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

Abstract

Objectives: The objectives of the study were to describe outcomes of children with uncomplicated severe acute malnutrition (SAM) attending community-based management of acute malnutrition (CMAM) treatment centres in Accra Metropolitan Area (AMA) and explore factors associated with non-adherence to clinic visits and defaulting from the treatment programme. Design: A retrospective cohort study analysing routinely collected data on children with uncomplicated SAM enrolled into CMAM in 2017 was conducted. Setting: Study was conducted at seven sites comprising Princess Marie Louise Children’s Hospital, three sub-metropolitan health facilities and three community centres, located in five sub-metropolitan areas in AMA. Participants: Children with uncomplicated SAM aged 6–59 months, enrolled from community-level facilities (pure uncomplicated SAM, PUSAM) or transferred after completing inpatient care (post-stabilisation uncomplicated SAM, PSSAM), participated in the study. Results: Out of 174 cases studied (105 PUSAM, sixty-nine PSSAM), 56·3 % defaulted, 34·5 % recovered and 8·6 % were not cured by 16 weeks. No deaths were recorded. Mid-upper arm circumference (MUAC) increased by 2·2 (95 % CI 1·8, 2·5) mm/week with full compliance and 0·9 (95 % CI 0·6, 1·2) mm/week with more than two missed visits. In breast-feeding children, MUAC increased at a slower rate than in other children by 1·3 (95 % CI 1·0, 1·5) mm/week. Independent predictors of subsequent missed visits were diarrhoea and fever, while children with MUAC < 110 mm on enrolment were at increased risk of defaulting. Conclusion: A high default rate and a long time to recovery are challenges for CMAM in AMA. Efforts must be made to improve adherence to treatment to improve outcomes.

Children’s Nutritional Rehabilitation Program in Beira, Mozambique: A Retrospective Study

“…Primary and secondary outcomes. We enrolled 1,231 children (708 [58%] were female and 513 [42%] were male) with a median age of 14 months (IQR, [10][11][12][13][14][15][16][17][18][19]. Clinical data are reported in Table 2.…”

“…Takyi et al confirmed poor adherence to NRPs for children in Ghana and argued that greater efforts must be made to promote adherence. 12 A study performed in Ethiopia involving HIV-positive adult patients showed poor adherence to nutritional programs and that the only sociodemographic variable with a significant effect on adherence is the educational status. 13 Therefore, further studies are needed to evaluate the factors that negatively affect adherence to health programs for children.…”

“…The effectiveness of NRPs in developing countries have been confirmed by other studies performed in Ghana and Pakistan. 12,14 The association between HIV and underweight, stunting, and wasting has been described in the literature. [15][16][17] Furthermore, it is known that among malnourished children, those living with HIV have a higher rate of severe malnutrition than HIV-negative children.…”

Does a child's mid‐upper arm circumference‐for‐age z‐score represent another nutritional indicator of childhood malnutrition status?

“…Mid‐upper arm circumference (MUAC), a common anthropometric measurement, is being used especially in emergency and crisis settings to assess the nutritional status of children, which might be an alternative option to measure WLZ/WHZ (Briend et al, 1987 ; Sultana et al, 2015 ; World Health Organization (WHO) Working Group, 1986 ). Children with a MUAC of less than 11 cm are categorized as malnourished (Bari et al, 2019 ; Briend et al, 1987 ; Fernández et al, 2010 ; Hossain et al, 2017 ; Takyi et al, 2020 ). Literature suggested several cut‐off values for MUAC, which range from <11 to 12.5 cm (WHO, 2009 ).…”

Evidence-based strategies needed to combat malnutrition in Sub-Saharan countries facing different stages of nutrition transition

“…The epidemiological studies focused on iodine (24,25) , anaemia (26,27) , linear growth (28) and obesity (29) . All three intervention studies deal with undernutrition (30)(31)(32) . The double burden of malnutrition and the 'double duty actions' (33) are not specifically addressed although the issue is discussed in the qualitative papers on community solutions.…”