Response to Malnutrition Treatment in Low Weight-for-Age Children: Secondary Analyses of Children 6–59 Months in the ComPAS Cluster Randomized Controlled Trial

Abstract

Weight-for-age z-score (WAZ) is not currently an admission criterion to therapeutic feeding programs, and children with low WAZ at high risk of mortality may not be admitted. We conducted a secondary analysis of RCT data to assess response to treatment according to WAZ and mid-upper arm circumference (MUAC) and type of feeding protocol given: a simplified, combined protocol for severe and moderate acute malnutrition (SAM and MAM) vs. standard care that treats SAM and MAM, separately. Children with a moderately low MUAC (11.5–12.5 cm) and a severely low WAZ (<−3) respond similarly to treatment in terms of both weight and MUAC gain on either 2092 kJ (500 kcal)/day of therapeutic or supplementary food. Children with a severely low MUAC (<11.5 cm), with/without a severely low WAZ (<−3), have similar recovery with the combined protocol or standard treatment, though WAZ gain may be slower in the combined protocol. A limitation is this analysis was not powered for these sub-groups specifically. Adding WAZ < −3 as an admission criterion for therapeutic feeding programs admitting children with MUAC and/or oedema may help programs target high-risk children who can benefit from treatment. Future work should evaluate the optimal treatment protocol for children with a MUAC < 11.5 and/or WAZ < −3.0.

Effectiveness of Acute Malnutrition Treatment at Health Center and Community Level with a Simplified, Combined Protocol in Mali: An Observational Cohort Study

“…This study showed that simplified, combined treatment of children with acute malnutrition can be effective in a routine care setting as observed in this rural Sahelian context where a total of 27 601 children were admitted to the treatment program over a period of over 3 years. All programmatic indicators exceeded the SPHERE standards [48] in all subgroups previously identified as potentially more vulnerable or less responsive to treatment [5,9,28,29] including children with concurrent wasting and stunting, children with high weight at admission and older children. Treatment provided by CHWs resulted in similarly high recovery as when treatment was provided at the health facility level.…”

“…Certain sub-groups have been previously identified as potentially responding less well to treatment [4,5,9,29,52] or generally more at risk of mortality [53,54]. Those include children with SAM by both criteria [4,5], children with severely low WHZ or MUAC [52], children with concurrent wasting and stunting [29,53,54], girls [5,55] and young children [5,9,52,56].…”

“…Certain sub-groups have been previously identified as potentially responding less well to treatment [4,5,9,29,52] or generally more at risk of mortality [53,54]. Those include children with SAM by both criteria [4,5], children with severely low WHZ or MUAC [52], children with concurrent wasting and stunting [29,53,54], girls [5,55] and young children [5,9,52,56]. We show that all of these groups responded well to the simplified protocol in a routine setting, as shown by the program indicators for these subgroups that exceeded the SPHERE standards.…”

“…The ComPAS trial previously showed non-inferiority of a protocol where children were admitted to malnutrition treatment based on their MUAC measure and treated with 2 daily sachets of RUTF for those with MUAC <115 mm and 1 daily sachet of RUTF for those with MUAC ≥115 <125 mm [4,[28][29][30][31]. However, the study left several questions unanswered including on the effectiveness of this protocol in a routine setting and among some potentially more vulnerable sub-groups.…”

How do children with severe underweight and wasting respond to treatment? A pooled secondary data analysis to inform future intervention studies

“…the targeting of malnourished children with the greatest risk of mortality (Bailey et al, 2021;Myatt et al, 2018). However, as low WAZ is not currently used at admission or routinely monitored during wasting treatment, little is known about how this group of children respond to either therapeutic or supplementary treatment protocols.…”