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Beyond prevention: A rightward shift in the distribution of weight-for-height following supplementation with SQ-LNS to children aged 6–23 months in post-conflict settings of Tigray, Ethiopia - A Non-Randomized Cluster Trial

Article scientifique 2026 Autre

Résumé

Abstract Introduction Acute malnutrition in children aged 6–23 months remains critical in Tigray, Ethiopia, where global acute malnutrition (GAM) rates have reached emergency levels. Small-quantity lipid-based nutrient supplements (SQ-LNS) show promise for prevention, but evidence from post-conflict settings is limited. Objective This study evaluated SQ-LNS effectiveness in preventing acute malnutrition and rightward shifting in the distribution of weight-for-height among young children in post-conflict settings of Tigray, Ethiopia. Methods A non-randomized cluster trial enrolled 8,145 children aged 6–23 months across four districts. The intervention group (n=6,752) received daily 20g SQ-LNS sachets for six months plus behavior change communication; the control group (n=1,393) received standard nutrition programming. Primary outcomes were acute malnutrition prevalence (WHZ < -2 or MUAC < 12.5cm) and distribution of weight-for-height z-scores. Data were collected biweekly and analyzed using longitudinal comparisons and difference-in-differences (DiD) estimation. Results Acute malnutrition declined from 22.2% to 4.6% in the intervention group (17.6 percentage point reduction) versus 20.1% to 14.0% in controls (6.1-point reduction). Mean WHZ scores increased from -0.35 to +0.37 in the intervention group (gain of +0.72 z-scores), while controls improved from -0.79 to -0.63 (gain of +0.16). The net intervention effect (DiD) showed a 4.1 percentage point reduction in WHZ-defined GAM and a 11.5-point reduction in MUAC-defined GAM. Mean WHZ and MUAC increased significantly more in the intervention group (DiD: +0.56 z-scores and +5.03mm, respectively). Critically, the entire WHZ distribution shifted rightward, indicating population-level nutritional improvement, not merely reduced caseloads. Conclusions Six months of daily SQ-LNS effectively prevented acute malnutrition and shifted the entire weight-for-height distribution rightward among young children in post-conflict settings of Tigray, Ethiopia. Benefits extended beyond treatment, lifting the whole child population’s nutritional status. Findings support SQ-LNS inclusion in post-conflict nutrition packages and highlight the importance of assessing distributional outcomes, not just prevalence, when evaluating nutritional interventions. Trial registration number This trial was registered at ClinicalTrials.gov, NCT06103084 .

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Bezabih, A., Noor, R., Demissie, M., Gebretsadik, G., Gebregziabher, H., Alem, K., Abrha, M., Zayzay, L., Teklu, Y., Hailu, Y., Tsegay, N., Gebreegziabher, T., Esayas, R., Bahresellasie, M., Asmelash, A., Kidane, H., Seyoum, D., Chitekwe, S. (2026). Beyond prevention: A rightward shift in the distribution of weight-for-height following supplementation with SQ-LNS to children aged 6–23 months in post-conflict settings of Tigray, Ethiopia - A Non-Randomized Cluster Trial. https://doi.org/10.64898/2026.03.30.26349799

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Afework Mulugeta Bezabih Ramadhani Noor Meseret Demissie Gebretsadkan Gebremedhin Gebretsadik Hadush Gebregziabher Kidanemariam Alem Mulugeta Woldu Abrha Leela Zayzay Yosef Teklu Yemane Hailu Nigsti Tsegay Tesfay Berhe Gebreegziabher Rieye Esayas Mengish Bahresellasie Ashenafi Asmelash Hailay Kidane Dawit Seyoum Stanley Chitekwe

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