How do children with severe underweight and wasting respond to treatment? A pooled secondary data analysis to inform future intervention studies

Datos Bibliográficos

ID15536631
AutoresGloria Odei Obeng-Amoako (0000-0001-5004-3701, Makerere University), Heather Stobaugh (0000-0003-3827-283X, Tufts University), Stephanie V Wrottesley (0000-0002-5419-2920, Euclid Network), Tanya Khara (0000-0002-6251-0052, Euclid Network), Paul Binns (0000-0001-8005-9835, Action for ME), Indi Trehan (0000-0002-3364-6858, University of Washington), Robert E Black (0000-0001-9926-7984, Johns Hopkins University), Patrick Webb (0000-0002-9857-3354, Tufts University), Martha Mwangome (0000-0003-4806-1307, Kenya Medical Research Institute), Jeanette Bailey (0000-0002-4343-4939, International Rescue Committee), Paluku Bahwere (0009-0008-6234-8121, Université Libre de Bruxelles), Carmel Dolan (0000-0003-1130-6948, Conservatoire for Dance and Drama), Erin Boyd (0000-0002-3611-7505, Tufts University), André Briend (0000-0001-9390-8541, University of Copenhagen), Mark Myatt (0000-0003-1119-1474, Gwynedd Council), Mark A Myatt (Brixton Health Llwyngwril Gwynedd Wales UK), Natasha Lelijveld (0000-0002-8452-0198, Euclid Network, autor de correspondencia)
Año2022
Volumen19
Número1
Páginase13434-e13434
Fecha de publicación2022-10-19
Peer ReviewedSí
Open AccessSí
TipoARTICLE
RevistaMaternal and Child Nutrition (JOURNAL)
Identificadores de la revistaISSN: 1740-8695 • E-ISSN: 1740-8709
EditorialWiley (PUBLISHER • GB)
DOI10.1111/mcn.13434
PMID36262055
OpenAlexW4306911496
IdiomaEN
Citas recibidas8
Referencias citadas36

Children with weight-for-age z-score (WAZ) <-3 have a high risk of death, yet this indicator is not widely used in nutrition treatment programming. This pooled secondary data analysis of children aged 6-59 months aimed to examine the prevalence, treatment outcomes, and growth trajectories of children with WAZ <-3 versus children with WAZ ≥-3 receiving outpatient treatment for wasting and/or nutritional oedema, to inform future protocols. Binary treatment outcomes between WAZ <-3 and WAZ ≥-3 admissions were compared using logistic regression. Recovery was defined as attaining mid-upper-arm circumference ≥12.5 cm and weight-for-height z-score ≥-2, without oedema, within a period of 17 weeks of admission. Data from 24,829 children from 9 countries drawn from 13 datasets were included. 55% of wasted children had WAZ <-3. Children admitted with WAZ <-3 compared to those with WAZ ≥-3 had lower recovery rates (28.3% vs. 48.7%), higher risk of death (1.8% vs. 0.7%), and higher risk of transfer to inpatient care (6.2% vs. 3.8%). Growth trajectories showed that children with WAZ <-3 had markedly lower anthropometry at the start and end of care, however, their patterns of anthropometric gains were very similar to those with WAZ ≥-3. If moderately wasted children with WAZ <-3 were treated in therapeutic programmes alongside severely wasted children, we estimate caseloads would increase by 32%. Our findings suggest that wasted children with WAZ <-3 are an especially vulnerable group and those with moderate wasting and WAZ <-3 likely require a higher intensity of nutritional support than is currently recommended. Longer or improved treatment may be necessary, and the timeline and definition of recovery likely need review

Anthropometry · Body mass index · Logistic regression · Malnutrition · Overweight · Standard score · Underweight · Wasting · Child Nutrition and Feeding Issues · Child Nutrition and Water Access · Medicine · Obesity, Physical Activity, Diet · Internal Medicine · Pediatrics