Children with Moderate Acute Malnutrition with No Access to Supplementary Feeding Programmes Experience High Rates of Deterioration and No Improvement: Results from a Prospective Cohort Study in Rural Ethiopia

James, Philip; Sadler, Kate; Wondafrash, Mekitie; Argaw, Alemayehu; Luo, Hanqi; Geleta, Benti; Kedir, Kiya; Getnet, Yilak; Belachew, Tefera; Bahwere, Paluku

doi:10.1371/journal.pone.0153530

Cited by 66 publications

(91 citation statements)

References 45 publications

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“…Additionally, at national level, there are discrepancies in treatment strategies for MAM, if any are present at all. We know that children defined as MAM (WHZ ≥ −3 and <−2 and/or MUAC ≥11.5 and <12.5 cm) are at higher risk of mortality, morbidity, and deteriorating into SAM; hence, finding an effective method of supporting this group is crucial for meeting the second Sustainable Development Goal of achieving zero hunger by 2030 and ending all forms of malnutrition (James et al, ; L. M. Lenters, Wazny, Webb, Ahmed, & Bhutta, ).…”

Section: Introductionmentioning

confidence: 99%

Systematic review of the treatment of moderate acute malnutrition using food products

Lelijveld

Beedle

Farhikhtah

et al. 2019

Maternal & Child Nutrition

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There is currently a lack of international guidance on the most appropriate treatment for moderate acute malnutrition (MAM), and discrepancies in national treatment guidelines exist. We aimed to explore whether food interventions are effective for MAM children 6-59 months old and whether they result in better outcomes compared with no treatment or management with nutrition counselling. A systematic literature search was conducted in October 2018, identifying studies that compared treating MAM children with food products versus management with counselling or no intervention. A total of 673 abstracts were screened, 101 full texts were read, and one study was identified that met our inclusion criteria. After broadening the criteria to include micronutrients in the control group and enrolment based on outdated anthropometric criteria, 11 studies were identified for inclusion. Seven of these found food products to be superior for anthropometric outcomes compared with counselling and/or micronutrient supplementation; two of the studies found no significant benefit of a food product intervention; and two studies were inconclusive.Hence, the majority of studies in this review found that food products resulted in greater anthropometric gains than counselling or micronutrient interventions. This was especially true if the supplementary food provided was of suitable quality and provided for an adequate duration. Improving quality of and adherence to counselling may improve its effectiveness, particularly in food secure contexts. There is currently a paucity of comparable studies on this topic as well as a lack of studies that include important functional outcomes beyond anthropometric proxies.

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Section: Introductionmentioning

confidence: 99%

Systematic review of the treatment of moderate acute malnutrition using food products

Lelijveld

Beedle

Farhikhtah

et al. 2019

Maternal & Child Nutrition

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“…Only one study in Ethiopia by James et al report similar findings, but they included supplementary feeding programme which was not included in our study. 5 However, majority of studies report prevalence of SAM more than MAM.…”

Section: Discussionmentioning

confidence: 99%

“…2 Whilst the contribution of SAM to global mortality and morbidity has been widely recognized with resulting international treatment protocols, the management of MAM remains debated. [3][4][5][6][7][8] Despite much efforts in the recent years to harmonize the understanding of MAM and its management, consensus is still not reached, especially in non-emergency and relatively food secure settings of low and middle income countries. 6,7,9,10 Targeted Supplementary Feeding Programmes (TSFPs) are the most commonly used approach for treating MAM.…”

Section: Introductionmentioning

confidence: 99%

Severe and moderate acute malnutrition detection in a rural hospital pediatric outpatient clinic and their comparison with the IAP charts: a two-year study

Ambike¹,

Haribhakta²,

Poyekar³

et al. 2017

Int J Contemp Pediatr

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Background: Children with moderate acute malnutrition (MAM) have an increased list of mortality, infections and impaired physical and cognitive development compared to well-nourished children. The Objectives of this study were to diagnose Severe Acute Malnutrition (SAM) and Moderate Acute Malnutrition (MAM) using WHO growth charts as a criterion and to compare the WHO classification with the IAP classification in the diagnosis of SAM and MAM.Methods: A two-year duration cross-sectional study conducted in Pediatric outpatient clinic of a rural hospital from January 2013 to December 2014. In case of moderate acute malnutrition (MAM) was diagnosed as weight-for-height >-3 but <-2 Z scores of the median according to WHO growth standards. We defined MAM as mid-upper am circumference (MUAC) of >11.0 cm and <12.5 cm with no bilateral pitting edema and SAM as MUAC less than 11.5 cm. We compared the values with the IAP charts for diagnosis of malnutrition. Our set up is not a nutrition rehabilitation centre, feeding programmes were not implemented.Results: The distribution of prevalence of SAM and MAM differs significantly across three age groups studied (P-value <0.001). However, it did not differ significantly between boys and girls aged between 6 months to 6 years (P-value >0.05). Of 90 SAM cases, 55 cases (61.1%) had Grade 1 IAP grade of malnutrition, 28 cases (31.1%) had Grade 2 IAP grade of malnutrition, 7 cases (7.8%) had Grade 3 IAP grade of malnutrition. None of the SAM cases fell in Grade 4 IAP. The distribution of prevalence of SAM and MAM differs significantly across various IAP grades of malnutrition (P-value <0.001).Conclusions: The IAP charts used for diagnosing malnutrition did not have any comparative value with the WHO charts used for the SAM MAM detection. WHO grading of SAM and MAM is more sensitive than IAP grading in early diagnosis of under nutrition and facilitate early treatment. Not having a targeted nutrition-specific intervention to address MAM in this set up places these children with MAM at excessive risk of adverse outcomes. Further preventive and curative approaches should urgently be considered.

