Management Of Severe Acute Malnutrition Research Articles

Impact of maternal education on the development of severe acute malnourished children

Background: Severe acute malnutrition (SAM) is a grave form of undernutrition that has been recognized as a medical and social disorder. Various factors contribute to the development of SAM, but the impact of maternal education on the nutritional status and development of the child is of paramount importance since focused interventions in this aspect can yield promising results. Aims and Objectives: The aims and objectives of the study are to assess the impact of maternal education on the development of children with SAM. Materials and Methods: A total of 125 SAM children in the age group 12–30 months were enrolled in this prospective observational study from among those admitted to the nutritional rehabilitation center of a tertiary care center in central India. The developmental status of SAM children was assessed using the Developmental Assessment Scale of Indian Infants. The association of maternal education with the development of SAM children was analyzed. Results: Overall developmental delay was observed in 44.8% of SAM children, whereas motor and mental development delay was noted in 45.6% and 44% of SAM children. The maternal education level was significantly associated with the overall development of the SAM child. (P=0.043 for motor development, P=0.017 for mental development, P=0.023 for motor developmental delay). Conclusion: Maternal education plays a key role in improving the developmental status of SAM children, who are more prone to developmental delays across various domains. Efforts toward enhancing maternal education, especially knowledge regarding child nutrition and development, can reduce the incidence and improve the management of SAM in children.

Therapeutic and Evolutionary Profiles of Children Aged 0-59 Months: A Case Study of Severe Acute Malnourished Treated at Hôpital Notre Dame Des Apôtres, N'Djamena

According to the World Health Organization, malnutrition is a pathological condition resulting from the relative or absolute insufficiency or excess of one or more essential nutrients, whether manifested clinically or detected only by biological, anthropometric or physiological analyses. It remains a major public health problem. The aim of this study was therefore to determine the therapeutic and evolutionary profiles of Severe Acute Malnutrition patients at Notre Dame des Apôtres Hospital in N'Djaména (Chad). This was a prospective, descriptive study carried out on 7 months, from January 1 to July 31, 2023. This included all severely acutely malnourished children with medical complications admitted to the hospital's therapeutic nutrition unit. The variables studied were therapeutic and evolutionary. Data were entered and analyzed using Excel 2016 spreadsheet and SSPS 18.0 software. Among the 1454 children admitted to the unit during our study, 41.82% were stabilized, 6.75% cured and 0.79% abandoned, with an average length of stay of 8.67 days. The mortality rate was 1.76%. Children on F75 accounted for 46%, 37% on plumpy nut and 10% on F100. Antibiotics and multivitamins are routinely used in the management of malnourished children. The results of this study show that parent education could be an asset in the management of severe acute malnutrition.

Barriers and facilitators of severe acute malnutrition management at Felege Hiwot Comprehensive Specialized Hospital, Bahir Dar, North West Ethiopia, descriptive phenomenological study.

Malnutrition is a clinical condition that affects all age groups, and it remains a major public health threat in Sub-Saharan Africa. As a result, this research aimed to investigate the barriers and facilitators of treating severe acute malnutrition at Felege Hiwot Comprehensive Specialized Hospital in Bahir Dar City, North West Ethiopia. A descriptive phenomenological study was conducted from February to April 2021. The final sample size taken was fifteen based on data saturation. In-depth and key informant interviews were conducted with nine caregivers, three healthcare workers, and three healthcare managers supported by observation. A criterion-based, heterogeneous purposive sampling technique was used to select the study participants. Each interview was audio-taped to ensure data quality. Thematic analysis was done to analyze the data using Atlas. ti version 7 software. Two major themes and six sub-themes emerged. Barriers related to severe acute malnutrition management include subthemes on socio-economic and socio-cultural conditions, perceived causes of severe acute malnutrition and its management, and the healthcare context. Facilitators of severe acute malnutrition management include severe acute malnutrition identification, service delivery, and being a member of community-based health insurance. Effective management of severe acute malnutrition was affected by a multiplicity of factors. The results reaffirm how socioeconomic and sociocultural conditions, perceived causes of severe acute malnutrition (SAM) and its management and the health care context were the major barriers, while able to identifying severe acute malnutrition, service delivery, and is a member of community-based health insurance were the major facilitators for SAM management. Therefore, special attention shall be given to SAM management.

