Abstract
The Optimising treatment for acute MAlnutrition (OptiMA) strategy trains mothers to use mid upper arm circumference (MUAC) bracelets for screening and targets treatment to children with MUAC < 125 mm or oedema with one therapeutic food at a gradually reduced dose. This study seeks to determine whether OptiMA conforms to SPHERE standards (recovery rate > 75 %). A single-arm proof-of-concept trial was conducted in 2017 in Yako district, Burkina Faso including children aged 6-59 months in outpatient health centres with MUAC < 125 mm or oedema. Outcomes were stratified by MUAC category at admission. Multivariate survival analysis was carried out to identify variables predictive of recovery. Among 4958 children included, 824 (16·6 %) were admitted with MUAC < 115 mm or oedema, 1070 (21·6 %) with MUAC 115-119 mm and 3064 (61·8 %) with MUAC 120-124 mm. The new dosage was correctly implemented at all visits for 75·9 % of children. Global recovery was 86·3 (95 % CI 85·4, 87·2) % and 70·5 (95 % CI 67·5, 73·5) % for children admitted with MUAC < 115 mm or oedema. Average therapeutic food consumption was 60·8 sachets per child treated. Recovery was positively associated with mothers trained to use MUAC prior to child's admission (adjusted hazard ratio 1·09; 95 % CI 1·01, 1·19). OptiMA was successfully implemented at the scale of an entire district under 'real-life' conditions. Programme outcomes exceeded SPHERE standards, but further study is needed to determine if increasing therapeutic food dosages for the most severely malnourished will improve recovery.
Highlights
Acute malnutrition is a major public health problem, affecting 49·5 million children worldwide each year and contributing to nearly half of all annual childhood deaths[1,2]
Acute malnutrition is a continuum condition, it is arbitrarily divided into moderate (MAM) and severe (SAM) categories defined by mid upper arm circumference (MUAC) or weight-for-height Z-score (WHZ)
Optimising treatment for acute MAlnutrition (OptiMA) made three strategic changes to the current Burkina Faso National Nutrition protocol[15]: screening for acute malnutrition was task-shifted to caretakers via community-based training in the use of MUAC bracelets; the case definition for acute malnutrition was modified to MUAC < 125 mm and/or oedema and only one product was used for treatment (RUTF) at a gradually reduced dose based on a child’s weight and MUAC status
Summary
Acute malnutrition is a major public health problem, affecting 49·5 million children worldwide each year and contributing to nearly half of all annual childhood deaths[1,2]. MAM (MUAC 115–124 mm or WHZ between –2 and –3) and SAM OptiMA made three strategic changes to the current Burkina Faso National Nutrition protocol[15]: screening for acute malnutrition was task-shifted to caretakers via community-based training in the use of MUAC bracelets; the case definition for acute malnutrition was modified to MUAC < 125 mm and/or oedema and only one product was used for treatment (RUTF) at a gradually reduced dose based on a child’s weight and MUAC status. We hypothesised that the OptiMA protocol was at least as effective as the national nutrition protocol in terms of children’s recovery rate and other standard programme indicators when compared against international SPHERE standards[16]
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