for effect of time and P = 0.69 for effect of type of food ) . The results suggest that complementary feeding of Malawian infants with FS has the same effect on their breast milk intake as complementary feeding with traditional CSB porridge BACKGROUND The World Health Organization recommends a liquid , milk-based diet ( F100 ) during the rehabilitation phase of the treatment of severe malnutrition . A dry , solid , ready-to-use food ( RTUF ) that can be eaten without adding water has been proposed to eliminate the risk of bacterial contamination from added water . The efficacies of RTUF and F100 have not been compared . OBJECTIVE The objective was to compare the efficacy of RTUF and F100 in promoting weight gain in malnourished children . DESIGN In an open-labeled , r and omized trial , 70 severely malnourished Senegalese children aged 6 - 36 mo were r and omly allocated to receive 3 meals containing either F100 ( n = 35 ) or RTUF ( n = 35 ) in addition to the local diet . The data from 30 children in each group were analyzed . RESULTS The mean ( + /- SD ) daily energy intake in the RTUF group was 808 + /- 280 ( 95 % CI : 703.8 , 912.9 ) kJ x kg body wt(-1 ) x d(-1 ) , and that in the F100 group was 573 + /- 201 ( 95 % CI : 497.9 , 648.7 ) kJ. kg body wt(-1 ) x d(-1 ) ( P < 0.001 ) . The average weight gains in the RTUF and F100 groups were 15.6 ( 95 % CI : 13.4 , 17.8 ) and 10.1 ( 95 % CI : 8.7 , 11.4 ) g x kg body wt(-1 ) x d(-1 ) , respectively ( P < 0.001 ) . The difference in weight gain was greater in the most wasted children ( P < 0.05 ) . The average duration of rehabilitation was 17.3 ( 95 % CI : 15.6 , 19.0 ) d in the F100 group and was 13.4 ( 95 % CI : 12.1 , 14.7 ) d in the RTUF group ( P < 0.001 ) . CONCLUSIONS This study indicated that RTUF can be used efficiently for the rehabilitation of severely malnourished children Aim : To determine if home‐based nutritional therapy will benefit a significant fraction of malnourished , HIV‐infected Malawian children , and to determine if ready‐to‐use therapeutic food ( RUTF ) is more effective in home‐based nutritional therapy than traditional foods . Methods : 93 HIV‐positive children > 1 y old discharged from the nutrition unit in Blantyre , Malawi were systematic ally allocated to one of three dietary regimens : RUTF , RUTF supplement or blended maize/soy flour . RUTF and maize/soy flour provided 730 kJ·kg−1·d−1 , while the RUTF supplement provided a fixed amount of energy , 2100 kJ/d . These children  did not receive antiretroviral chemotherapy . Children were followed fortnightly . Children completed the study when they reached 100 % weight‐for‐height , relapsed or died . Outcomes were compared using regression modeling to account for differences in the severity of malnutrition between the dietary groups . Results : 52/93 ( 56 % ) of all children reached 100 % weight‐for‐height . Regression modeling found that the children receiving RUTF  gained weight more rapidly and were more likely to reach 100 % weight‐for‐height than the other two dietary groups ( p<0.05 ) Background : The st and ard treatment of severe malnutrition in Malawi often utilises prolonged inpatient care , and after discharge results in high rates of relapse . Aims : To test the hypothesis that the recovery rate , defined as catch-up growth such that weight-for-height z score > 0 ( WHZ , based on initial height ) for ready-to-use food ( RTUF ) is greater than two other home based dietary regimens in the treatment of malnutrition . Methods : HIV negative children > 1 year old discharged from the nutrition unit in Blantyre , Malawi were systematic ally allocated to one of three dietary regimens : RTUF , RTUF supplement , or blended maize/soy flour . RTUF and maize/soy flour provided 730 kJ/kg/day , while the RTUF supplement provided a fixed amount of energy , 2100 kJ/day . Children were followed fortnightly . Children completed the study when they reached WHZ > 0 , relapsed , or died . Outcomes were compared using a time-event model . Results : A total of 282 children were enrolled . Children receiving RTUF were more likely to reach WHZ > 0 than those receiving RTUF supplement or maize/soy flour ( 95 % v 78 % , RR 1.2 , 95 % CI 1.1 to 1.3 ) . The average weight gain was 5.2 g/kg/day in the RTUF group