G262(P) The management of moderate acute malnutrition in children aged 6–59 months: a systematic review and meta-analysis

Abstract

Background Acute malnutrition is a leading cause of morbidity and mortality in children aged under five years, especially in low- and middle- income countries (LMICs). Although severe acute malnutrition (SAM) is considered a more life-threatening condition, moderate acute malnutrition (MAM) affects a greater proportion of children globally, and unlike SAM, there are currently no WHO recommendations for MAM treatment. This systematic review and meta-analysis will aim to assess the effectiveness of product-based interventions, versus standard care, in the management of MAM in LMICs. Methods Studies conducted in LMICs that compared the effectiveness of food-based products versus standard care in promoting recovery from MAM in children, were included in this review following a search of five databases. A mixed-methods approach was used to analyse data. Where appropriate, combined outcome data were analysed using random-effects meta-analyses, and assessed for heterogeneity. Descriptive analysis was also used to summarise findings on any reported information regarding the characteristics of children who recovered from MAM, versus those who did not recover. Results A total of seven randomised-controlled trials were identified for inclusion in this review. Of these, five compared a lipid-based nutrient supplement (LNS) with a fortified-blended flour (FBF), one compared two types of LNS, and one compared food-based supplements with nutrition counselling. There was some evidence that children aged 6–59 months with MAM who are treated with an LNS have an increased probability of recovery compared to children treated with CSB+/++ (RR 1.03, 95% CI: 1.00 to 1.06, p=0.022). Furthermore, treatment with an LNS was associated with a lower risk of persistent MAM at the end of a treatment programme, compared with CSB+/++ (RR 0.82, 95% CI: 0.71 to 9.95, p=0.007), and with a lower risk of progressing to SAM, compared to a blended food product (RR 0.87, 95% CI: 0.76 to 0.99, p=0.042). Conclusions Supplementation with an LNS was shown to improve recovery and prevent non-response, progression to SAM and death compared to supplementation with a FBF. Further research is needed to determine the role of nutrition education in MAM management, and identify children at risk of failure to recover.