Treatment of severe and moderate acute malnutrition in low- and middle-income settings: a systematic review, meta-analysis and Delphi process
Insights
Ready-to-use therapeutic food (RUTF) improves nutritional recovery for severe acute malnutrition (SAM). Interventions for moderate acute malnutrition (MAM) also show promise, though more research is needed to confirm effectiveness.
Area of Science:
- Global Health
- Pediatric Nutrition
- Public Health Interventions
Background:
- Moderate acute malnutrition (MAM) and severe acute malnutrition (SAM) impact over 52 million children globally.
- Focus on low- and middle-income countries.
Purpose of the Study:
- Evaluate the effectiveness of interventions for SAM and MAM in children under five.
- Assess inpatient and community-based management protocols.
Main Methods:
- Systematic literature search and meta-analysis of 14 studies.
- Study quality assessed using CHERG adaptation of GRADE criteria.
- Delphi process to estimate case fatality and recovery rates for the Lives Saved Tool (LiST).
Main Results:
- Ready-to-use therapeutic food (RUTF) increased nutritional recovery by 51% for SAM compared to standard care.
- Ready-to-use supplementary food (RUSF) improved recovery and reduced non-response rates for MAM compared to corn-soy blend (CSB).
- Inpatient SAM treatment case fatality rates varied (3.4%-35%); weight gain differences were statistically significant but small.
Conclusions:
- Gaps remain in estimating the overall effectiveness of SAM and MAM treatment approaches.
- High-quality program evaluations and impact studies in diverse settings are needed.
- Adherence to standardized treatment protocols is crucial for improving mortality and recovery rates.
Background:
Globally, moderate acute malnutrition (MAM) and severe acute malnutrition (SAM) affect approximately 52 million children under five. This systematic review evaluates the effectiveness of interventions for SAM including the World Health Organization (WHO) protocol for inpatient management and community-based management with ready-to-use-therapeutic food (RUTF), as well as interventions for MAM in children under five years in low- and middle-income countries.
Methods:
We systematically searched the literature and included 14 studies in the meta-analysis. Study quality was assessed using CHERG adaptation of GRADE criteria. A Delphi process was undertaken to complement the systematic review in estimating case fatality and recovery rates that were necessary for modelling in the Lives Saved Tool (LiST).
Results:
Case fatality rates for inpatient treatment of SAM using the WHO protocol ranged from 3.4% to 35%. For community-based treatment of SAM, children given RUTF were 51% more likely to achieve nutritional recovery than the standard care group. For the treatment of MAM, children in the RUSF group were significantly more likely to recover and less likely to be non-responders than in the CSB group. In both meta-analyses, weight gain in the intervention group was higher, and although statistically significant, these differences were small. Overall limitations in our analysis include considerable heterogeneity in many outcomes and an inability to evaluate intervention effects separate from commodity effect. The Delphi process indicated that adherence to standardized protocols for the treatment of SAM and MAM should have a marked positive impact on mortality and recovery rates; yet, true consensus was not achieved.
Conclusions:
Gaps in our ability to estimate effectiveness of overall treatment approaches for SAM and MAM persist. In addition to further impact studies conducted in a wider range of settings, more high quality program evaluations need to be conducted and the results disseminated.
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