Prevention of Acute Malnutrition: Distribution of Special Nutritious Foods and Cash, and Addressing Underlying Causes—What to Recommend When, Where, for Whom, and How

Abstract

Acute malnutrition is associated with increased morbidity and mortality risk. When episodes are prolonged or frequent, acute malnutrition is also associated with poor growth and development, which contributes to stunting Nutrition-specific and nutrition-sensitive strategies to prevent undernutrition during the first 1,000 days from conception to 24 months of age can reduce the risks of wasting, stunting, and micronutrient deficiencies. Under circumstances that exacerbate the underlying causes of undernutrition and increase the incidence of wasting, such as food insecurity related to lean seasons or emergencies, or increased incidence of illness, such as diarrhea or measles, additional efforts are required to prevent and treat wasting. Special nutritious foods directly meet the increased nutrient requirements of children at risk for wasting; assistance to vulnerable households, in the form of cash or food, enables households to better meet the food, health, and other needs of household members and may increase resilience; water, sanitation, and hygiene (WASH) and health interventions help prevent and address illness and hence reduce wasting risk. The contributions of specific interventions to reducing the incidence of wasting are difficult to assess under emergency conditions, due to ethical constraints and to the fact that multiple strategies are implemented at the same time. However, pragmatic studies under real-life circumstances, using different designs, e.g., including a group receiving "best possible" treatment, can provide evidence about what works, to what extent, at what cost, and under which circumstances. Programs should address the most important causes in given contexts, be feasible to implement at scale, and assess implementation, coverage, and outcomes.

Nutrition and Hospital Mortality, Morbidity and Health Outcomes

“…Acute malnutrition takes place in a few weeks to months, it primarily affects lean body stores and is usually managed effectively to prevent permanent impact, especially in children. It occurs in a range of instances including during emergencies, seasonally and endemically [17]. These situations usually contribute to undernutrition through severe restrictions to nutrient and energy supply.…”

“…In undernutrition, there is a greater risk of death which is related not only to the infection but also to the loss of muscle mass with concordant limits to immunity and primary metabolic functions. Fat stores, which are used up in cases of undernutrition without infection, may also play a role in survival and regulate bone linear growth [17].…”

Impact of stakeholder perspectives on cost-effectiveness estimates of four specialized nutritious foods for preventing stunting and wasting in children 6–23 months in Burkina Faso

“…In 2017, there were an estimated 151 million children worldwide under five who were stunted (< − 2 standard deviations in height-for-age) and 51 million who were wasted (< − 2 standard deviations in weight-for-height) [1]. The first 1000 days of life, which begins in utero and continues into the first two post-natal years, has been identified as a critical window of opportunity to prevent such manifestations of undernutrition [2,3], thereby avoiding long-term consequences to human capital and societal development [4,5].…”

Management of SAM and MAM

“…There is growing recognition that it can be counter-productive to see wasting as a distinct problem from chronic manifestations of under-nutrition (such as stunting or micronutrient deficiencies), since such problems often co-exist among affected Prevention of acute malnutrition, with coexisting chronic malnutrition, requires a far wider spectrum of interventions beyond clinical management, and need to focus on multi-sectoral actions for improving child feeding practices, promoting dietary diversity and reducing exposure to illnesses. Diverse strategies, including a combination of food security, behaviour change, water and sanitation, medical, cash-based, surveillance approaches etc., are therefore recommended (De Pee et al, 2015;Tonguet-Papucci et al, 2015). …”