Location: Children's Nutrition Research CenterTitle: Community-based management of acute malnutrition for infants under 6 months of age is safe and effective: Analysis of operational data
|WOELTJE, MAEVE - University Of Washington|
|EVANOFF, ANASTASIA - Harvard University|
|HELMINK, BETH - Washington University|
|CULBERTSON, DIANA - Seattle Children'S Research Institute|
|MALETA, KENNETH - Kamuzu Central Hospital|
|MANARY, MARK - Washington University|
|TREHAN, INDI - Washington University|
Submitted to: Public Health Nutrition
Publication Type: Peer Reviewed Journal
Publication Acceptance Date: 12/14/2021
Publication Date: 12/17/2021
Citation: Woeltje, M.M., Evanoff, A.B., Helmink, B.A., Culbertson, D.L., Maleta, K.M., Manary, M.J., Trehan, I. 2021. Community-based management of acute malnutrition for infants under 6 months of age is safe and effective: Analysis of operational data. Public Health Nutrition. 26:246-255. https://doi.org/10.1017/S1368980021004894.
Interpretive Summary: Malnutrition among infants under 6 months of age is a large problem, but inpatient treatment may be slowed down by social and economic barriers. This study aimed to gauge the usefulness of outpatient management using ready-to-use and supplementary foods for these infants in rural Malawi. The results showed that community managed outpatient treatment was safe and worked, with high rates of nutritional recovery among both severely and moderately malnourished infants under 6 months, comparable to older infants treated as inpatients. Randomised prospective studies comparing this outpatient approach with therapeutic or supplementary foods with other strategies as part of outpatient or inpatient management are warranted.
Technical Abstract: To assess the effectiveness of outpatient management with ready-to-use and supplementary foods for infants under 6 months (u6m) of age who were unable to be treated as inpatients due to social and economic barriers. Review of operational acute malnutrition treatment records. Twenty-one outpatient therapeutic feeding clinics in rural Malawi. Infants u6m with acute malnutrition treated as outpatients because of barriers to inpatient treatment. The comparison group consisted of acutely malnourished children 6–9 months of age who were being treated at the same time in the same location in the context of two different randomised clinical trials. A total of 323 infants u6m were treated for acute malnutrition (130 severe and 193 moderate). A total of 357 infants 6–9 months old with acute malnutrition (seventy-four severe and 283 moderate) were included as contemporaneous controls. Among infants u6m with severe acute malnutrition, 98 (75.4 %) achieved nutritional recovery; in comparison, 56 (75.7 %) of those with severe acute malnutrition 6–9 months old recovered. Among infants u6m with moderate acute malnutrition, 157 (81.3 %) recovered; in comparison, 241 (85.2 %) of thoseaged 6–9 months recovered. In a rural Malawian population of infants u6m who had generally already stopped exclusive breast-feeding and were now acutely malnourished, treatment with therapeutic or supplementary foods under the community management of acute malnutrition model was safe and effective. In settings where social and financial factors make hospital admission challenging, consideration should be given to lowering the recommended age of ready-to-use therapeutic and supplementary foods to infants u6m.