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“…A 2016 study [12] notes that the current Ethiopian strategy for managing MAM nationally is to restrict supplementary feeding programs (SFPs) for treatment to districts (woredas) that are chronically food-insecure. In areas not considered chronically food-insecure, there are no public SFPs; instead, providers rely on existing infant and child health interventions such as vitamin A supplementation, de-worming, water treatment, improved sanitation, and nutrition counseling.…”

Section: Introductionmentioning

confidence: 99%

“…In areas not considered chronically food-insecure, there are no public SFPs; instead, providers rely on existing infant and child health interventions such as vitamin A supplementation, de-worming, water treatment, improved sanitation, and nutrition counseling. Researchers have noted that while this policy is logical in terms of efficiency, it may be failing to adequately address the problem of widespread malnutrition, because aggregate, average food security at the woreda level is may mask severe food insecurity at the household level [7,12,13]. Household food security has been shown to be associated with developing MAM and a failure to recover from MAM [14,15].…”

Section: Introductionmentioning

confidence: 99%

Risk factors associated with poor health outcomes for children under the age of 5 with moderate acute malnutrition in rural fagita lekoma district, Awi Zone, Amhara, Ethiopia, 2016

Adamu¹,

Jara

Alemayehu

et al. 2017

BMC Nutr

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Background: Left untreated, moderate acute malnutrition (MAM) in children can lead to severe acute malnutrition, stunting, developmental delays, and death. Despite recent progress the prevalence of malnutrition remains high throughout Ethiopia. The ability to make accurate prognoses and develop effective treatment strategies for children with MAM is currently limited and, as result, a significant proportion of children with MAM fail to recover even with treatment. We seek to address this limitation by assessing the risk factors for poor outcomes among children under the age of 5 with MAM in a rural area of Ethiopia's Amhara Region. This region is considered relatively food secure and does not have food supplementation treatment programs. Methods: We conducted a prospective cohort study of 404 randomly sampled children, 0-59 months old stratified by household food security status. We followed the study children for approximately 2 months, assessing their health status; and used bivariate and multivariate Cox-proportional hazard regression models to identify risk factors for poor health outcomes. Results: Household food security was significantly associated with low recovery from MAM: 191 (60%) of children in food-insecure and 129 (40%) of children in food-secure households had poor health outcomes. The risk factors found to be significantly associated with poor health outcomes included the duration of exclusive breastfeeding (AHR 1.50, 95%CI: 1.05, 2.15), dietary diversity (AHR 1.74, 95%CI: 1.18, 2.54), and maternal mid-upper arm circumference (AHR=1.36, 95% CI: 1.04, 1.86). Children from pregnancies that were wanted but unplanned had 80% higher incidence of poor health outcomes than others, and children from pregnancies that were both unwanted and unplanned had more than double the incidence of poor health outcomes compared to their counterparts. Conclusion: We found that without treatment, the majority of children from food insecure households and over a third of children from food secure households did not recover from MAM. Maternal factors particularly the mother's ability to plan her pregnancy were the main determinants of recovery in this study. Together these findings support arguments for targeting of nutrition support programs to vulnerable households regardless of regional food security status, and for closely integrating robust family planning, and antenatal care services with nutrition interventions.

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Children with Moderate Acute Malnutrition with No Access to Supplementary Feeding Programmes Experience High Rates of Deterioration and No Improvement: Results from a Prospective Cohort Study in Rural Ethiopia

Cited by 66 publications

References 45 publications

Systematic review of the treatment of moderate acute malnutrition using food products

Systematic review of the treatment of moderate acute malnutrition using food products

Severe and moderate acute malnutrition detection in a rural hospital pediatric outpatient clinic and their comparison with the IAP charts: a two-year study

Risk factors associated with poor health outcomes for children under the age of 5 with moderate acute malnutrition in rural fagita lekoma district, Awi Zone, Amhara, Ethiopia, 2016

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