Micronutrient supplementation practices in relation to the World Health Organisation 2013 guidelines on management of severe acute malnutrition.

In 2013, the World Health Organisation (WHO) updated the recommendations for micronutrient deficiency correction in hospitalised under-5 children with complicated severe acute malnutrition (SAM). This study aimed to describe the micronutrient deficiency correction practices in relation to WHO 2013 recommendations. Data from medical records of under-5 children admitted for SAM management at two hospitals in South Africa and three tertiary hospitals in Ghana were extracted. Micronutrient correction practices were compared to the WHO 2013 recommendations by considering the dosage, timing of micronutrient supplementation (vitamin A, ironand folic acid) and therapeutic feeds administered. In total, 723 medical records were included. Nearly half (48.3%) of the children received at least one of the studied micronutrients as a supplement. Vitamin A was supplemented in 27.4% of the children, while iron and folic acid were supplemented in 9.5% and 34.9%, respectively. Among the children who received vitamin A, 60.1% received the first dose on Day 1 of admission. Also, 46.4% of the iron-supplemented children received iron within the first week of admission. Vitamin A, iron and folic acid were administered within the dose range of 100,000-180,000 IU, 3.1-7.7 mg per kg per day, and 3-5 mg per day, respectively. Additionally, 71.7% of the children reportedly received therapeutic feeds that met WHO recommendations.The micronutrient deficiency correction practices regarding dose and timing differed from the 2013 WHO guidelines. Qualitative studies investigating the reasons for the disparities are recommended.

Effectiveness of Home-Based Administration of Ready to Use Therapeutic Formula (RUTF) in the Management of Severe Acute Malnutrition (SAM)

Objective: To evaluate the growth of children with uncomplicated Severe Acute Malnutrition (SAM) treated with Ready-to-Use Therapeutic Formula (RUTF) on an outpatient department basis. Methodology: This prospective observational study was conducted on 66 children at the Outpatient setting of the MCH Centre, Federal Government Polyclinic Hospital, Islamabad, Pakistan, from January 2023 to June 2023, after approval from the hospital’s ethical committee. Children aged 6-59 months suffering from severe acute malnutrition (SAM) were selected for nutritional rehabilitation with Ready-to-Use Therapeutic Formula (RUTF) after meeting the selection criteria defined by WHO. RUTF is a nutrient mixture formulated primarily for the therapy of severe acute malnutrition without complications. Results: The mean age of patients was 16.98±6.12 months. Out of 66 patients, 26 (39.3%) were male, and 40 (60.6%) were female. The mean weight before RUTF treatment was 6.53±1.21 kg, mean Height/Length was 71.65±7.01 cm, mean MUAC was 10.88±0.36 cm, mean BSR was 91.21±2.32 mg/dL, and mean weight after RUTF treatment was 9.17±1.53 kg. There was a significant difference in the weight of children after RUTF treatment (6.53±1.21 vs 9.17±1.53, p=0.0001) with no side effects. The weight increased after treatment with RUTF. Conclusion: According to WHO recommendations, we conclude that RUTF is helpful in enhancing weight gain in children with uncomplicated severe acute malnutrition under the age of five. RUTF

Arm circumference for age, arm circumference and weight-for-height z-score for the evaluation of severe acute malnutrition: a retrospective cohort study in eastern Democratic Republic of Congo.

