Abstract
The objectives of most treatment programs for severe acute malnutrition (SAM) in children focus on initial recovery only, leaving post‐discharge outcomes, such as relapse, poorly understood and undefined. This study aimed to systematically review current literature and conduct secondary data analyses of studies that captured relapse rates, up to 18‐month post‐discharge, in children following recovery from SAM treatment. The literature search (including PubMed and Google Scholar) built upon two recent reviews to identify a variety of up‐to‐date published studies and grey literature. This search yielded 26 articles and programme reports that provided information on relapse. The proportion of children who relapsed after SAM treatment varied greatly from 0% to 37% across varying lengths of time following discharge. The lack of a standard definition of relapse limited comparability even among the few studies that have quantified post‐discharge relapse. Inconsistent treatment protocols and poor adherence to protocols likely add to the wide range of relapse reported. Secondary analysis of a database from Malawi found no significant association between potential individual risk factors at admission and discharge, except being an orphan, which resulted in five times greater odds of relapse at 6 months post‐discharge (95% CI [1.7, 12.4], P = 0.003). The development of a standard definition of relapse is needed for programme implementers and researchers. This will allow for assessment of programme quality regarding sustained recovery and better understanding of the contribution of relapse to local and global burden of SAM.
Highlights
Around 17 million children worldwide suffer from severe acute malnutrition (SAM), defined as having a weight‐for‐height z‐score (WHZ) less than −3 SD or a mid‐upper arm circumference (MUAC) less than 115 mm (United Nations Children's Fund, World Health Organization, & World Bank Group, 2017)
Standard community‐based management of acute malnutrition (CMAM) programme report forms based on the Sphere Minimum Standard guidelines do include space to record relapse up to 2 months post‐discharge, without standardized guidance on how to capture relapse accurately or an evidence‐base to prove the importance of allocating resources to do so, it is infrequently reported
We evaluated the strengths and weaknesses of each research article and programme report independently to ensure that quality of study design was considered when interpreting results
Summary
Around 17 million children worldwide suffer from severe acute malnutrition (SAM), defined as having a weight‐for‐height z‐score (WHZ) less than −3 SD or a mid‐upper arm circumference (MUAC) less than 115 mm (United Nations Children's Fund, World Health Organization, & World Bank Group, 2017). Most of the research conducted around SAM addresses the causes, short‐term consequences, and treatment methods for achieving immediate recovery, little is known about the overall health and nutrition of children following discharge. A small body of evidence is emerging from the few studies that followed children after treatment for SAM, demonstrating poor post‐discharge outcomes after initial recovery including mortality, morbidity, and functional implications (Bahwere, Mtimuni, Sadler, Banda, & Collins, 2012; Lelijveld et al, 2016). One of the most immediate outcomes that needs to be understood and addressed is relapse to SAM. We aimed to systematically review current literature and conduct secondary data analyses on a dataset from Malawi to better understand relapse rates in children following recovery from SAM treatment
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