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Title: Relapse after severe acute malnutrition: A systematic literature review and secondary data analysis

item STOBAUGH, HEATHER - Rti International, Usa
item MAYBERRY, AMY - Action Against Hunger
item MCGRATH, MARIE - Emergency Nutrition Network
item BAHWERE, PALUKU - Valid International
item ZAGRE, NOEL - United Nations Children Fund
item MANARY, MARK - Children'S Nutrition Research Center (CNRC)
item BLACK, ROBERT - Johns Hopkins School Of Public Health
item LELIJVELD, NATASHA - Hospital For Sick Children (SICKKIDS)

Submitted to: Maternal and Child Nutrition
Publication Type: Review Article
Publication Acceptance Date: 9/15/2018
Publication Date: 4/1/2019
Citation: Stobaugh, H.C., Mayberry, A., McGrath, M., Bahwere, P., Zagre, N.M., Manary, M.J., Black, R., Lelijveld, N. 2019. Relapse after severe acute malnutrition: A systematic literature review and secondary data analysis. Maternal and Child Nutrition. 15(2):e12702.

Interpretive Summary:

Technical 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.