Little is known about the use of mid-upper arm circumference for age (MUACZ) for diagnosing of severe acute malnutrition (SAM) and its correlation with WHZ (weight-for-height Z-score) in an area endemic for severe acute malnutrition (SAM) and with a high prevalence of kwashiorkor. Our study aims to analyze the concordance between the diagnostic criteria of SAM in a region presenting these characteristics. We analyzed a database of children admitted from 1987 to 2008 for the management of SAM in Eastern Democratic Republic of Congo. Anthropometric indicators (z-score) were calculated and classified into 3 categories according to WHO standards. Cohen's kappa coefficient (κ) was calculated to assess the concordance between these indicators. Out of the 9969 selected children aged 6 to 59 months, 30.2% had nutritional edema, 70.1% had a height-for-age (HAZ) z-score <-2, 11.5% WHZ<-3 z-score, 14.9% had a MUAC < 115mm and 21.8% had a MUACZ <-3 z-score. With the classic combination WHZ and MUAC, 36% of children with SAM had both criteria at the same time and MUAC alone being the indicator that recruited more children with SAM (77%) compared with 65% with WHZ only. By replacing MUAC with MUACZ, 34% of SAM children fulfilled both criteria, WHZ and MUACZ. MUACZ alone recruited more children with SAM (88%) compared with 46% with WHZ alone. Considering these three indicators together, MUACZ remained the indicator that recruited more children with SAM (85%). WHZ and MUAC showed a moderate agreement [ κ (95% CI) = 0.408(0.392-0.424)], WHZ and MUACZ a weak agreement [ κ (95% CI) = 0.363(0.347-0.379)] and MUAC and MUACZ a good agreement [ κ (95% CI) = 0.604 (0.590-0.618)]. Adjusting MUAC according to age improves its effectiveness in identifying severe acute malnutrition. With low concordance, MUAC and WHZ remain complementary in our context. MUACZ proves to be crucial, especially in the presence of kwashiorkor and chronic malnutrition, becoming a valuable tool for assessing severe acute malnutrition in our context.

Perspective on alternative therapeutic feeds to treat severe acute malnutrition in children aged between 6 and 59 months in sub-Saharan Africa: a narrative review.

Worldwide, nearly 200 million children younger than 5 years old suffer from stunting and wasting, 2 different types of undernutrition. Moreover, 45% of deaths among children in that age group are associated with these conditions. Severe acute malnutrition (SAM) refers to children with a weight-for-height z score < -3, a midupper arm circumference < 115 mm, or the presence of bilateral edema, and is especially prevalent in low- and middle-income countries. Undernutrition in children can have a major impact on both their physical and cognitive development. It can lead to infections and death if it remains undetected or untreated. The use of therapeutic feeds is an important component in the management of SAM, which remains a challenge in poorly resourced countries. The aim of this review was to assess the alternatives to the standard therapeutic foods used to treat SAM and to summarize their advantages and disadvantages, providing an overview of current research. A literature search was performed from September to November 2022 using PubMed, the Trip medical database, and the German Institute for Medical Documentation and Information (DIMDI). This review includes 13 randomized controlled trials testing alternatives to the standard therapeutic foods used to treat SAM by using alternative ingredients or a reduced dosage. The results show that, while a few alternative ready-to-use therapeutic food formulas lead to recovery rates similar to those seen with the standard protocol, many alternatives were less effective in the affected children. Thus, the evidence is not yet strong enough to change the World Health Organization's guidelines. The review identifies promising results of treatment alternatives related to treatment outcomes and costs. Additional research should focus on the interventions that positively impact the recovery process of severely malnourished children to facilitate the treatment and enable greater treatment coverage worldwide.

Acute malnutrition relapse and associated factors among 6-59 months old children treated in the community-based management of acute malnutrition in Dessie, Kombolcha, and Haik towns, Northeast Ethiopia.

Undernutrition is a major health concern in many developing countries, and is one of the main health problems affecting children in Ethiopia. Although many children experience multiple relapses following the management of severe acute malnutrition, it is scarcely studied in Ethiopia. A community-based cross-sectional study was conducted in Dessie, Kombolcha, and Haik towns among 6-59-month-old children enrolled and discharged from community-based acute malnutrition management (CMAM). The total sample size was 318 children, and data were collected from April 15, 2021, to May 14, 2021. The data were entered into EPI data version 4.4.1 before being exported and analyzed with SPSS version 25 software. A multivariate logistic regression analysis was performed, and a 95% confidence interval and p-value <0.05 were used to identify significantly associated variables. Additionally, the weight-for-height z-score (WHZ) was generated using the WHO Anthro 3.2.2 software. The overall acute malnutrition relapse after discharge from CMAM was 35.2% (6.6% relapsed to severe acute malnutrition and 28.6% relapsed to moderate acute malnutrition). The following variables were significantly associated with the relapse of acute malnutrition: child age (AOR: 3.08, 95% CI; 1.76, 5.39), diarrhea after discharge (AOR: 2.93, 95%CI; 1.51, 5.69), have not immunized (AOR: 3.05, 95% CI; 1.14, 8.23), MUAC at discharge (AOR: 3.16, 95% CI; 1.56, 6.40), and poorest and poor wealth index (AOR: 3.65, 95% CI; 1.45, 9.18) and (AOR: 2.73, 95% CI; 1.13, 6.59), respectively. Over one-third of children treated with the CMAM program reverted to SAM or MAM. The age of the child, diarrhea after discharge, lack of immunization, MUAC at discharge (<13 cm), and poor and poorest wealth index were significantly associated with acute malnutrition relapse. Therefore, adequate health education and counseling services are essential for mothers to improve child immunization coverage and maintain adequate hygiene to prevent diarrhea. In addition, further experimental research is needed to investigate the effect of MUAC at discharge on the risk of acute malnutrition relapse.

