Children with Moderate Acute Malnutrition with No Access to Supplementary Feeding Programmes Experience High Rates of Deterioration and No Improvement: Results from a Prospective Cohort Study in Rural Ethiopia

Philip James, Kate Sadler, Mekitie Wondafrash, Alemayehu Argaw, Hanqi Luo, Benti Geleta, Kiya Kedir, Yilak Getnet, Tefera Belachew, Paluku Bahwere, Philip James, Kate Sadler, Mekitie Wondafrash, Alemayehu Argaw, Hanqi Luo, Benti Geleta, Kiya Kedir, Yilak Getnet, Tefera Belachew, Paluku Bahwere

Abstract

Background: Children with moderate acute malnutrition (MAM) have an increased risk of mortality, infections and impaired physical and cognitive development compared to well-nourished children. In parts of Ethiopia not considered chronically food insecure there are no supplementary feeding programmes (SFPs) for treating MAM. The short-term outcomes of children who have MAM in such areas are not currently described, and there remains an urgent need for evidence-based policy recommendations.

Methods: We defined MAM as mid-upper arm circumference (MUAC) of ≥11.0 cm and <12.5 cm with no bilateral pitting oedema to include Ethiopian government and World Health Organisation cut-offs. We prospectively surveyed 884 children aged 6-59 months living with MAM in a rural area of Ethiopia not eligible for a supplementary feeding programme. Weekly home visits were made for seven months (28 weeks), covering the end of peak malnutrition through to the post-harvest period (the most food secure window), collecting anthropometric, socio-demographic and food security data.

Results: By the end of the study follow up, 32.5% (287/884) remained with MAM, 9.3% (82/884) experienced at least one episode of SAM (MUAC <11 cm and/or bilateral pitting oedema), and 0.9% (8/884) died. Only 54.2% of the children recovered with no episode of SAM by the end of the study. Of those who developed SAM half still had MAM at the end of the follow up period. The median (interquartile range) time to recovery was 9 (4-15) weeks. Children with the lowest MUAC at enrolment had a significantly higher risk of remaining with MAM and a lower chance of recovering.

Conclusions: Children with MAM during the post-harvest season in an area not eligible for SFP experience an extremely high incidence of SAM and a low recovery rate. Not having a targeted nutrition-specific intervention to address MAM in this context places children with MAM at excessive risk of adverse outcomes. Further preventive and curative approaches should urgently be considered.

Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Fig 1. Agricultural calendar of Jimma zone…
Fig 1. Agricultural calendar of Jimma zone and study implementation period.
Fig 2. Subject flow diagram.
Fig 2. Subject flow diagram.
Fig 3. Kaplan-Meier failure function estimates for…
Fig 3. Kaplan-Meier failure function estimates for recovering from moderate acute malnutrition with no episode of severe acute malnutrition during follow up, by mid-upper arm circumference category at enrolment.
Fig 4. Survival curve for developing Severe…
Fig 4. Survival curve for developing Severe Acute Malnutrition as per Ethiopian operational criteria (MUAC

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