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 40.2% 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 vs. 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, KP, Pakistan. A total of 80 clusters (each cluster comprising ≈ 250-300 households) were defined in the catchment population of 12-health facilities. Children aged 6-18 months were recruited n=1680. The intervention included a daily ration of 50g-locally produced Ready-to-Use-Supplementary Food (Wawa-Mum). The main outcome of this study was a change in LAZ vs 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 utilization of locally produced supplement.Out of the total 1680, 51.1% (n=859) were male. Mean age 13.9 months (S.D +-4.4). At baseline, 36.9%(n=618) were stunted. In the intervention group mean LAZ Score significantly increased from -1.13(2.2 SD) at baseline to -0.93(1.8 SD) at six-month follow-up(p-value 0.01) compared to the control group. The incidence rate of stunting in the intervention arm was 1.3 vs 3.4 per person year in the control arm. The control group had a significantly increased likelihood of stunting (HR 1.7, 95% CI 1.46-2.05, p-value <0.001) vs the intervention group. Locally produced ready-to-use supplementary food is an effective intervention for reducing stunting in children below two years of age. This can be provided as part of a malnutrition prevention package to overcome the alarming rates of stunting in Pakistan.