Soya-maize-sorghum ready-to-use therapeutic food (SMS-RUTF) for the management of severe acute malnutrition among children: A systematic review and meta-analysis

In managing severe acute malnutrition (SAM) among children, the World Health Organization has endorsed the use of ready-to-use therapeutic foods (RUTF), especially the peanut and milk-based (PM-RUTF), which has been proven for its efficacy. Unfortunately, the distribution of PM-RUTF is challenged by high financial cost and reliance on imports for milk and peanuts. Researchers explore the Soy-Maize-Sorghum (SMS)-RUTF as the alternative, in which the formulation has two types; milk-free soya-maize-sorghum (FSMS)-RUTF and low milk content SMS (MSMS)-RUTF. The aim of this study was to evaluate the efficacy, safety, and acceptance of SMS-RUTFs in the management of SAM among children as compared with PM-RUTF. Eligible studies were searched through PubMed, Scopus, and Embase up to July 14, 2023. Studies reporting the effects of SMS-RUTF, FSMS-RUTF, or MSMS-RUTF intake on SAM with PM-RUTF as the control were considered eligible. The included randomized controlled trials were then assessed for the risk of bias using Cochrane Risk of Bias 2.0. Odds Ratio (OR) and mean difference (MD) were calculated using a random-effects meta-analysis. The analysis focused on investigating the recovery, mortality, weight gain, and hemoglobin levels. Five randomized controlled trials involving a total of 5,513 children were incorporated in this review. Of which, four studies were included in the statistical analysis. Those receiving SMS-RUTF was 0.77 times less likely to recover from SAM as compared to control (95% CI: 0.66–0.90, p&lt;0.01). The SMS-RUTF group had 1 kg lower weight gain as compared to control (95% CI: -1.25–0.75, p&lt;0.01). However, the SMS-RUTF group had significantly higher increase of hemoglobin level than control (MD: 0.80 g/dL [95% CI: 0.68–0.93], p&lt;0.01). Adverse effects were observed similar in both SMS-RUFT and control groups. SMS-RUFT received low acceptance from the participants suspected to be caused by poor packaging. In conclusion, SMS-RUTF is less effective than PM-RUTF in managing SAM among children but can be used to improve anemia as indicated by increased hemoglobin levels.

Non-Puerperal Adoptive Breastfeeding as Lactational Rescue in the Rohingya Refugee Camp: 2 Case Studies.

Non-puerperal adoptive lactation sometimes requires long preparation and substantial expense for pharmacological intervention to be successful, which are not feasible in refugee camps. Here we report two case studies of non-puerperal adoptive breastfeeding of two infants in the Rohingya Refugee Camp of Cox's Bazar, Bangladesh. Two non-pregnant, non-breastfeeding caregivers with previous experience of breastfeeding brought two adopted infants-one a 12-day-old female with severe acute malnutrition, and the other a 2-day-old male with normal anthropometric measurements-to a nutritional stabilization center for feeding. After counseling, both families opted for adoptive lactation. Both infants were treated with a modified Action Against Hunger protocol of in-patient management of severe acute malnutrition using the supplementary suckling technique, a procedure to feed the baby with supplementary feed. Diluted F100 was used as the supplementary feed; the energy and protein gained from it were just enough to maintain body physiology and were not responsible for any weight gain. When the infants gained weight, indicating that the caregivers were producing milk, we reduced the supplementary feed as per protocol guidelines. The caregivers were prescribed domperidone and counseled on their ability to breastfeed the infants. The cases required 35 days and 20 days, respectively, for the full establishment of breastfeeding. This is the first report of successful adoptive breastfeeding in a refugee camp. With proper counseling and motivation of the caregiver, induced lactation can be started without a preparatory period and with very low-cost intervention.

