Globally, moderate acute malnutrition affects a total of 11% of children under the age of 5 years (UNICEF, 2008). In Ethiopia, overall 10 % of children aged 6 to 59months wasted, and 9.7% are moderately wasted (EDHS, 2011). The conventional food distributed in supplementary feeding programs is fortified blended flour made of corn and soy, fortified with vitamins and minerals called Super Cereal (SC). But there was a need to introduce ready-to-eat foods to meet the current demands for treating moderately malnourished children in Ethiopia. Therefore a study was designed to evaluate the new products; the two Chickpea-based RUSF (C-RUSF and CMS-RUSF) against the widely used super cereal and improved product supper cereal plus for their effectiveness in the supplementary feeding programs in Ethiopia. The study was conducted from 9th June 2014 to 22nd October 2014. The study was a cluster-randomized controlled effectiveness trial that was conducted in the four regions of Ethiopia; Amhara, Oromia, SNNPR, and Tigray using the 4 study products. The subjects were 2425 moderately malnourished children aged 6-59 months with 606 study subjects in each region. During the study baseline and end-line assessment were done in all the study sites. The study tools included anthropometric measurements, recording dietary and morbidity history, and focus group discussions in some selected study sites. The intervention foods include chickpea-based RUSF (C-RUSF); Chickpea, Maize and Soya RUSF (CMS-RUSF); Super cereal PLUS (CSB++), and a comparator Super cereal (CSB+). Anthropometric measurements, food distribution, and assessment for their adherence to the supplementary feeding program protocol were done on a weekly basis. Statistically significant higher overall recovery rate (42%) was observed in children fed Super-cereal plus (SC+). Children in the lower age group are more likely to be recover when eating formula 2 (CMS-RUSF) than higher age (> 24 months). The more vulnerable age group for moderately acute malnutrition will have the highest probability to react for treatment timely. The Knowledge, attitude, and practices of caregivers as assessed for each of the four products have shown satisfactory improvement. SC+ has a statistically significantly higher rate of recovery compared with SC, formula 1 and 2. Nevertheless, there is no significant difference among SC, formulas 1 and 2 in terms of recovery rate. However, based on the cost-effectiveness analysis, formula 2 was found to dominate all the other products. Most of the cost data were collected from the WFP procurement section. There should be strong or robust cost-effectiveness analysis using independent data sources. Further study might be needed among the products under a controlled setup like animal trials. 

• Chickpea
• Maize
• Soya
• Effectiveness Trial
• Supplementary Products
• Moderate Acute Malnutrition
• Super Cereal
• Cluster-randomized controlled trial
• Supplementary feeding
• Evaluation
• Children
• Management
• Super Cereal PLU

Hailu T, Tessema M, Tesfaye B, Kebede A, Belay A, Ayana G, et al. Effectiveness of Chickpea-Based Ready-to-Use-Supplementary Foods for Management of Moderate Acute Malnutrition in Ethiopia: A Cluster-Randomized Control Trial "Effectiveness of Chickpea-Based Ready-to-Use-Supplementary Foods for Management of Moderate Acu. Vol. 11, EC Nutrition. 2017.

Children with moderate acute malnutrition have nutritional requirements that differ from non-malnourished and severely malnourished children. They require an increased intake of energy and essential nutrients over and above those required by non-malnourished children and, when necessary, treatment for any associated medical conditions. The study was aimed to evaluate chickpea only (Formula 1) and chickpea-maize-soya (Formula 2) ready-to-use food against two other widely-used supplementary foods: Super Cereal and the improved product, Super Cereal PLUS, for their effectiveness in the supplementary feeding programs. Therefore, the dataset that captures information from the individual child was recorded on the Individual questionnaire and subsequently TSF Individual Card. The variables assessed included; anthropometric measurements such as weight, height/length, MUAC, and edema while the other information collected included demographic characteristics, appetite test, infections/diseases( fever, cough, diarrhea, vomiting), age, sex, date of admission, vaccination in children 6-59months, vitamin A supplementation in last 6months, address, and type of follow up required until recovery. 
Training and piloting of the questionnaires were conducted in a 9 days’ workshop at Dreamliner Hotel where 3 concurrent pieces of training were conducted. There was an initial 5-day training for the coordinators (Training of Trainers) and followed by a 9-day training of the enumerators. The team from the first level of training was responsible for follow-on training. The study implementation manual developed for the purpose of standardization of the training and subsequent implementation was used to develop the training slides that were used for this purpose. In a cluster-randomized controlled Effectiveness trial, the study design was followed with 3 intervention arms that included C-RUSF; CMS-RUSF; SC-PLUS (SC+), and a comparator SC (CSB). This involved a total of 2,425 Ethiopian children aged 6 to 59months with MAM in four regions. Therefore the objective of this study was to evaluate the effectiveness of C-RUSF, CMS-RUSF, and SC+ as compared to SC widely used in Ethiopia with a primary outcome of moderately malnourished children recovery rate. 

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