Predictors of recovery in children aged 6–59 months with uncomplicated severe acute malnutrition: a multicentre study

Abstract

Objective: To identify predictors of recovery in children with uncomplicated severe acute malnutrition (SAM). Design: This is a secondary data analysis from an individual randomised controlled trial, where children with uncomplicated SAM were randomised to three feeding regimens, namely RUTF-C, RUTF-L, or A-HPF, under two age strata (6–17 months and 18–59 months) for 16 weeks or until recovery. Three sets of predictors that could influence recovery, viz. child, family, and nutritional predictors, were analysed. Setting: Rural and urban slum areas of three states of India, viz. Rajasthan, Delhi, and Tamil Nadu Subjects: In total, 906 children (age: 6–59 months) were analysed to estimate the adjusted hazard ratio (AHR) using the Cox proportional hazard ratio model to identify various predictors. Results: Being a female child [AHR: 1.269 (1.016–1.584)], better employment status of the child’s father [AHR: 1.53 (1.197–1.95)], and residence in a rental house [AHR: 1.485 (1.137–1.94)] increased the chances of recovery. No hospitalisation [AHR: 1.778 (1.055–2.997)], no fever, [AHR: 2.748 (2.161–3.494)], and ≤2 episodes of diarrhoea [AHR: 1.579 (1.035–2.412)] during the treatment phase; availability of community-based peer support to mothers for feeding [AHR: 1.61 (1.237–2.097)]; and a better weight-for-height Z-score (WHZ) at enrolment [AHR: 1.811 (1.297–2.529)] predicted higher chances of recovery from SAM. Conclusion: The probability of recovery increases in children with better WHZ, and with the initiation of treatment for acute illnesses to avoid hospitalisation, availability of peer support, and better employment status of the father.

Enteric pathogen detection among children discharged from outpatient treatment for severe acute malnutrition and associations with subsequent relapse in South Sudan

“…Exposure to enteric pathogens has been associated with a range of health effects among young children living in low-and middle-income countries, including moderate-to-severe diarrhoea (MSD) (22,25) and chronic undernutrition (13,37). While diarrhoea is understood to contribute to the development and persistence of AM and SAM (12,38,39), and children suffering from AM or SAM are 3 -12 times more likely to die from diarrhoea than non-malnourished children (40), few studies have estimated the burden of enteric pathogens among children suffering or recently recovered from AM or uncomplicated SAM and none have examined the impact of exposure on sustained recovery. A post-hoc analysis of the Global Enterics Multicenter Study demonstrated that not only is enteric pathogen exposure more likely to result in MSD among children suffering from AM compared with children without AM, but also that those exposures are more likely to result in death among children with AM (18).…”

The Role of Food Insecurity and Dietary Diversity on Recovery from Wasting among Hospitalized Children Aged 6–23 Months in Sub-Saharan Africa and South Asia

“…However, the nutritional recovery appears slower among children discharged from the hospital compared with children treated in the community, although the reasons for this slower rate of recovery are not clearly understood [5,6]. Multiple factors, including differences in the etiology of wasting among individual children, the presence of comorbidities, and socioeconomic vulnerabilities, all influence nutritional recovery following hospital discharge [7,8].…”