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Levels and determinants of child wasting relapse: a prospective cohort study from Somalia

Kemish Kenneth Alier1, Shelley Walton1, Samantha Grounds1

  • 1Johns Hopkins University, Department of International Health, Baltimore, USA.

Journal of Global Health
|February 20, 2026
PubMed

Insights

Severe acute malnutrition relapse rates in Somalia are high, particularly in rural areas and among younger children. Cash assistance programs show promise in reducing relapse among children recovering from severe acute malnutrition.

Area of Science:

  • Pediatrics
  • Public Health
  • Nutrition Science

Background:

  • Severe acute malnutrition (SAM) relapse is a significant concern in Somalia, yet evidence on its rates and determinants is limited.
  • Understanding these factors is crucial for effective intervention strategies in the region.

Purpose of the Study:

  • To assess the rates of SAM relapse in children discharged from outpatient therapeutic programs (OTP) in Somalia.
  • To identify risk factors associated with SAM relapse in this vulnerable population.

Main Methods:

  • A prospective cohort study involving 160 children aged 7-53 months discharged from OTP was conducted.
  • Children were followed for six months, with data collected on anthropometrics, morbidity, and household factors.
  • Survival analysis and Cox proportional hazard models were used to determine relapse rates and associated factors.

Main Results:

  • Cumulative SAM relapse incidence reached 26.0% by six months post-discharge based on weight-for-height z-score (WHZ) and 13.2% based on mid-upper arm circumference (MUAC).
  • Higher relapse rates were observed in rural areas and among children with lower WHZ at admission.
  • Factors associated with increased relapse risk included severe malnutrition at admission and longer OTP stays; cash assistance demonstrated a protective effect.

Conclusions:

  • SAM relapse rates in Somalia are substantial and influenced by anthropometric indicators, geographic location, and demographic characteristics.
  • Cash assistance programs present a viable complementary intervention to reduce SAM relapse.
  • Findings can guide targeted interventions and policy development to improve long-term outcomes for children recovering from SAM.
Abstract

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