Community-Based Management of Acute Malnutrition for Infants Under 6 Months of Age Is Safe and Effective: Analysis of Operational Data

2021 ◽  
pp. 1-27
Author(s):  
Maeve M. Woeltje ◽  
Anastasia B. Evanoff ◽  
Beth A. Helmink ◽  
Diana L. Culbertson ◽  
Kenneth M. Maleta ◽  
...  
Keyword(s):  
Randomized Clinical Trials ◽  
Severe Acute Malnutrition ◽  
Acute Malnutrition ◽  
Community Based ◽  
Malnourished Children ◽  
Nutritional Recovery ◽  
Economic Barriers ◽  
Moderate Acute Malnutrition ◽  
Supplementary Foods ◽  
Operational Data

Abstract Objective: To assess the effectiveness of outpatient management with ready-to-use and supplementary foods for infants under 6 months (u6m) of age who were unable to be treated as inpatients due to social and economic barriers. Design: Review of operational acute malnutrition treatment records. Setting: 21 outpatient therapeutic feeding clinics in rural Malawi. Participants: Infants u6m with acute malnutrition treated as outpatients because of barriers to inpatient treatment. The comparison group consisted of acutely malnourished children 6-9 months of age who were being treated at the same time in the same location in the context of two different randomized clinical trials. Results: A total of 323 infants u6m were treated for acute malnutrition (130 severe and 193 moderate). A total of 357 infants 6-9 months old with acute malnutrition (74 severe and 283 moderate) were included as contemporaneous controls. Among infants u6m with severe acute malnutrition, 98 (75.4%) achieved nutritional recovery; in comparison, 56 (75.7%) of those with SAM 6-9 months old recovered. Among infants u6m with moderate acute malnutrition, 157 (81.3%) recovered; in comparison 241 (85.2%) of those aged 6-9 months recovered. Conclusions: In a rural Malawian population of infants u6m who had generally already stopped exclusive breastfeeding and were now acutely malnourished, treatment with therapeutic or supplementary foods under the community management of acute malnutrition model was safe and effective. In settings where social and financial factors make hospital admission challenging, consideration should be given to lowering the recommended age of ready-to-use therapeutic and supplementary foods to infants u6m.

scholarly journals Development and Acceptability of Locally Made Fish-Based, Ready-to-Use Products for the Prevention and Treatment of Malnutrition in Cambodia

2018 ◽  
Vol 39 (3) ◽  
pp. 420-434 ◽  
Author(s):  
Sanne Sigh ◽  
Nanna Roos ◽  
Daream Sok ◽  
Bindi Borg ◽  
Chhoun Chamnan ◽  
...  
Keyword(s):  
Severe Acute Malnutrition ◽  
Acute Malnutrition ◽  
Treatment Intervention ◽  
Intervention Trial ◽  
Overall Acceptability ◽  
High Prevalence ◽  
Prevention And Treatment ◽  
Moderate Acute Malnutrition ◽  
Hedonic Scale ◽  
Supplementary Foods

Background: Cambodia has a high prevalence of moderate acute malnutrition and severe acute malnutrition (SAM). The SAM treatment requires ready-to-use therapeutic foods (RUTFs), whereas ready-to-use supplementary foods (RUSFs) are used for prevention of acute malnutrition. Three locally produced fish-based products were developed: an RUTF paste (NumTrey-Paste) for treatment and 2 wafer versions, one for prevention (NumTrey-RUSF) and one for treatment (NumTrey-RUTF). Objective: To assess the acceptability of NumTrey-Paste and NumTrey-RUSF in comparison to a standard biscuit product (BP-100) used for the treatment of SAM. Methods: Acceptability of NumTrey-RUSF and NumTrey-Paste was tested in a nonblinded crossover taste trial among children (n = 52), aged ≥ 6 months to 18 years, and their caregivers. Eight organoleptic qualities were assessed on a 5-point hedonic scale, as well as a ranking test. A score of 1 to 3 was categorized as acceptable. The acceptability of NumTrey-RUTF was assessed using the caregivers’ perception during an SAM treatment intervention. Results: Taste trial: The proportion of children categorizing products as overall acceptable was lowest for NumTrey-Paste compared to for BP-100 and NumTrey-RUSF (21% vs 43% [BP-100] and 36% [NumTrey-RUSF]). No difference was found in the proportion of children who ranked BP-100 or NumTrey-RUSF as “liked most” ( P > .05). Acceptability of NumTrey-RUSF ranked highest in appearance and taste (caregiver), whereas acceptability of NumTrey-Paste was ranked lowest in appearance and smell among the products. Intervention trial: The acceptability of NumTrey-RUTF increased from 72% to 86%. Conclusions: The overall acceptability was ranked lowest for a pure paste product. However, filling the paste into a wafer made the product more acceptable.

