Critical evaluation of the appetite test for children with severe acute malnutrition

Abstract

objectives The appetite test is used to risk stratify for children with severe acute malnutrition (SAM) in inpatient or outpatient care. The test is recommended in guidelines despite lack of evidence. We evaluated its ability to identify children at risk of a poor treatment outcome.methods We conducted an observational study of children diagnosed with SAM at three health facilities in Ethiopia. The appetite test was done independently, and the result did not affect decisions about hospitalisation and clinical care. Data were analysed using mixed linear and logistic regression models.results Appetite was tested in 298 (89%) of 334 children enrolled; 56 (19%) passed. Children failing the appetite test had a 6.6% higher weight gain per day (95% CI: 2.6, 10.8) adjusted for type of treatment, oedema, duration of follow-up and age than children passing the test. We found medical complications in 179 (54%) children. Medical complications were associated with blood markers of metabolic disturbance. Children with medical complications tended to have lower weight gain than those without complications (3.5%, 95% CI: À0.25, 7.0). Neither the appetite test nor medical complications were correlated with bacteraemia or treatment failure.conclusions Our findings question the use of the appetite test to identify children who need inpatient care. An assessment of medical complications alone could be a useful risk indicator but needs to be evaluated in other settings.keywords severe acute malnutrition, appetite, community management, risk assessment, therapeutic foods Sustainable Development Goals (SDGs): SDG 2 (zero hunger), SDG 3 (good health and well-being), SDG 17 (partnerships for the goals)

Effectiveness and Coverage of Treatment for Severe Acute Malnutrition Delivered by Community Health Workers in the Guidimakha Region, Mauritania

“…All children aged 6 to 59 months presented to a HF or to a CHW’s site, and/or detected by community volunteers (Relais Commaunitaires in French) or mobile clinics with mild or moderate oedema (+, ++), a MUAC less than 115 mm, and/or a WHZ less than −3 were included in the analysis. All severe oedema cases (+++), children with other severe medical conditions, or those who failed the appetite test were referred for inpatient treatment [ 18 , 19 ]. Non complicated cases were treated at home.…”

Repetitive transcranial magnetic stimulation improves cognitive impairment via the regulation of SDF-1α/CXCR4 axis in rats with ischemic stroke

“…A correlation between the neurobehavioral recovery and the increased SDF-1α and CXCR-4 expression has been described in Yin, L., et al ' research [69]. Furthermore, cognitive functional recovery could arise from the elevated levels of SDF-1α and CXCR4 in ischemia rats [70]. Additionally, our prior study has shown that 10 Hz rTMS could signi cantly increase the protein expression levels of SDF-1α and CXCR4 in striatum in MCAO rats,which contributed to the restoration of motor function [23].…”

Treatment outcomes among children treated for uncomplicated severe acute malnutrition: a retrospective study in Accra, Ghana

“…A history of poor appetite could indicate undiagnosed infection (26) . However, there was no correlation between appetite test results and laboratory evidence of infection in a study by Zangenberg et al (27) in Ethiopia and children who failed the test at enrolment had higher weight gain compared with those who passed (27) . Nevertheless, further evidence for possible infection among PUSAM is provided by significantly more PUSAM presenting Univariable analysis shows results for all tested parameters; multivariable analysis only includes independent predictors *P < 0•05, **P < 0•01, *** P < 0•001.…”