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Relapse and post-discharge body composition of children treated for acute malnutrition using a simplified, combined
Natasha Lelijveld1,2, Eunice Musyoki3, Susan Were Adongo3
1No Wasted Lives, Action Against Hunger, London, United Kingdom.
Insights
A simplified malnutrition treatment protocol for children showed similar recovery and relapse rates compared to standard care. This approach can help more children and conserve resources, supporting global malnutrition goals.
Area of Science:
- Global Health
- Pediatric Nutrition
- Malnutrition Treatment
Background:
- Over 50 million children globally suffer from severe and moderate acute malnutrition (SAM and MAM), with 80% lacking access to care.
- Existing treatment protocols often separate care for SAM and MAM, potentially limiting reach and resource efficiency.
- The Combined Protocol for Acute Malnutrition Study (ComPAS) previously demonstrated non-inferior recovery rates for a simplified, combined protocol.
Purpose of the Study:
- To assess the post-discharge outcomes of children treated with a simplified, combined SAM/MAM protocol in Kenya.
- To evaluate anthropometry, body composition, and illness recurrence 4 months after treatment cessation.
- To provide evidence for policy decisions regarding simplified malnutrition treatment strategies.
Main Methods:
- A comparative study involving 850 children (aged 6-59 months) in Kenya, treated under either a combined or standard care protocol.
- The combined protocol used mid-upper arm circumference (MUAC)-based ready-to-use therapeutic food (RUTF) dosing for both SAM and MAM.
- Standard care involved weight-based RUTF for SAM and ready-to-use supplementary food (RUSF) for MAM. Outcomes assessed included anthropometry, body composition (bioelectrical impedance analysis), and illness history.
Main Results:
- Children treated with the combined protocol exhibited similar anthropometry, fat-free mass, fat mass, and skinfold thickness z-scores at 4 months post-discharge compared to the standard care group.
- No significant difference in relapse rates was observed between the two protocols for either SAM (3% vs 3%) or MAM (10% vs 12%).
- MAM children receiving RUTF showed comparable body composition to those on RUSF, with no adverse adiposity.
Conclusions:
- The simplified combined protocol, even with reduced RUTF dosage for some SAM cases, achieved comparable post-discharge outcomes to standard care.
- The findings support the effectiveness of the combined protocol, showing no evidence of adverse effects and similar relapse rates.
- Implementing a simplified, combined approach can enhance treatment coverage, optimize resource utilization, and contribute to achieving Sustainable Development Goal Two.
Introduction:
Severe and moderate acute malnutrition (SAM and MAM) affect more than 50 million children worldwide yet 80% of these children do not access care. The Combined Protocol for Acute Malnutrition Study (ComPAS) trial assessed the effectiveness of a simplified, combined SAM/MAM protocol for children aged 6-59 months and found non-inferior recovery compared to standard care. To further inform policy, this study assessed post-discharge outcomes of children treated with this novel protocol in Kenya.
Methods:
Six 'combined' protocol clinics treated SAM and MAM children using an optimised mid-upper arm circumference (MUAC)-based dose of ready-to-use therapeutic food (RUTF). Six 'standard care' clinics treated SAM with weight-based RUTF rations; MAM with ready-to-use supplementary food (RUSF). Four months post-discharge, we assessed anthropometry, recent history of illness, and body composition by bioelectrical impedance analysis. Data was analysed using multivariable linear regression, adjusted for age, sex and allowing for clustering by clinic.
Results:
We sampled 850 children (median age 18 months, IQR 15-23); 44% of the original trial sample in Kenya. Children treated with the combined protocol had similar anthropometry, fat-free mass, fat mass, skinfold thickness z-scores, and frequency of common illnesses 4 months post-discharge compared the standard protocol. Mean subscapular skinfold z-scores were close to the global norm (standard care: 0.24; combined 0.27). There was no significant difference in odds of relapse between protocols (SAM, 3% vs 3%, OR = 1.0 p = 0.75; MAM, 10% vs 12%, OR = 0.90 p = 0.34).
Conclusions:
Despite the lower dosage of RUTF for most SAM children in the combined protocol, their anthropometry and relapse rates at 4 months post-discharge were similar to standard care. MAM children treated with RUTF had similar body composition to those treated with RUSF and neither group exhibited excess adiposity. These results add further evidence that a combined protocol is as effective as standard care with no evidence of adverse effects post-discharge. A simplified, combined approach could treat more children, stretch existing resources further, and contribute to achieving Sustainable Development Goal Two.
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