Trends in severe acute malnutrition admissions, characteristics, and treatment outcomes in Malawi from 2011 through 2019

Abstract

Community-based Management of Acute Malnutrition (CMAM) has been successfully implemented across Malawi, yet trends in admissions, clinical characteristics, and treatment outcomes in children with severe acute malnutrition (SAM) have not been examined. The objective was therefore to investigate trends in admissions, clinical characteristics including proportion of children with HIV and oedema, and treatment outcomes across the decade following implementation of CMAM. This research involved a retrospective analysis of existing data routinely collected across Malawi by the Ministry of Health between 2011 and 2019. These data showed a rise in outpatient therapeutic feeding (OTP) admissions from 30323 children in 2011 to 37655 in 2019 (p=0.045). However, a significant decrease in nutritional rehabilitation unit (NRU) admissions was observed over the same period, from 11389 annual admissions in 2011 to 6271 in 2019 (p=0.006). In children identified with SAM, the proportion with oedema were seen to be lower in OTP by 12.6% between 2011 and 2018 (p=0.02) and by 26.2% in NRUs in this timeframe (p=0.01). There was a 9.1% decrease in the proportion of children with SAM who had HIV over time in OTP (p=0.03). HIV prevalence was 6.1% lower between 2012 and 2017 in NRUs but this difference was not significant (p=0.06). The prevalence of HIV in children with SAM was about twice as high as in children in NRUs, at 14.5% in 2017, compared to those enrolled to OTP, at 7.1% in 2017. From 2011 to 2019, death rates decreased by only 0.7% in OTP to a rate of 1.2% (p=0.02). Mortality rates also did not change in NRUs over time being 9.8% in 2019 (p=0.4). These trends indicate that while there has been a decrease in NRU admissions, these children remain at risk of mortality with NRUs having a higher absolute number of children who die compared to OTP.