compared to 3.1 g/kg/day for the maize/soy and RTUF supplement groups . Six months later , 96 % of all children that reached WHZ > 0 were not wasted . Conclusions : Home based therapy of malnutrition with RTUF was successful ; further operational work is needed to implement this promising therapy BACKGROUND Severe acute malnutrition affects 13 million children worldwide and causes 1 - 2 million deaths every year . Our aim was to assess the clinical and nutritional efficacy of a probiotic and prebiotic functional food for the treatment of severe acute malnutrition in a HIV-prevalent setting . METHODS We recruited 795 Malawian children ( age range 5 to 168 months [ median 22 , IQR 15 to 32 ] ) from July 12 , 2006 , to March 7 , 2007 , into a double-blind , r and omised , placebo-controlled efficacy trial . For generalisability , all admissions for severe acute malnutrition treatment were eligible for recruitment . After stabilisation with milk feeds , children were r and omly assigned to ready-to-use therapeutic food either with ( n=399 ) or without ( n=396 ) Synbiotic2000 Forte . Average prescribed Synbiotic dose was 10(10 ) colony-forming units or more of lactic 
    Output:
    
agent
***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: OBJECTIVES To compare the effectiveness of locally adapted Institute of Child and Mother Health ( ICMH ) protocol with the WHO protocol for the management of severely malnourished children in Bangladesh . DESIGN Quasi-experimental non-r and omized clinical trial . SETTING Hospital based . PARTICIPANTS Severely malnourished children ( 2 - 59 mo ) with weight for height<70 % ( n=60 ) . INTERVENTION Children treated with either WHO protocol ( Group I , n=30 ) or ICMH protocol ( Group II , n=30 ) . OUTCOME VARIABLES Clinical improvement , weight gain , time taken to achieve target weight gain , and mortality among the study subjects . RESULTS Mean ( SD ) weight related to gain in Group I and Group II was 11.2 ( 4.1 ) and 11.1 ( 3.9 ) g/kg/day , respectively . The weight gain was not related to the age group or type of malnutrition . The time taken for edema to subside ( 7.3 d vs 8 d ) and for improvement of appetite ( 6.5 d to 7.3 d vs 6.7 d to 8.4 d ) was similar between the groups . The target weight gain was achieved in 28.3 ( 11.5 ) days in Group I against 27.9 ( 6.2 ) days in Group II ( P=0.88 ) . The mortality rate was 6.7 % in each group . CONCLUSION Treatment of severe malnutrition with locally adapted ICMH protocol using locally available foods is as efficacious as the WHO protocol Over 1300 severely malnourished children ( < 60 % of US National Center for Health Statistics weight-for-height , with edema , or both ) are admitted each year to the Children 's Nutrition Unit in Dhaka . Fatality during treatment is low and recovery is rapid . Our aim was to determine whether this initial success is sustained when children return home . A previous attempt to address this question was frustrated by the difficulty in tracing children after discharge because most are from slum settlements and families move frequently . This prospect i ve study with fortnightly monitoring was therefore undertaken . The main outcomes of interest were anthropometric status , relapse , morbidity , and mortality .  Children ( n = 437 ) who had been treated for severe malnutrition when aged 12 - 59 mo and had reached the discharge criterion of 80 % of weight-for-height , were followed for the next 12 mo . During follow-up , 7.5 % were lost without trace , 0.6 % relapsed , and 2.3 % died . Morbidity was high , with a mean of seven episodes of diarrhea during the year . Outpatient visits for diarrhea occurred for 67 % of children , and 58 % had pneumonia ( 10 % had pneumonia three times ) . After 12 mo , mean weight-for-height was 91 % ( -0.92 z score ) but mean height-for-age remained at 84 % ( -4.14 z score ) . Weight gain , but not height gain , tended to be lower in children who experienced more diarrhea . Fever and cough were not associated with either weight or height gain . The high prevalence of illness highlights the need for continued accessible health care and for interventions to reduce disease acquisition BACKGROUND Childhood malnutrition is common in Malawi , and the st and ard treatment , which follows international guidelines , results in poor recovery rates . Higher recovery rates have been seen in pilot studies of home-based therapy with ready-to-use therapeutic food ( RUTF ) . OBJECTIVE The objective was to compare the recovery rates among children with moderate and severe wasting , kwashiorkor , or both receiving either home-based therapy with RUTF or st and ard inpatient therapy .  