Evaluation of The Integrated Protocol for The Management of Severe Malnutrition in Children at The National Hospital of Nouakchott-Mauritania

Malnutrition is a worldwide concern with worrisome outcomes that affect substantially the lifestyle of infants. The main aim is to investigate the efficacy of the IMSAM protocol over malnourished Mauritanian children during hospitalization. A cohort of 230 participants, including 126 boys and 104 girls collected from rural and urban areas with an average age of 15.52 ± 7.727 months were enrolled. The study is carried out in the Pediatric Service of the National Hospital Center of Nouakchott, Mauritania on children who have undergone the national protocol for the Integrated Management of Severe Acute Malnutrition (IMSAM). In addition, the medical and nutritional treatment, and body measurements were appreciated as well as the anthropometric parameters. The findings exhibit during nutritional-based intervention significant differences between the mean of weight during the pre- and post-intervention (P &lt; 0.001). Moreover, through a regression test, we found a negatively predicted weight gain (P &lt; 0.05) by the variables Z-score of weight to height (P / T) Edema after Nutritional Support and final health status. Last, but by no means least, the IMSAM-based intervention with rational management might make inroads into mitigating adverse outcomes of malnutrition through maximizing social skills.

Evaluation of Micronutrients and Pro-Inflammatory Cytokines Levels in Nutritionally Deprived Children—A Tertiary Care Hospital-Based Study

Background: Severe acute malnutrition (SAM) is a significant public health problem in developing countries, including India, where a significant proportion of children suffer from malnutrition. Objective: This research aims to investigate the factors contributing to severe acute malnutrition (SAM). Additionally, the study seeks to explore the relationship between micronutrient levels and pro-inflammatory cytokines in SAM children with and without clinical complications. Furthermore, the effectiveness of antibiotic treatment in SAM children without complications is evaluated. Methods: The study involved three groups comprising 66 subjects each: a healthy control group, SAM children with complications, and SAM children without complications. Blood samples were collected, and various analyses were conducted, including biochemical, hematological, micronutrient, and pro-inflammatory marker quantification. The data were analyzed using SPSS version 22.0. Results: The results indicate that the levels of IL-6, CRP, and TNF-α were significantly higher in the SAM group with complications compared to both the control group and the SAM group without complications. Zinc and copper levels were significantly lower in both SAM groups compared to the control group, and a negative correlation was observed between zinc levels and inflammatory markers. The study also assessed the efficacy of antibiotic treatment in SAM children without complications by comparing their weight, height, weight-for-height, and weight-for-age at baseline and after a 15-day follow-up period. Significant improvements in these parameters were observed in both the group receiving antibiotic treatment and the group not receiving antibiotic treatment. Conclusion: The findings suggest that a combination of antibiotic treatment and nutritional support can lead to significant clinical improvements in SAM children without complications. This study has important implications for the management and treatment of SAM in India and other developing countries.

Assessment of Philippine Integrated Management of Acute Malnutrition (PIMAM) Program Implementation and Challenges in Maguindanao Hospitals, Philippines

This study aimed to evaluate the implementation of the Philippine Integrated Management of Acute Malnutrition (PIMAM) Program in Maguindanao Provincial Hospital (MPH), Dinaig Municipal Hospital (DMH), and South Upi Municipal Hospital (SUMH), Philippines. Employing a descriptive-evaluative design, data were gathered from 107 respondents comprising top management and hospital staff, selected via purposive sampling. A survey questionnaire was utilized as the primary data collection tool, supplemented by secondary data obtained from hospitals' PIMAM-ITP coordinators regarding the status of patients upon discharge from the Inpatient Therapeutic Program (ITP). Data were analyzed using mean and percentage. Results indicated high levels of implementation of PIMAM-ITP across the hospitals concerning guidelines, facilities, materials, screening, treatment, and discharge procedures. Notably, 74% of discharged patients from ITP hospitals were classified as "successfully treated," with the remaining categorized as defaulter (16%), deceased (8%), medically transferred (2%), or non-respondent (0%). The program demonstrated effectiveness in systematically addressing acute malnutrition. However, challenges persisted, particularly concerning caregiver compliance and funding allocation for training on the National Guidelines for the Management of Severe Acute Malnutrition among personnel involved in program implementation.

