Community management of acute malnutrition (CMAM) programme in Pakistan effectively treats children with uncomplicated severe wasting

Abstract

Severe wasting is the most widespread form of severe acute malnutrition, affecting an estimated 17 million children globally. This analysis assesses the effectiveness of Pakistan's community management of acute malnutrition (CMAM) programme. We conducted a retrospective case series analysis of 32,458 children aged 6–59 months who were admitted to the programme with a mid‐upper arm circumference (MUAC) < 115 mm (January 1–December 31, 2014). We found that at admission, 59.6% of the children were girls and 87.4% were in the age group 6–23 months old. While in the programme, 120 children (0.4%) died, 3,456 (10.6%) defaulted, and 28,882 (89.0%) were discharged after a mean length of stay of 69.3 ± 25.7 days. Children's mean weight gain while in the programme was 3.2 ± 2.7 g/kg body weight/day. At discharge, 28,499 children (98.7% of discharged) had recovered (MUAC ≥ 125 mm). The odds of death were significantly higher among children with weight‐for‐height (WHZ) < −3 and/or height‐for‐age (HAZ) < −2 at admission. The odds of recovery on the basis of MUAC ≥125 mm were higher among children with HAZ ≥ −2 at admission. The odds of recovery on the basis of WHZ ≥ −2 were significantly higher among children with WHZ ≥ −3 and/or HAZ < −2 at admission. Pakistan's CMAM programme is effective in achieving good survival and recovery rates. Population‐level impact could be increased by giving priority to children 6–23 months old and children with multiple anthropometric failure and by scaling up CMAM in the provinces and areas where the risk, prevalence, and/or burden of severe acute malnutrition is highest.

Treatment outcomes of severe acute malnutrition and predictors of recovery in under-five children treated within outpatient therapeutic programs in Ethiopia: a systematic review and meta-analysis

“…defaulting rate < 15%) [29,46] . But the present result is below the findings of the study results in Pakistan [51], Ghana [49] and Nigeria [50] with defaulting rates of 10.6, 28.5 and 40%, respectively. All these findings are from the primary studies and this might be the possible reason for the variations.…”

“…Likewise, the current finding is is in line with the death rate reported from Nigeria (2%) [50]. Nonetheless, this finding is higher than the study findings from Ghana (1.6%) [49], Cameroon (0.8%) [52] and Pakistan (0.4%) [51]. The possible explanations for the differences might be due to disparity in the organization of OTP centers, sociodemographic differences in study subjects and difference in the background of care takers of children.…”

“…This finding is comparable with a study finding in Ghana with the recovery rate of 70.9% (346 out of 488) [49], but significantly higher than a study finding in Nigeria, where only 58% (4492 of 7742) of children get cured form SAM [50]. The current recovery rate is also lower than the findings of retrospective studies conducted in Cameroon and Pakistan, where 72.8% (185 of 254) & 89% (28,882 of 32,458) of children get recovered, respectively [51,52]. The discrepancies could be attributed by differences in the number of study population, study design and the sociodemographic characteristics of the study participants as well as variation in the clinical expertise of health care providers.…”

Effectiveness of home-based fortified diet in the rehabilitation of malnourished children in resource restrained country: an institution based retrospective study

“…Despite frequent telephonic reminders, children did not show-up for their follow-up visits. Default rates of up to 11% have been reported by other researchers in the region (23). The researchers suggested non-affordability and lack of awareness as likely causes, and recommended home monitoring of children by health workers to reduce the default rate (24,25).…”

Aiming higher for maternal and child nutrition in South Asia

“…Evidence suggests that wasting adversely affects the linear growth of children, indicating that the early identification and treatment of wasting may play a role in stunting prevention efforts (Khara & Dolan, ). In their paper, Aguayo et al () conduct a retrospective case series analysis to examine the effectiveness of Pakistan's community management of acute malnutrition programme. Most (87%) severely wasted children were aged 6–23 months, the age range during which there is a steep increase in the percentage of stunted children in Pakistan.…”