Long-term outcomes for children with disability and severe acute malnutrition in Malawi

Abstract

IntroductionSevere acute malnutrition (SAM) and disability are major global health issues. Although they can cause and influence each other, data on their co-existence are sparse. We aimed to describe the prevalence and patterns of disability among a cohort of children with SAM.MethodsA longitudinal cohort study in Malawi followed SAM survivors up to 7 years postdischarge. Clinical and anthropometric profiles were compared with sibling and community controls. Disability at original admission was identified clinically; at 7-year follow-up a standardised screening tool called ‘the Washington Group Questionnaire’ was used.Results60/938 (6.4%) of admissions to SAM treatment had clinically obvious disability at admission. Post-treatment mortality was high, with only 11/60 (18%) surviving till 7-year follow-up. SAM children with a disability at admission had 6.99 (95% CI 3.49 to 14.02; p<0.001) greater risk of dying compared with children without disability. They were also older, less likely to be HIV positive or have oedema and more severely malnourished. Long-term survivors were more stunted, had less catch-up growth, smaller head circumference, weaker hand grip strength and poorer school achievement than non-disabled survivors.The Washington Group Questionnaire confirmed disability in all who had been identified clinically, and identified many who had not been previously flagged.ConclusionDisability is common among children affected by SAM. Those with disability-associated SAM have greatly increased risk of dying even if they survive the initial episode of malnutrition. Survivors have poorer growth, physical strength and school achievement. To enable all children to survive and thrive post-SAM, it is vital to focus more on those with disabilities. SAM treatment programmes should consider using not just clinical assessment but structured assessments to better identify at-risk individuals as well as understand the population of children for which they are developing services.

Nutritional status of children living within institution-based care: a retrospective analysis with funnel plots and control charts for programme monitoring

“… 10 30 Children with disabilities who are wasted are at high risk of mortality and require specific care and inclusion in malnutrition treatment programmes. 31 It is also notable that nearly a third of children younger than 5 years and over half of those with disabilities had a small head circumference, which although associated with preterm birth or some disabilities, could be an indicator of impacted brain development.…”

Children Living with Disabilities Are Absent From Severe Malnutrition Guidelines

“…Recent work suggests that formal screening tools may help with this: many types of disabilities, especially those that are less severe or less obvious are missed via routine clinical examination alone. 6 Some disabilities can be challenging to diagnose clinically, and malnutrition treatment failure, relapse cases or malnutrition in older children should prompt investigations towards disability. Technical difficulties in measuring the height or length of children with postural impairments (e.g., muscle contractures in cerebral palsy) also need to be addressed, for example via alternative indicators.…”

“…5 CLWD also have greater risk of adverse outcomes, including death, following treatment for severe acute malnutrition (SAM). 6…”

“…5 CLWD also have greater risk of adverse outcomes, including death, following treatment for severe acute malnutrition (SAM). 6 There is an imperative through the UN Convention on the Rights of Persons with Disabilities and the Sustainable Development Goals 2, 7 for international actors to commit to greater inclusion of persons living with disabilities in health care and in related sectors such as humanitarian practice initiatives. [8][9][10] The 2013 update of the WHO SAM guidelines recognise disability as an underlying factor for malnutrition.…”

Body composition of adults with a history of severe acute malnutrition during childhood using the deuterium dilution method in eastern DR Congo: the Lwiro Cohort Study

“…Acute malnutrition is a major public health problem in low- and middle-income countries (LMICs) ( 1 ) accounting for ≥45% of the 5.9 million annual deaths among children aged <5 y ( 2 ). In addition to the consequences in terms of mortality, malnutrition has serious adverse effects on physical development leading to growth retardation, mental and physical disability ( 3 ), and is associated with a significant risk of developing cardiometabolic diseases in adulthood ( 4–7 ). This increased risk of chronic noncommunicable diseases (NCDs) in adulthood is potentially related to an imbalance in body composition (BC), especially the risk of disproportionate fat accumulation which may or may not be related to subsequent catch-up growth ( 8 ).…”