Predictors of recovery in children aged 6-59 months with uncomplicated severe acute malnutrition: a multicentre study
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Sam Marconi David1, Preethi N Ragasudha1, Sunita Taneja2
1Department of Community Health, Christian Medical College, Vellore, TN, India.
Insights
Children with severe acute malnutrition (SAM) recovered faster when they had better weight-for-height Z-scores (WHZ) and their fathers had better employment status. Early treatment of illnesses and peer support also improved recovery rates in SAM children.
Area of Science:
- Pediatrics
- Public Health
- Nutrition Science
Background:
- Severe acute malnutrition (SAM) is a critical global health issue affecting millions of children.
- Identifying predictors of recovery is crucial for improving treatment outcomes and reducing mortality in SAM.
- Previous studies have explored various factors, but a comprehensive analysis of child, family, and nutritional predictors is needed.
Purpose of the Study:
- To identify key predictors of recovery in children diagnosed with uncomplicated severe acute malnutrition (SAM).
- To analyze child, family, and nutritional factors that influence the rate of recovery from SAM.
- To provide evidence-based insights for optimizing therapeutic interventions for SAM.
Main Methods:
- Secondary data analysis of an individual randomized controlled trial involving 906 children (6-59 months) with uncomplicated SAM.
- Children were assigned to ready-to-use therapeutic food (RUTF) or augmented home-prepared foods for 16 weeks or until recovery.
- Cox proportional hazard ratio models were used to identify predictors of recovery, analyzing child, family, and nutritional variables.
Main Results:
- Female children, those with fathers in better employment, and living in rental housing showed increased recovery chances.
- Absence of hospitalization, no fever, and fewer than three episodes of diarrhea during treatment were significant positive predictors.
- Higher weight-for-height Z-score (WHZ) at enrollment and availability of peer support for mothers also predicted faster recovery.
Conclusions:
- Recovery from SAM is influenced by a combination of child's nutritional status, family socio-economic factors, and quality of care during treatment.
- Improving father's employment, providing peer support, and prompt treatment of acute illnesses can enhance recovery rates.
- Better initial weight-for-height Z-score (WHZ) is a strong predictor of successful recovery in children with SAM.
Objective:
To identify predictors of recovery in children with uncomplicated severe acute malnutrition (SAM).
Design:
This is a secondary data analysis from an individual randomised controlled trial, where children with uncomplicated SAM were randomised to three feeding regimens, namely ready-to-use therapeutic food (RUTF) sourced from Compact India, locally prepared RUTF or augmented home-prepared foods, under two age strata (6-17 months and 18-59 months) for 16 weeks or until recovery. Three sets of predictors that could influence recovery, namely child, family and nutritional predictors, were analysed.
Setting:
Rural and urban slum areas of three states of India, namely Rajasthan, Delhi and Tamil Nadu.
Participants:
In total, 906 children (age: 6-59 months) were analysed to estimate the adjusted hazard ratio (AHR) using the Cox proportional hazard ratio model to identify various predictors.
Results:
Being a female child (AHR: 1·269 (1·016, 1·584)), better employment status of the child's father (AHR: 1·53 (1·197, 1·95)) and residence in a rental house (AHR: 1·485 (1·137, 1·94)) increased the chances of recovery. No hospitalisation (AHR: 1·778 (1·055, 2·997)), no fever, (AHR: 2·748 (2·161, 3·494)) and ≤ 2 episodes of diarrhoea (AHR: 1·579 (1·035, 2·412)) during the treatment phase; availability of community-based peer support to mothers for feeding (AHR: 1·61 (1·237, 2·097)) and a better weight-for-height Z-score (WHZ) at enrolment (AHR: 1·811 (1·297, 2·529)) predicted higher chances of recovery from SAM.
Conclusion:
The probability of recovery increases in children with better WHZ and with the initiation of treatment for acute illnesses to avoid hospitalisation, availability of peer support and better employment status of the father.
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