DESIGN A controlled , comparative , clinical effectiveness trial was conducted in southern Malawi with 1178 malnourished children . Children were systematic ally allocated to either st and ard therapy ( 186 children ) or home-based therapy with RUTF ( 992 children ) according to a stepped wedge design to control for bias introduced by the season of the year . Recovery , defined as reaching a weight-for-height z score > -2 , and relapse or death were the primary outcomes . The rate of weight gain and the prevalence of fever , cough , and diarrhea were the secondary outcomes . RESULTS Children who received home-based therapy with RUTF were more likely to achieve a weight-for-height z score > -2 than were those who received st and ard therapy ( 79 % compared with 46 % ; P < 0.001 ) and were less likely to relapse or die ( 8.7 % compared with 16.7 % ; P < 0.001 ) . Children who received home-based therapy with RUTF had greater rates of weight gain ( 3.5 compared with 2.0 g . kg(-1 ) . d(-1 ) ; difference : 1.5 ; 95 % CI : 1.0 , 2.0 g . kg(-1 ) . d(-1 ) ) and a lower prevalence of fever , cough , and diarrhea than did children who received st and ard therapy . CONCLUSION Home-based therapy with RUTF is associated with better outcomes for childhood malnutrition than is st and ard therapy The effect of different energy densities of complementary foods on breast milk consumption is not well understood . In this study , we tested the hypothesis that provision of fortified spread ( FS ) , a micronutrient fortified , energy-dense ( 22 kJ/g ) , ready-to-use food , to Malawian infants would not decrease their breast milk intake more than a traditional corn + soy blended flour ( CSB ) .  Forty-four healthy 6-mo-old infant and mother pairs were enrolled in a prospect i ve , parallel group , investigator-blinded , r and omized controlled complementary feeding trial . Infants were r and omized to receive 25 g/d of FS , 50 g/d of FS , or 72 g/d of CSB . The primary outcome was the difference in breast milk intake after 1 mo of complementary feeding as measured by the dose-to-mother deuterium oxide dilution technique . Outcomes were compared using repeated measures ANOVA . A total of 41 mother-infant pairs completed the study . At enrollment , 88 % of the infants had received corn porridge .  At baseline , the infants consumed 129 + /- 18 g.kg body wt(-1 ) x d(-1 ) ( mean + /- SD ) of breast milk . After 1 mo of complementary feeding with 25 g/d FS , 50 g/d FS , or 72 g/d CSB , their breast milk consumption was 115 + /- 18 g.kg body wt(-1 ) x d(-1 ) , a significant reduction ; however , the effects of the complementary foods did not differ from one another ( F-value model = 4.33 , P = 0.0008 for effect of time and P = 0.69 for effect of type of food ) . The results suggest that complementary feeding of Malawian infants with FS has the same effect on their breast milk intake as complementary feeding with traditional CSB porridge BACKGROUND The World Health Organization recommends a liquid , milk-based diet ( F100 ) during the rehabilitation phase of the treatment of severe malnutrition . A dry , solid , ready-to-use food ( RTUF ) that can be eaten without adding water has been proposed to eliminate the risk of bacterial contamination from added water . The efficacies of RTUF and F100 have not been compared . OBJECTIVE The objective was to compare the efficacy of RTUF and F100 in promoting weight gain in malnourished children . DESIGN In an open-labeled , r and omized trial , 70 severely malnourished Senegalese children aged 6 - 36 mo were r and omly allocated to receive 3 meals containing either F100 ( n = 35 ) or RTUF ( n = 35 ) in addition to the local diet . The data from 30 children in each group were analyzed . RESULTS The mean ( + /- SD ) daily energy intake in the RTUF group was 808 + /- 280 ( 95 % CI : 703.8 , 912.9 ) kJ x kg body wt(-1 ) x d(-1 ) , and