Assessment of the Efficiency of Application of the National Protocol for Integrated Management of Severe Acute Malnutrition in National Hospital Center of Nouakchott -Mauritania

Assessment of the Efficiency of Application of the National Protocol for Integrated Management of Severe Acute Malnutrition in National Hospital Center of Nouakchott -Mauritania

Factors influencing the implementation of severe acute malnutrition guidelines within the healthcare referral systems of rural subdistricts in North West Province, South Africa.

Severe acute malnutrition (SAM) is associated with 30.9% of South Africa's audited under-five children deaths regardless of available guidelines to reduce SAM at each level of a three tyre referral system. Existing research has explored and offered solutions for SAM guidelines implementation at each referral system level, but their connectedness in continuation of care is under-explored. Therefore, I examined implementation of SAM guidelines and factors influencing implementation within subdistrict referral systems. An explanatory qualitative case study design was used. The study was conducted in two subdistricts involving two district hospitals; three community health centres, four clinics, and two emergency service stations. Between February to July 2016 and 2018, data were collected using 39 in-depth interviews with clinical, emergency service and administrative personnel; 40 reviews of records of children younger than five years; appraisals of nine facilities involved in referrals and observations. Thematic content analysis was used to analyse all data except records which were aggregated to elicit whether required SAM guidelines' steps were administered per case reviewed. Record reviews revealed SAM diagnosis discrepancies demonstrated by incomplete anthropometric assessments; non-compliance to SAM management guidelines was noted through skipping some critical steps including therapeutic feeding at clinic level. Record reviews further revealed variations of referral mechanisms across subdistricts, contradictory documentation within records, and restricted continuation of care. Interviews, observations and facility appraisals revealed that factors influencing these practices included inadequate clinical skills; inconsistent supervision and monitoring; unavailability of subdistrict specific referral policies and operational structures; and suboptimal national policies on therapeutic food. SAM diagnosis, management, and referrals within subdistrict health systems need to be strengthened to curb preventable child deaths. Implementation of SAM guidelines needs to be accompanied by job aids and supervision with standardised tools; subdistrict-specific referral policies and suboptimal national policies to ensure availability and accessibility of therapeutic foods.

Feasibility trial for the management of severe acute malnutrition in older children with sickle cell anemia in Nigeria

AbstractChildren with sickle cell anemia (SCA) living in Nigeria are at an increased risk of malnutrition, which contributes to increased morbidity and mortality. However, evidence-based guidelines for managing malnutrition in children with SCA are lacking. To address this gap, we conducted a multicenter, randomized controlled feasibility trial to assess the feasibility and safety of treating children with SCA aged from 5 to 12 years and having uncomplicated severe acute malnutrition (body mass index z score of <−3.0). Children with SCA and uncomplicated severe acute malnutrition were randomly allocated to receive supplemental ready-to-use therapeutic food (RUTF) with or without moderate-dose hydroxyurea therapy (20 mg/kg per day). Over a 6-month enrollment period, 3190 children aged from 5 to 12 years with SCA were evaluated for eligibility, and 110 of 111 children who were eligible were enrolled. During the 12-week trial, no participants withdrew or missed visits. One participant died of unrelated causes. Adherence was high for hydroxyurea (94%, based on pill counts) and RUTF (100%, based on the number of empty sachets returned). No refeeding syndrome event or hydroxyurea-related myelosuppression occurred. At the end of the trial, the mean change in body mass index z score was 0.49 (standard deviation = 0.53), and 39% of participants improved their body mass index z score to ≥−3.0. Our findings demonstrate the feasibility, safety, and potential of outpatient treatment for uncomplicated severe acute malnutrition in children with SCA aged from 5 to 12 years in a low-resource setting. However, RUTF sharing with household and community members potentially confounded the response to malnutrition treatment. This trial was registered at clinicaltrials.gov as #NCT03634488

Effect of ready-to-use therapeutic foods on time to recovery among children with severe acute malnutrition in Ethiopia: a prospective cohort study

