Follow-up between 6 and 24 months after discharge from treatment for severe acute malnutrition in children aged 6-59 months: A systematic review

Abstract

BackgroundSevere acute malnutrition (SAM) is a major global health problem affecting some 16.9 million children under five. Little is known about what happens to children 6–24 months post-discharge as this window often falls through the gap between studies on SFPs and those focusing on longer-term effects.MethodsA protocol was registered on PROSPERO (PROSPERO 2017:CRD42017065650). Embase, Global Health and MEDLINE In-Process and Non-Indexed Citations were systematically searched with terms related to SAM, nutritional intervention and follow-up between June and August 2017. Studies were selected if they included children who experienced an episode of SAM, received a therapeutic feeding intervention, were discharged as cured and presented any outcome from follow-up between 6–24 months later.Results3,691 articles were retrieved from the search, 55 full-texts were screened and seven met the inclusion criteria. Loss-to-follow-up, mortality, relapse, morbidity and anthropometry were outcomes reported. Between 0.0% and 45.1% of cohorts were lost-to-follow-up. Of those discharged as nutritionally cured, mortality ranged from 0.06% to 10.4% at an average of 12 months post-discharge. Relapse was inconsistently defined, measured, and reported, ranging from 0% to 6.3%. Two studies reported improved weight-for-height z-scores, whilst three studies that reported height-for-age z-scores found either limited or no improvement.ConclusionsOverall, there is a scarcity of studies that follow-up children 6–24 months post-discharge from SAM treatment. Limited data that exists suggest that children may exhibit sustained vulnerability even after achieving nutritional cure, including heightened mortality and morbidity risk and persistent stunting. Prospective cohort studies assessing a wider range of outcomes in children post-SAM treatment are a priority, as are intervention studies exploring how to improve post-SAM outcomes and identify high-risk children.

Phenotype is sustained during hospital readmissions following treatment for complicated severe malnutrition among Kenyan children: A retrospective cohort study

“…Treatment guidelines have also changed since 1987, which means that the results of their study may need to be re‐evaluated. Although data on the mortality and relapse to SAM of children managed in Community‐Based Management of Acute Malnutrition programmes (uncomplicated SAM) have been reported (O'Sullivan, Lelijveld, Rutishauser‐Perera, Kerac, & James, ; Stobaugh et al, ), only a few papers reported nutritional outcomes of children after treatment from cSAM (Fergusson et al, ; Kerac et al, ; Kerac et al, ; Lelijveld et al, ).…”

“…Two studies explicitly noted that children that relapsed to SAM were readmitted to the hospital although any clinical comorbidities were not specified (Khanum et al, 1998;van Roosmalen-Wiebenga et al, 1987). In the study of Khanum et al (1998) Kerac, & James, 2018;Stobaugh et al, 2018), only a few papers reported nutritional outcomes of children after treatment from cSAM (Fergusson et al, 2009;Kerac et al, 2009;Kerac et al, 2014;Lelijveld et al, 2016).…”

Are innovative ready to use therapeutic foods more effective, accessible and cost-efficient than conventional formulations? A review

“…Follow-up can potentially help individuals avoid developing SAM, while a more individualized approach to the treatment of both forms of malnutrition can improve recovery outcomes and reduce relapses. O’Sullivan et al’s (2018) systemic review of the literature on post-treatment reveals that more studies are needed that chronicle post-treatment recovery. They raise the concern over RUTF treatment schedules, which they argue may need to be more flexible depending on the individual circumstances.…”

“…Lenter (2013) focuses on how effective the WHO protocol has been in treating SAM with RUTFs compared to standard care, setting a benchmark for future studies. More recently, contributions to the field include the state of RUTFs and Ready to Use Supplementary Foods (RUSFs) 2 used specifically in Ethiopia (Ersino et al, 2018), O’Sullivan et al’s (2018) review of literature published on recovery rates post-discharge of SAM treatment, and a systemic review of the effectiveness of using RUTF interventions during the rehabilitation phase of SAM by NGO Campbell Collaboration (Schoonees et al, 2019). These reviews highlight not only the successes of RUTFs in treating SAM in children living in low and medium income countries, but also acknowledge that improvements can be made to RUTF formulations as well as how and when they are administered.…”

A quantitative cross-sectional survey of psychosocial stimulation and counselling interventions at nutritional rehabilitation units in Southern Malawi

“…Following discharge from inpatient treatment at NRUs, children with SAM have a high risk of mortality, poor nutritional outcomes including stunting and recurrence of malnutrition, and inhibited development which is longlasting 22,24,[34][35][36][37] . Based on the results of this survey, NRUs in Malawi require additional investment in comprehensive interventions to improve outcomes in these most vulnerable children.…”