Response to Malnutrition Treatment in Low Weight-for-Age Children: Secondary Analyses of Children 6–59 Months in the ComPAS Cluster Randomized Controlled Trial

Jeanette Bailey,Kate Sadler,Carmel Dolan,André Briend,Mark Myatt,Marko Kerac,Heather Stobaugh,Tanya Khara,Natasha Lelijveld,Richard Lino Lako,Charles Opondo

doi:10.3390/nu13041054

Abstract

Weight-for-age z-score (WAZ) is not currently an admission criterion to therapeutic feeding programs, and children with low WAZ at high risk of mortality may not be admitted. We conducted a secondary analysis of RCT data to assess response to treatment according to WAZ and mid-upper arm circumference (MUAC) and type of feeding protocol given: a simplified, combined protocol for severe and moderate acute malnutrition (SAM and MAM) vs. standard care that treats SAM and MAM, separately. Children with a moderately low MUAC (11.5–12.5 cm) and a severely low WAZ (<−3) respond similarly to treatment in terms of both weight and MUAC gain on either 2092 kJ (500 kcal)/day of therapeutic or supplementary food. Children with a severely low MUAC (<11.5 cm), with/without a severely low WAZ (<−3), have similar recovery with the combined protocol or standard treatment, though WAZ gain may be slower in the combined protocol. A limitation is this analysis was not powered for these sub-groups specifically. Adding WAZ < −3 as an admission criterion for therapeutic feeding programs admitting children with MUAC and/or oedema may help programs target high-risk children who can benefit from treatment. Future work should evaluate the optimal treatment protocol for children with a MUAC < 11.5 and/or WAZ < −3.0.

Highlights

Malnutrition is a major underlying cause of morbidity and mortality in children [1].At any given time, stunting, defined by deficits in a child’s height-for-age, affects at least149 million children under five years of age, and wasting, defined by deficits in a child’s weight-for-height and/or a low mid-upper arm circumference, affects about 49 million children [2]
Stunting is typically addressed through development programs that primarily focus on its prevention, whereas wasting is often addressed through humanitarian programs that primarily focus on its treatment in order to prevent near-term mortality
Our objectives were to (1) assess outcomes and response to treatment in children admitted with a mid-upper arm circumference (MUAC) < 11.5 cm as two separate groups—those with a Weight-for-age z-score (WAZ) < −3 and those with a WAZ ≥ −3—both of which would be included in current therapeutic feeding programs, as well as children with a moderately low MUAC (i.e., MUAC between 11.5 cm and 12.5 cm) and a WAZ < −3, who would be eligible for admission into supplementary feeding programs in many settings; (2) explore outcomes and response to treatment by dosage protocol: a simplified, MUAC-based dosage in a combined treatment program compared to the weight-based dosage offered in standard care

Summary

Introduction

At any given time, stunting, defined by deficits in a child’s height-for-age, affects at least. 149 million children under five years of age, and wasting, defined by deficits in a child’s weight-for-height and/or a low mid-upper arm circumference, affects about 49 million children [2]. Malnutrition contributes to approximately half of all deaths in children less than 5 years of age [1], and deaths associated with wasting may be significantly underestimated [5]. The coronavirus pandemic is likely to further increase wasting and associated mortality [6]. Stunting is typically addressed through development programs that primarily focus on its prevention, whereas wasting is often addressed through humanitarian programs that primarily focus on its treatment in order to prevent near-term mortality

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