Seasonal effect and long-term nutritional status following exit from a Community-Based Management of Severe Acute
Insights
High default rates in severe acute malnutrition (SAM) programs are a concern. Nutritional status post-treatment is significantly impacted by seasonal food security, with relapse and non-recovery rates higher during periods of insecurity.
Area of Science:
- Public Health
- Pediatrics
- Nutrition Science
Background:
- Severe acute malnutrition (SAM) programs in India face high default rates (38%).
- Understanding long-term nutritional outcomes post-treatment is crucial for program improvement.
- This study tracks children after exiting a Community Management of Acute Malnutrition (CMAM) program.
Purpose of the Study:
- To describe the nutritional status of children after completing or defaulting from SAM treatment.
- To identify factors influencing nutritional recovery and relapse post-program exit.
- To evaluate the impact of food security on nutritional outcomes.
Main Methods:
- Follow-up of 1956 children (aged 6-59 months) for 3-18 months post-exit.
- Children were categorized as cured (MUAC ≥120mm) or defaulters (MUAC <115mm).
- Nutritional status and mortality were assessed at multiple time points, considering food security periods.
Main Results:
- High tracing rates achieved for both cured (76.2%) and defaulter (68.7%) groups.
- Non-recovery rates for defaulters decreased over time (41% at 3 months to 3.6% at 18 months).
- Relapse rates for cured children were low (9.1% at 3 months to 0% at 18 months).
- Undernutrition prevalence increased during low food security periods for both groups.
- Mortality risk was significantly higher for defaulters with MUAC <110mm.
Conclusions:
- Seasonal food security is a key predictor of short-term nutritional status post-exit.
- Relapse and non-recovery from SAM are exacerbated by food insecurity.
- A mid-upper arm circumference (MUAC) of 110mm may be a suitable admission criterion for SAM programs in this context.
Background/Objectives:
Children aged 6 months to 5 years completing treatment for severe acute malnutrition (SAM) in a Médecins Sans Frontières Community Management of Acute Malnutrition (CMAM) program in Bihar, India, showed high cure rates; however, the program suffered default rates of 38%. This report describes the nutritional status of 1956 children followed up between 3 and 18 months after exiting the program.
Subjects/Methods:
All children aged 6-59 months discharged as cured with mid-upper arm circumference (MUAC) ⩾120 mm or who defaulted from the program with MUAC <115 mm were traced at 3, 6, 9, 12 and 18 months (±10 days) before three exit reference dates: first at the end of the food insecure period, second after the 2-month food security and third after the 4-month food security.
Results:
Overall, 68.7% (n=692) of defaulters and 76.2% (n=1264) of children discharged as cured were traced. Combined rates of non-recovery in children who defaulted with MUAC <115 mm were 41%, 30.1%, 9.9%, 6.1% and 3.6% at 3, 6, 9, 12 and 18 months following exit, respectively. Combined rates of relapse among cured cases (MUAC ⩾120 mm) were 9.1%, 2.9%, 2.1%, 2.8% and 0% at 3, 6, 9, 12 and 18 months following discharge, respectively. Prevalence of undernutrition increased substantially for both groups traced during low food security periods. Odds of death were much higher for children defaulting with MUAC <110 mm when compared with children discharged as cured, who shared the same mortality risk as those defaulting with MUAC 110-<115 mm.
Conclusions:
Seasonal food security predicted short-term nutritional status after exit, with relapse rates and non-recovery from SAM much higher during food insecurity. Mortality outcomes suggest that a MUAC of 110 mm may be considered an appropriate admission point for SAM treatment programs in this context.
Related Concept Videos
01:24Metabolic States of the Body: Fasting and Starvation
01:30Inflammatory Bowel Disease III: Diagnostic Studies and Management I-Nutritional Therapy
Diagnostic studies
A colonoscopy is the definitive screening test, distinguishing ulcerative colitis from other colon diseases with similar symptoms. During a colonoscopy test, inflamed mucosa with exudate ulcerations can be observed, and biopsies are taken to determine the histologic characteristics of the...
01:15Enteral Nutrition II: Nasointestinal and Gastrostomy Feeding
Nasointestinal Feeding
Nasointestinal feeding involves placing a tube...