Editors' ChoiceMalnutrition

Outpatient Treatment of Severe Acute Malnutrition

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Science Translational Medicine  26 Jun 2013:
Vol. 5, Issue 191, pp. 191ec105
DOI: 10.1126/scitranslmed.3006771

In developing countries, about 26 million children under age 5 suffer from severe acute malnutrition (SAM). The odds of mortality from any disease are nine times higher for children with SAM as comparing with their well-nourished peers. The management of SAM was previously restricted to hospital-based treatment, but the Outpatient Therapeutic feeding Program (OTP) and ready-to-use therapeutic foods have brought SAM management closer to the community.

Yebyo et al. conducted a retrospective cohort study in Ethiopia on 628 children who were treated for SAM in the OTP from 2008 to 2012. The authors used the demographic, anthropometric, disease, medication, and therapeutic feeding data to explore program outcomes and determinants of the children’s recovery rate.

Upon admission to OTP, children received a weekly Plumpy’Nut (ready-to-use therapeutic food) ration according to their body weight. They were also supposed to receive a routine treatment regimen including Vitamin A, folic acid, antibiotics, deworming medication, and measles vaccine, but these were not always provided. Children were discharged from the program once they gained 85% of target weight-for-height.

During the study period, 61.78% of children recovered from malnutrition, whereas another 13.85% left the study early (“defaulted”). The average rate of weight gain was 5.23 gm/kg/day. Comorbid conditions had a major effect on study outcomes: Children without medical complications gained weight at a rate of 6.30 gm/kg/day, but the children with at least one medical condition gained weight at an average rate of only 4.16 gm/kg/day. Recovery rate increased by 4% for each packet of Plumpy’Nut the child consumed. The inclusion of amoxicillin and deworming in the treatment regimen increased the probability of recovery by 95 and 74%, respectively. Conversely, diarrhea and appetite loss were associated with a decreased recovery rate. However, the study found that many of the comorbid medical conditions were managed improperly, and the average length of stay under the OTP intervention was much longer than expected.

This OTP for the management of SAM children was moderately successful. The overall recovery rate and weight gain were lower than the world standard, but the defaulter and mortality rates were within acceptable limits. To optimize the effectiveness of this program, the staff would need to receive further training in the proper management of SAM.

H. G. Yebyo et al., Outpatient therapeutic feeding program outcomes and determinants in treatment of severe acute malnutrition in Tigray, Northern Ethiopia: A retrospective cohort study. PLoS One. 8, e65840 (2013). [Full Text]

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