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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

(2016) PLOS ONE. 11(4).
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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 >= 11.0cm and < 12.5cm 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 < 11cm 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.
Keywords
SOCIOECONOMIC-STATUS, MALNOURISHED CHILDREN, MANAGEMENT, HEALTH, BANGLADESH, UNDERNUTRITION, CHILDHOOD, METAANALYSIS, AFRICA, GROWTH

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Chicago
James, Philip, Kate Sadler, Mekitie Wondafrash Kibebew, Alemayehu Alemayeha, Hanqi Luo, Benti Geleta, Kiya Kedir, Yilak Getnet, Tefera Belachew, and Paluku Bahwere. 2016. “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.” Plos One 11 (4).
APA
James, P., Sadler, K., Wondafrash Kibebew, M., Alemayeha, A., Luo, H., Geleta, B., Kedir, K., et al. (2016). 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. PLOS ONE, 11(4).
Vancouver
1.
James P, Sadler K, Wondafrash Kibebew M, Alemayeha A, Luo H, Geleta B, et al. 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. PLOS ONE. 2016;11(4).
MLA
James, Philip, Kate Sadler, Mekitie Wondafrash Kibebew, et al. “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.” PLOS ONE 11.4 (2016): n. pag. Print.
@article{7192774,
  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 {\textrangle}= 11.0cm and {\textlangle} 12.5cm 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 {\textlangle} 11cm 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.},
  articleno    = {e0153530},
  author       = {James, Philip and Sadler, Kate and Wondafrash Kibebew, Mekitie and Alemayehu, Alemayehu and Luo, Hanqi and Geleta, Benti and Kedir, Kiya and Getnet, Yilak and Belachew, Tefera and Bahwere, Paluku},
  issn         = {1932-6203},
  journal      = {PLOS ONE},
  keyword      = {SOCIOECONOMIC-STATUS,MALNOURISHED CHILDREN,MANAGEMENT,HEALTH,BANGLADESH,UNDERNUTRITION,CHILDHOOD,METAANALYSIS,AFRICA,GROWTH},
  language     = {eng},
  number       = {4},
  pages        = {26},
  title        = {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},
  url          = {http://dx.doi.org/10.1371/journal.pone.0153530},
  volume       = {11},
  year         = {2016},
}

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