TY - JOUR
T1 - Post-Recovery Relapse of Children Treated with a Simplified, Combined Nutrition Treatment Protocol in Mali
T2 - A Prospective Cohort Study
AU - Kangas, Suvi T.
AU - Coulibaly, Issa Niamanto
AU - Tausanovitch, Zachary
AU - Ouologuem, Bareye
AU - Marron, Bethany
AU - Radin, Elizabeth
AU - Ritz, Christian
AU - Dembele, Salimou
AU - Ouédraogo, Césaire T.
AU - Bailey, Jeanette
N1 - Funding Information:
The implementation of this research was funded by The Rockefeller Foundation and by Google.org grant number 1909-59874. The data analysis and manuscript write-up work was funded under the Thompson Family Foundation. The findings and conclusions contained withing are those of the authors and do not necessarily reflect positions or policies of the funders.
Publisher Copyright:
© 2023 by the authors.
PY - 2023/6
Y1 - 2023/6
N2 - The present study aimed to determine the 6-month incidence of relapse and associated factors among children who recovered from acute malnutrition (AM) following mid-upper arm circumference (MUAC)-based simplified combined treatment using the ComPAS protocol. A prospective cohort of 420 children who had reached a MUAC ≥ 125 mm for two consecutive measures was monitored between December 2020 and October 2021. Children were seen at home fortnightly for 6 months. The overall 6-month cumulative incidence of relapse [95%CI] into MUAC < 125 mm and/or edema was 26.1% [21.7; 30.8] and 1.7% [0.6; 3.6] to MUAC < 115 mm and/or edema. Relapse was similar among children initially admitted to treatment with a MUAC < 115 mm and/or oedema and among those with a MUAC ≥ 115 mm but <125 mm. Relapse was predicted by lower anthropometry both at admission to and discharge from treatment, and a higher number of illness episodes per month of follow-up. Having a vaccination card, using an improved water source, having agriculture as the main source of income, and increases in caregiver workload during follow-up all protected from relapse. Children discharged as recovered from AM remain at risk of relapsing into AM. To achieve reduction in relapse, recovery criteria may need to be revised and post-discharge strategies tested.
AB - The present study aimed to determine the 6-month incidence of relapse and associated factors among children who recovered from acute malnutrition (AM) following mid-upper arm circumference (MUAC)-based simplified combined treatment using the ComPAS protocol. A prospective cohort of 420 children who had reached a MUAC ≥ 125 mm for two consecutive measures was monitored between December 2020 and October 2021. Children were seen at home fortnightly for 6 months. The overall 6-month cumulative incidence of relapse [95%CI] into MUAC < 125 mm and/or edema was 26.1% [21.7; 30.8] and 1.7% [0.6; 3.6] to MUAC < 115 mm and/or edema. Relapse was similar among children initially admitted to treatment with a MUAC < 115 mm and/or oedema and among those with a MUAC ≥ 115 mm but <125 mm. Relapse was predicted by lower anthropometry both at admission to and discharge from treatment, and a higher number of illness episodes per month of follow-up. Having a vaccination card, using an improved water source, having agriculture as the main source of income, and increases in caregiver workload during follow-up all protected from relapse. Children discharged as recovered from AM remain at risk of relapsing into AM. To achieve reduction in relapse, recovery criteria may need to be revised and post-discharge strategies tested.
KW - acute malnutrition
KW - combined protocol
KW - community-based management of acute malnutrition
KW - Mali
KW - mid-upper-arm circumference
KW - moderate acute malnutrition
KW - ready-to-use therapeutic food
KW - relapse
KW - severe acute malnutrition
KW - simplified protocol
U2 - 10.3390/nu15112636
DO - 10.3390/nu15112636
M3 - Journal article
C2 - 37299599
AN - SCOPUS:85161420443
SN - 2072-6643
VL - 15
JO - Nutrients
JF - Nutrients
IS - 11
M1 - 2636
ER -