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A Prospective Comparison of Standard and Modified Acute Malnutrition Treatment Protocols during COVID-19 in South

Shannon Doocy1, Sarah King2,3, Sule Ismail3,4

  • 1Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21205, USA.

Nutrients
|December 9, 2023
PubMed

Insights

A modified Community Management of Acute Malnutrition (CMAM) protocol in South Sudan showed similar recovery rates and length of stay compared to the standard protocol for malnourished children. Simplified protocols may be beneficial post-pandemic.

Area of Science:

  • Global Health
  • Pediatrics
  • Nutrition Science

Background:

  • Acute malnutrition (AM) poses a significant threat to children's health globally.
  • The Community Management of Acute Malnutrition (CMAM) protocol is a cornerstone of AM treatment.
  • The COVID-19 pandemic necessitated adaptations to standard healthcare protocols, including those for AM.

Purpose of the Study:

  • To compare the recovery rate and length of stay (LoS) for acutely malnourished children treated under South Sudan's standard CMAM protocol versus a COVID-modified protocol.
  • To evaluate the effectiveness of simplified AM treatment protocols.
  • To assess the feasibility of adopting modified protocols in post-pandemic settings.

Main Methods:

  • A non-randomized prospective cohort study was conducted in 2022.
  • Children aged 6-59 months with acute malnutrition were treated under standard or modified CMAM protocols (mid-upper-arm circumference-only entry/exit criteria, simplified dosing).
  • Recovery rates and LoS were compared for outpatient therapeutic (OTP) and therapeutic supplementary feeding programs (TSFP) using descriptive statistics and mixed-effects models.

Main Results:

  • Initially, the modified protocol showed shorter LoS and higher recovery rates in both OTP and TSFP.
  • However, after adjusting for site and child characteristics, these differences were not statistically significant.
  • Adjusted models indicated similar treatment outcomes between the standard and modified protocols for both recovery and LoS.

Conclusions:

  • Modified CMAM protocols, incorporating simplified criteria and dosing, performed comparably to the standard protocol in treating acute malnutrition.
  • The findings suggest that simplified protocols could be beneficial, particularly in resource-limited settings or during public health emergencies.
  • Long-term monitoring of recovery and relapse rates is recommended to fully understand the implications of adopting simplified protocols.

Keywords:
COVID-19 nutrition adaptationsSouth Sudanacute malnutritioncommunity management of acute malnutritionsimplified nutrition treatment protocol

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