Including malnourished siblings in treatment improves nutritional outcomes for children with sickle cell anemia in Northern Nigeria: Results from a feasibility trial

Best treatment approaches for malnutrition in children with sickle cell anemia (SCA) remain underexplored. We hypothesized that (1) children with SCA (CwSCA) enrolled in a malnutrition trial alongside their non-SCA siblings would experience greater nutritional improvements than those without an enrolled sibling and (2) enrolled malnourished siblings without SCA would have higher baseline nutritional status and greater improvements in nutritional status than CwSCA. We tested these hypotheses as part of a randomized controlled feasibility trial at 2 medical centers in northern Nigeria, a low-resource setting with a significant burden of malnutrition and SCA. Participants included 108 CwSCA (5-12 years) with severe malnutrition (body mass index (BMI) z-score <-3.0), 21 of whom had an enrolled sibling (Sibling) with severe malnutrition but without SCA (5-12 years, n = 22). All participants received daily ready-to-use therapeutic food (RUTF) for 12 weeks. CwSCA with a Sibling had a higher mean BMI z-score change than CwSCA without a Sibling (0.8 vs 0.4, P = .003). The mean baseline BMI z-scores for the CwSCA (-3.7) were comparable to those of their Siblings (-3.6; P = .47). Improvement in BMI z-score was similar between CwSCA and their malnourished siblings without SCA. In conclusion, our findings suggest that including malnourished siblings in nutritional interventions enhances outcomes for CwSCA. We postulate that the additional calories delivered by co-treating siblings reduce intrahousehold competition for RUTF, thereby allowing CwSCA to consume a greater share of the therapeutic food. This trial was registered at clinicaltrials.gov (NCT03634488).