BackgroundThe therapeutic feeding unit (TFU) provides comprehensive inpatient clinical care for children suffering from severe acute malnutrition (SAM) in three stages: stabilization, transition, and rehabilitation. During the transitional and rehabilitation phases, children receive either F-100 or ready-to-use therapeutic food (RUTF). Although both promote weight gain, RUTF is more energy dense than F-100. There is limited and contrasting evidence regarding their effect on recovery time. Therefore, this study aimed to assess the effect of RUTF on time to recovery among SAM children aged 6–59 months admitted to the TFU in Ethiopia.MethodsHealth Facility-based prospective cohort study was conducted among 476 children treated in three hospitals and four health centers in the Sidama region from September 2021 to January 2022. A structured questionnaire adopted from the Ethiopian national protocol for the management of SAM was used for data collection. Data were entered into EpiData version 3.1 and exported to SPSS version 20 for analysis. The Kaplan-Meir curve and log-rank test were used to compare time to recovery between children who received RUTF and F-100. Multivariable Cox proportional hazard analysis was conducted to assess the association between time to recovery and the type of therapeutic food, controlling for the confounding variables.ResultsThe median recovery time was significantly shorter in children receiving RUTF (7 days; 95% CI: 6.62–7.38) compared to F-100 (10 days; 95% CI: 8.94–11.06). Children below 24 months (AHR = 0.54, 95% CI: 0.42–0.69), dehydrated (AHR = 1.34, 95% CI: 1.07–1.75), edematous malnutrition (AHR = 1.29, 95% CI: 1.03–1.61), and anemic (AHR = 2.57, 95% CI: 1.90–3.48) during admission were associated with time to recovery.ConclusionsChildren who received RUTF recovered faster than children who received F-100. Administering RUTF to children below 24 months, who present with anemia and dehydration can improve their recovery rate and shorten their stay in the health facility.

A crisis within a crisis: Role of COVID-19 pandemic in poor compliance of Community-based Management of Severe Acute Malnutrition among children younger than five years in Pakistan

Introduction In order to attain Sustainable Development Goal 2 (SDG-II) of eradicating malnutrition among children by 2030, Pakistan has initiated a Community-based Management of Severely Acute Malnutrition (CMAM) program. This program has been established at the public level to detect and treat uncomplicated Severely Acute Malnourished (SAM) children at an early stage. However, during the outbreak of COVID-19, very poor compliance with the CMAM program was observed. Consequently, the nutritional quality of children’s diets has deteriorated, with malnutrition rates expected to rise. Therefore, this study has been set up to evaluate the effect of the COVID-19 lockdown on the health of SAM children and compliance with the CMAM program. Methodology This study used a multicenter cross-sectional design in District Dera Ghazi Khan’s rural areas located in the Southern Province of Punjab. Data were collected from the parents/guardians of SAM children through the researcher-administrated questionnaire. The sample size was 196, and data were analyzed through SPSS version 25. Results The majority of the children enrolled were males (52.5%), had fathers aged between 41 and 50 years (52.0%), mothers aged between 21 and 30 years (52.5%), had illiterate fathers (40.1%), illiterate mothers (73.8%) and had a monthly household income of PKR &lt;15,000 (91.1%). All of the respondents mentioned that COVID-19 affected them in one way or the other (100.0%), with a majority of them did not visit the hospital during COVID-19 for their SAM child (52.5%) as they were afraid of COVID-19 (63.2%) and/or they lacked access to transport for visiting a hospital (93.4%). Bivariate analysis revealed that the father’s age (P = 0.02) and income (P = 0.00) is associated with the perceived effect of COVID-19 on income. In contrast, only the gender of the child (P = 0.00) is related to the visit to the hospital, and the gender of the child (P = 0.01) and mother’s literacy (P = 0.00) is associated with the choice of treatment from any other setup, including Hakeem and Peer. Conclusion This study concludes that health emergencies like the COVID-19 pandemic pose a significant barrier to access to healthcare services and subject a more vulnerable state to already vulnerable groups like SAM children. To lessen their vulnerability, initiatives like mobile health care services should be introduced, especially for socially disadvantaged communities, localities, and groups on regular basis and for future emergencies.

Perceived quality of care for severe acute malnutrition management among caregivers of under-five children with severe acute malnutrition in Addis Ababa, Ethiopia, 2022: a mixed-method study.

