Topical Area: Medical Nutrition, Nutrition Translation
Objectives : Identify the most significant factors affecting the trajectory of recovery from severe acute malnutrition (SAM), as measured by average daily weight gain in each child 6-59 months of age who were diagnosed and treated for SAM and treated, adjusting for covariates including: breastfeeding status, number of children in household, illness, and distance to health center.
Hypothesis 1a: Children 6-59 months enrolled in SAM treatment have slower times to recovery and slower weight gain if they are admitted for treatment at a lower anthropometric cut-off admission (weight for height z-score< -4) than children admitted for treatment at a higher anthropometric cut-off (weight for height z-score ≥-4).
Hypothesis 1b: Older children (24-59 months) recover more quickly than younger children (6-23 months) controlling for ration size.
Methods : A retrospective panel data analysis on children 6-59 months enrolled in standard outpatient treatment for severe acute malnutrition (SAM) between 2014 and 2016 was conducted. The study period was between September-December 2018. Children were exhaustively sampled. Children with edema, children with implausible z-scores for W/H (< -5 and >5) and H/A (< -6 and >6), children who were referred for inpatient therapeutic feeding to a stabilization center, and children from the same household, except in the case of twins, were eliminated from the analysis. There was one database per country. A total of 1384 children between 6-59 months were included in the analysis.
The most significant factors affecting the proportional weight gain include age at enrollment (p=0.001, 95%CI= -0.00- -0.00) and Weight for height z-score (WHZ) (p=0.00, 95%CI= 0.04- 0.05) in each child 6-59 months of age who were diagnosed with SAM and treated, adjusting for covariates including: breastfeeding status, number of children in household, illness, and distance to health center. Sex of child did not significantly affect proportional weight gain (p=0.404, 95%CI= -0.012-0.005).
The existing protocol to treat severe acute malnutrition should be modified to treat younger children and children who are admitted with a lower weight for height z-score due to different vulnerabilities.
Funding Sources :
The research was conducted as part of a dissertation at The Friedman School of Nutrition Science and Policy at Tufts University. Data were obtained from World Vision.
Friedman School of Nutrition Science and Policy