Increased risk of acquisition and transmission of ESBL-producing Enterobacteriaceae in malnourished children exposed to amoxicillin

2019 ◽  
Vol 75 (3) ◽  
pp. 709-717 ◽  
Author(s):  
Naouale Maataoui ◽  
Céline Langendorf ◽  
Fatou Berthe ◽  
Jumamurat R Bayjanov ◽  
Willem van Schaik ◽  
...  
Keyword(s):  
Placebo Group ◽  
Severe Acute Malnutrition ◽  
Controlled Trial ◽  
Acute Malnutrition ◽  
Double Blind ◽  
Adjusted Risk ◽  
Malnourished Children ◽  
Nutritional Recovery ◽  
Adjusted Risk Ratio ◽  
Increased Risk

Abstract Objectives Routine amoxicillin for children with uncomplicated severe acute malnutrition raises concerns of increasing antibiotic resistance. We performed an ancillary study nested within a double-blind, placebo-controlled trial in Niger testing the role of routine 7 day amoxicillin therapy in nutritional recovery of children 6 to 59 months of age with uncomplicated severe acute malnutrition. Methods We screened 472 children for rectal carriage of ESBL-producing Enterobacteriaceae (ESBL-E) as well as their household siblings under 5 years old, at baseline and Week 1 (W1) and Week 4 (W4) after start of therapy, and characterized strains by WGS. ClinicalTrials.gov: NCT01613547. Results Carriage in index children at baseline was similar in the amoxicillin and the placebo groups (33.8% versus 27.9%, P = 0.17). However, acquisition of ESBL-E in index children at W1 was higher in the amoxicillin group than in the placebo group (53.7% versus 32.2%, adjusted risk ratio = 2.29, P = 0.001). Among 209 index and sibling households possibly exposed to ESBL-E transmission, 16 (7.7%) had paired strains differing by ≤10 SNPs, suggesting a high probability of transmission. This was more frequent in households from the amoxicillin group than from the placebo group [11.5% (12/104) versus 3.8% (4/105), P = 0.04]. Conclusions Among children exposed to amoxicillin, ESBL-E colonization was more frequent and the risk of transmission to siblings higher. Routine amoxicillin should be carefully balanced with the risks associated with ESBL-E colonization.

scholarly journals Preparation of Ready to Use Supplementary Food for Treating Moderate Acute Malnutrition in Children Aged 6 to 59 Months

2020 ◽  
Vol 14 (3) ◽  
pp. 22
Author(s):  
Patricia M. Ntsama ◽  
Julie Judith T. Tsafack ◽  
Gabriel Nama Medoua ◽  
Carl M F Mbofung
Keyword(s):  
Sensory Evaluation ◽  
Severe Acute Malnutrition ◽  
Protein Digestibility ◽  
Acute Malnutrition ◽  
Balanced Diet ◽  
Malnourished Children ◽  
Threatening Condition ◽  
Life Threatening ◽  
Moderate Acute Malnutrition ◽  
Moderate Malnutrition

<p>Children with moderate malnutrition have a high risk of mortality and MAM is associated with a high number of nutrition-related deaths. If some of these children suffering from MAM do not receive adequate support, they may progress towards severe acute malnutrition (SAM), which is a life-threatening condition. Therefore, the management of MAM should be a public health priority<strong></strong></p><p>A well-balanced diet was prepared based on the recommendation of WHO for the treatment of moderate acute malnourished children aged 6 -59 months.  According to the formulae, nine products of RUSF were prepared using cereals, legumes, seeds, oil, sugar, and vitamin and mineral premix. Three products of RUSF MSPe, PBPe, and ISPe were found to be better among the nine products by the mothers after sensory evaluation.</p><p>Based on sensory evaluation in children, RUSF   MSPe was found to be the best among the three products. The product was analyzed for proximate composition, mineral, vitamin, digestibility of protein.  The protein, fat, carbohydrate, dietary fiber, total ash, vitamin C, Vitamin A,  iron, calcium and zinc of 100 g of the product were found to be  15.9g, 33.7g, 44.3g, 6.6g, 2.2g, 54.6 mg, 855 µg,  14.1 mg,  66.6 g and  12.4 µg respectively. The diet can supply 544.5 Kcal/100 g. The energy contributed by the protein, fat, and carbohydrate was found to be 11.68%, 55.7%, and 32.62% of total Kcals respectively. The protein digestibility adjusted to the chemical index PDCASS was 0.95.</p>Hence, the prepared RUSF is in accordance with the specification given by WHO which could be effective in the treatment of moderate acute malnourished children after the clinical trial.