All the factors at the institutional, provider, and client levels have an impact on the quality of care. In low- and middle-income countries, poor quality of severe acute malnutrition (SAM) management at health institutions is a major contributor to child morbidity and mortality. This study aimed to determine the perceived quality of care for SAM management among caregivers of under-five children. This study was conducted in public health facilities that provide inpatient SAM management in Addis Ababa, Ethiopia. An institution-based convergent mixed-method study design was implemented. Quantitative data were analyzed by using a logistic regression model, while thematic analysis was used to analyze the qualitative data. A total of 181 caregivers and 15 healthcare providers were recruited. The overall perceived quality of care for SAM management was 55.80% (CI: 48.5-63.10). Urban residence (AOR = 0.32, 95% CI: 0.16-0.66), college and above level education (AOR = 4.42, 95% CI: 1.41-13.86), working as a government employee (AOR = 2.72, 95% CI: 1.05-7.05), readmitted to the hospital (AOR = 0.47, 95% CI: 0.23-0.94), and length of hospital stays >7 days (AOR = 2.1, 95% CI: 1.01-4.27) were found to be significantly associated factors with perceived low-quality care for SAM management. Additionally, lack of support and attention from higher levels of management, and lack of supplements, separate units, and laboratory facilities were among the factors that impede the provision of quality care. Perceived quality of SAM management services was low against the national goal of quality improvement to meet the expectations of both internal and external clients. Rural residents, those with more educational qualifications, government employees, newly admitted patients, and patients who stayed longer in hospitals were the most unsatisfied groups. Improving support and logistic supply to health facilities, providing client-centered care, and responding to caregivers' demands may help to improve quality and satisfaction.

Optimising the dosage of ready-to-use therapeutic food in children with uncomplicated severe acute malnutrition in the Democratic Republic of the Congo: a non-inferiority, randomised controlled trial

Current standard management of severe acute malnutrition uses ready-to-use therapeutic food (RUTF) at a single weight-based calculation resulting in an increasing amount of RUTF provided to the family as the child's weight increases during recovery. Using RUTF at a gradually reduced dosage as the child recovers could reduce costs while achieving similar growth response. We conducted an open-label, non-inferiority, randomised controlled trial in the Democratic Republic of the Congo. Children aged 6-59 months with a mid-upper-arm circumference (MUAC) of less than 115mm or a weight-for-height z-score (WHZ) of less than-3 or bipedal oedema and without medical complication were randomly assigned (1:1 ratio) using a specially developed software and random blocks (size was kept confidential), to either the current standard treatment (increasing the RUTF amount with increasing weight) or the OptiMA strategy (decreasing the RUTF dose with increasing weight and MUAC). The main endpoint was proportion of children who achieved recovery over the 6 months follow up period, as defined as meeting the following criteria for two consecutive weeks after a minimum of 4 weeks' treatment: axillary temperature less than 37.5°C, no bipedal oedema, and anthropometric improvement (either MUAC 125mm or greater or WHZ-1.5 or higher). We performed analyses on the intention-to-treat (ITT) (all children) and per-protocol populations (participants who had a minimum prescription of 4 weeks' RUTF, received at least 90% of the total amount of RUTF they were supposed to receive as per the protocol, and had a maximum interval of 6 weeks between any two visits in the 6-month follow-up). The non-inferiority margin was 10%. This trial is registered at ClinicalTrials.gov, and is now closed NCT03751475. Between July 22, 2019, and January 20, 2020, 491 children were randomly assigned, of whom 482 were analysed (240 in the standard group and 242 in the OptiMA group). In the ITT analysis, 234 (98%) children in the standard group and 231 (96%) children in OptiMA recovered (difference 2.0%, 95% CI-2.0% to 6.4%). In the PP analysis, 234 (98%) children in the standard group and 228 (97%) in OptiMA recovered (difference 1.3%, 95% CI-2.3% to 5.1%). Sensitivity analyses applying the same anthropometric recovery criteria to each group also showed non-inferiority of the OptiMA strategy in ITT and PP analysis. This non-inferiority trial treating uncomplicated children with MUAC of less than 115mm or a WHZ of less than-3 or bipedal oedema with decreasing RUTF dose as MUAC and weight increase demonstrated non-inferiority compared to the standard protocol in a highly food-insecure context in the Democratic Republic of the Congo. These findings add evidence on the safety of RUTF dose reduction with significant RUTF cost savings. Innocent Foundation and European Civil Protection and Humanitarian Aid Operations. For the French translation of the abstract see Supplementary Materials section.