that in the F100 group was 573 + /- 201 ( 95 % CI : 497.9 , 648.7 ) kJ. kg body wt(-1 ) x d(-1 ) ( P < 0.001 ) . The average weight gains in the RTUF and F100 groups were 15.6 ( 95 % CI : 13.4 , 17.8 ) and 10.1 ( 95 % CI : 8.7 , 11.4 ) g x kg body wt(-1 ) x d(-1 ) , respectively ( P < 0.001 ) . The difference in weight gain was greater in the most wasted children ( P < 0.05 ) . The average duration of rehabilitation was 17.3 ( 95 % CI : 15.6 , 19.0 ) d in the F100 group and was 13.4 ( 95 % CI : 12.1 , 14.7 ) d in the RTUF group ( P < 0.001 ) . CONCLUSIONS This study indicated that RTUF can be used efficiently for the rehabilitation of severely malnourished children Aim : To determine if home‐based nutritional therapy will benefit a significant fraction of malnourished , HIV‐infected Malawian children , and to determine if ready‐to‐use therapeutic food ( RUTF ) is more effective in home‐based nutritional therapy than traditional foods . Methods : 93 HIV‐positive children > 1 y old discharged from the nutrition unit in Blantyre , Malawi were systematic ally allocated to one of three dietary regimens : RUTF , RUTF supplement or blended maize/soy flour . RUTF and maize/soy flour provided 730 kJ·kg−1·d−1 , while the RUTF supplement provided a fixed amount of energy , 2100 kJ/d . These children  did not receive antiretroviral chemotherapy . Children were followed fortnightly . Children completed the study when they reached 100 % weight‐for‐height , relapsed or died . Outcomes were compared using regression modeling to account for differences in the severity of malnutrition between the dietary groups . Results : 52/93 ( 56 % ) of all children reached 100 % weight‐for‐height . Regression modeling found that the children receiving RUTF  gained weight more rapidly and were more likely to reach 100 % weight‐for‐height than the other two dietary groups ( p<0.05 ) Background : The st and ard treatment of severe malnutrition in Malawi often utilises prolonged inpatient care , and after discharge results in high rates of relapse . Aims : To test the hypothesis that the recovery rate , defined as catch-up growth such that weight-for-height z score > 0 ( WHZ , based on initial height ) for ready-to-use food ( RTUF ) is greater than two other home based dietary regimens in the treatment of malnutrition . Methods : HIV negative children > 1 year old discharged from the nutrition unit in Blantyre , Malawi were systematic ally allocated to one of three dietary regimens : RTUF , RTUF supplement , or blended maize/soy flour . RTUF and maize/soy flour provided 730 kJ/kg/day , while the RTUF supplement provided a fixed amount of energy , 2100 kJ/day . Children were followed fortnightly . Children completed the study when they reached WHZ > 0 , relapsed , or died . Outcomes were compared using a time-event model . Results : A total of 282 children were enrolled . Children receiving RTUF were more likely to reach WHZ > 0 than those receiving RTUF supplement or maize/soy flour ( 95 % v 78 % , RR 1.2 , 95 % CI 1.1 to 1.3 ) . The average weight gain was 5.2 g/kg/day in the RTUF group compared to 3.1 g/kg/day for the maize/soy and RTUF supplement groups . Six months later , 96 % of all children that reached WHZ > 0 were not wasted . Conclusions : Home based therapy of malnutrition with RTUF was successful ; further operational work is needed to implement this promising therapy BACKGROUND Severe acute malnutrition affects 13 million children worldwide and causes 1 - 2 million deaths every year . Our aim was to assess the clinical and nutritional efficacy of a probiotic and prebiotic functional food for the treatment of severe acute malnutrition in a HIV-prevalent setting . METHODS We recruited 795 Malawian children ( age range 5 to 168 months [ median 22 , IQR 15 to 32 ] ) from July 12 , 2006 , to March 7 , 2007 , into a double-blind , r and omised , placebo-controlled efficacy trial . For generalisability , all admissions for severe acute malnutrition treatment were eligible for recruitment . After stabilisation with milk feeds , children were r and omly assigned to ready-to-use therapeutic food either with ( n=399 ) or without ( n=396 ) Synbiotic2000 Forte . Average prescribed Synbiotic dose was 10(10 ) colony-forming units or more of lactic 
    Output:
    