scholarly journals Program and Caseload Implications of Adopting the Global MUAC Criteria for Community Management of Acute Malnutrition in Children Under 5 Years Old in Ethiopia

2020 ◽  
Vol 4 (Supplement_2) ◽  
pp. 157-157
Author(s):  
Yosef Asefaw ◽  
Seifu Hagose ◽  
Girmay Ayana ◽  
Solomon Hailu ◽  
Tadess Kebebe ◽  
...  
Keyword(s):  
Severe Acute Malnutrition ◽  
Acute Malnutrition ◽  
Cross Sectional ◽  
Number Of Children ◽  
Funding Sources ◽  
Malnourished Children ◽  
The Mean ◽  
Gates Foundation ◽  
Moderate Acute Malnutrition ◽  
Cluster Randomized

Abstract Objectives Ethiopia has been hesitant to shift to the global MUAC-based definitions for acute malnutrition given the two to four times potential increase in caseload suggested by several cross-sectional surveys. Thus, the objective of this study was to provide specific evidence on the caseload implications for Ethiopia of aligning with the WHO recommended criteria. Methods A cluster-randomized control study was conducted in four districts of Amhara and Oromia regions of Ethiopia in a total of 36 health posts (HPs). Districts and HPs were selected based on previous high case report. In each district, an equal numbers of HPs were randomly assigned to use either the global MUAC criteria of &lt;11.5 cm for severe acute malnutrition (SAM) and the moderate acute malnutrition (MAM) criteria of ≥11.5cm to &lt;12.5 cm (intervention) or the current Ethiopian criteria of &lt;11 cm for SAM and ≥11 cm to &lt;12 cm for MAM (control). All 6–59 mo children were screened regularly for 16 wks. Malnourished children were admitted to the study according to the criteria assigned to their HP. Results A total of 349 SAM and 986 MAM new cases were admitted during the 16 wk recruitment. Of the new SAM cases, 225 were in intervention and 124 were in control HPs. The ratio of SAM in intervention compared to control HPs was 1.78 (1.14–2.42, 95%CI), which indicates an increase in admissions of 78% (P = 0.019). The mean (±SD) monthly SAM admissions per HPs were 1.71 (0.53) in control and 2.97 (3.31) in intervention (P = 0.191). For MAM, 592 cases were in intervention and 394 were in control for a ratio of 1.50 (1.11–1.89). The global MUAC criteria increased caseload by 50% (P = 0.015) compared to control. The mean monthly new MAM admissions per HPs were 5.47 (4.02) in control and 8.22 (3.28) in intervention (P = 0.045). The mean number of children served during biweekly combined sessions for SAM and MAM was 19.67 (9.28) in intervention and 13.08 (8.28) in control (P = 0.026). For sessions restricted to SAM, a mean of 4.26 (4.11) was served in intervention and 1.92 (1.88) in control (P = 0.028). Conclusions The increases in cases and workload resulting from shifting from Ethiopia's current national SAM and MAM admission and discharge criteria to the WHO criteria are likely to be on a smaller scale than is usually claimed based on various cross-sectional surveys. Most HPs were not overwhelmed due to the shift. Funding Sources Bill and Melinda Gates Foundation.

scholarly journals Malaria and malnutrition co-existence among under-five children of tribal dense regions of Odisha: a community based study

2018 ◽  
Vol 5 (7) ◽  
pp. 3024
Author(s):  
Ashish Mahapatra ◽  
Sabyasachi Mohapatra ◽  
Niloy Mitter ◽  
Sushree Swagata Dash ◽  
Rudra Prasanna Mishra ◽  
...  
Keyword(s):  
Rainy Season ◽  
Malaria Infection ◽  
Nutritional Assessment ◽  
Severe Acute Malnutrition ◽  
Acute Malnutrition ◽  
Age Group ◽  
Community Based ◽  
Malnourished Children ◽  
Significant Difference ◽  
Estimate Prevalence

Background: “Malaria and malnutrition are closely related in the months of hunger gap when malnutrition is at its peak often coincides with rainy season when the number of malaria cases shoot up. The disease combines in a vicious circle. Children sick with malaria are more likely to become dangerously malnourished”. Severely malnourished children with malaria infection may have no fever, or be hypothermic. Proactive screening for malaria in severely malnourished children is needed even if the child has no symptoms of malaria. The objectives of the study were to estimate prevalence of “malaria and malnutrition” co-existence in under 5 children of tribal dense regions and to determine if any significant difference between this co-existent condition against the disease alone.Methods: Eight villages were selected based on their inaccessibility and demography spread across Bamnipal and Sukinda region. Malaria testing using antigen based RDK and nutritional assessment using MUAC tapes were conducted in of 6 months to <5 yrs children.Results: A total of 224 children of under 5 yrs age group were screened. 50.4% of them were suffering from malaria, 38% of the children were at risk or suffering from severe acute malnutrition. Of the 113 children with malaria, 45% were having malnutrition. Out of 86 malnourished children 59% were diagnosed with malaria. 22.7% of children were found to have malaria and malnutrition together.Conclusions: Malaria and Malnutrition are co-existent and synergistic to each other.

scholarly journals “No weight for height” case detection strategies for therapeutic feeding programs: sensitivity to acute malnutrition and target composition based on representative surveys in humanitarian settings

BMC Nutrition ◽  
2021 ◽  
Vol 7 (1) ◽  
Author(s):  
Benjamin Guesdon ◽  
Alexia Couture ◽  
Elise Lesieur ◽  
Oleg Bilukha
Keyword(s):  
Severe Acute Malnutrition ◽  
Significant Proportion ◽  
Acute Malnutrition ◽  
Case Detection ◽  
Cross Sectional ◽  
Feeding Programs ◽  
Target Composition ◽  
Malnourished Children ◽  
Moderate Acute Malnutrition ◽  
Detection Strategies

Abstract Background One newly proposed approach to determining eligibility of children aged 6–59 months for therapeutic feeding programs (TFPs) is to use mid-upper arm circumference (MUAC) < 115 mm, bilateral oedema or Weight-for-Age Z-score (WAZ) < − 3 as admission criteria (MUAC+SWAZ). We explored potential consequences of this approach on the eligibility for treatment, as compared with the existing WHO normative guidance. We also compared sensitivity and specificity parameters of this approach for detecting wasted children to the previously described “Expanded MUAC” approach. Methods We analyzed data from 558 population representative cross-sectional cluster surveys conducted since 2007. We retrieved all children classified as severe acute malnutrition (SAM), moderate acute malnutrition (MAM), and those who are both wasted and stunted (WA + ST), and calculated proportions of previously eligible children who would now be excluded from treatment, as well as proportions of non-malnourished children among those who would become eligible. We also analyzed the expected changes in the number and demographics (sex, age) of the selected populations of children according to the different admission approaches. Results Both MUAC+SWAZ and Expanded MUAC case detection approaches substantially increase the sensitivity in detecting SAM, as compared to an approach which restricts detection of SAM cases to MUAC< 115 mm and oedema. Improved sensitivity however is attained at the expense of specificity and would require a very large increase of the size of TFPs, while still missing a non-negligible proportion (20–25%) of the SAM caseload. While our results confirm the sensitivity of the MUAC+SWAZ case detection approach in detecting WA + ST (over 80%), they show, on the other hand, that about half of the additional target detected by using SWAZ criterion will be neither SAM nor WA + ST. Conclusions These results suggest that recently promoted approaches to case detection inflate TFPs’ targets through the allocation of treatment to large numbers of children who have not been shown to require this type of support, including a significant proportion of non-acutely malnourished children in the MUAC+SWAZ approach. Considering the scarcity of resources for the implementation of TFPs, the rationale of abandoning the use of WHZ and of these alternative case detection strategies need to be critically reviewed.

scholarly journals Incidence Correction Factors for Moderate and Severe Acute Child Malnutrition From 2 Longitudinal Cohorts in Mali and Burkina Faso

2020 ◽  
Vol 189 (12) ◽  
pp. 1623-1627
Author(s):  
Francisco M Barba ◽  
Lieven Huybregts ◽  
Jef L Leroy
Keyword(s):  
Burkina Faso ◽  
Low Income ◽  
Severe Acute Malnutrition ◽  
Acute Malnutrition ◽  
Cross Sectional ◽  
Incidence Data ◽  
Moderate Acute Malnutrition ◽  
Cluster Randomized ◽  
Definition Of ◽  
Mid Upper Arm Circumference

Abstract Child acute malnutrition (AM) is an important cause of child mortality. Accurately estimating its burden requires cumulative incidence data from longitudinal studies, which are rarely available in low-income settings. In the absence of such data, the AM burden is approximated using prevalence estimates from cross-sectional surveys and the incidence correction factor $K$, obtained from the few available cohorts that measured AM. We estimated $K$ factors for severe acute malnutrition (SAM) and moderate acute malnutrition (MAM) from AM incidence and prevalence using representative cross-sectional baseline and longitudinal data from 2 cluster-randomized controlled trials (Innovative Approaches for the Prevention of Childhood Malnutrition—PROMIS) conducted between 2014 and 2017 in Burkina Faso and Mali. We compared K estimates using complete (weight-for-length z score, mid-upper arm circumference (MUAC), and edema) and partial (MUAC, edema) definitions of SAM and MAM. $K$ estimates for SAM were 9.4 and 5.7 in Burkina Faso and in Mali, respectively; K estimates for MAM were 4.7 in Burkina Faso and 5.1 in Mali. The MUAC and edema–based definition of AM did not lead to different $K$ estimates. Our results suggest that $K$ can be reliably estimated when only MUAC and edema-based data are available. Additional studies, however, are required to confirm this finding in different settings.

scholarly journals Survival and predictors of mortality among severe acute malnourished under-five children admitted at Felege-Hiwot comprehensive specialized hospital, northwest, Ethiopia: a retrospective cohort study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Amare Kassaw ◽  
Desalegne Amare ◽  
Minyichil Birhanu ◽  
Aragaw Tesfaw ◽  
Shegaw Zeleke ◽  
...  
Keyword(s):  
Public Health ◽  
Oxygen Saturation ◽  
Retrospective Cohort ◽  
Severe Acute Malnutrition ◽  
Acute Malnutrition ◽  
Altered Consciousness ◽  
Time To Death ◽  
Under Five ◽  
Predictors Of Mortality ◽  
Malnourished Children

Abstract Background Malnutrition is still a global public health problem contributing for under-five morbidity and mortality. The case is similar in Ethiopia in which severe acute malnutrition is the major contributor to mortality being an underlying cause for nearly 45% of under-five deaths. However, there is no recent evidence that shows the time to death and public health importance of oxygen saturation and chest in drawing in the study area. Therefore, estimated time to death and its predictors can provide an input for program planners and decision-makers. Methods A facility -based retrospective cohort study was conducted among 488 severe acute malnourished under-five children admitted from the 1st of January 2016 to the 30th of December 2019. The study participants were selected by using simple random sampling technique. Data were entered in to Epi-Data version 3.1 and exported to STATA version15 statistical software for further analysis. The Kaplan Meier was used to estimate cumulative survival probability and a log-rank test was used to compare the survival time between different categories of explanatory variables. The Cox-proportional hazard regression model was fitted to identify predictors of mortality. P-value< 0.05 was used to declare statistical significance. Results Out of the total 488 randomly selected charts of children with severe acute malnutrition, 476 records were included in the final analysis. A total of 54(11.34%) children died with an incidence rate of 9.1death /1000 person- days. Failed appetite test (AHR: 2.4; 95%CI: 1.26, 4.67), altered consciousness level at admission (AHR: 2.4; 95%CI: 1.08, 4.67), oxygen saturation below 90% (AHR: 3.3; 95%CI: 1.40, 7.87), edema (AHR 2.9; 95%CI: 1.45, 5.66) and HIV infection (AHR: 2.8; 95%CI: 1.24, 6.36) were predictors of mortality for children diagnosed with severe acute malnutrition. Conclusion The overall survival status of severe acute malnourished children was low as compared to national sphere standards and previous reports in the literature. The major predictors of mortality were oxygen saturation below 90%, altered consciousness, HIV infection, edema and failed appetite test. Therefore, early screening of complications, close follow up and regular monitoring of sever acute malnourished children might improve child survival rate.

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