Admission profile and discharge outcomes for infants aged less than 6 months admitted to inpatient therapeutic care in 10 countries. A secondary data analysis

Abstract

Evidence on the management of acute malnutrition in infants aged less than 6 months (infants <6mo) is scarce. To understand outcomes using current protocols, we analysed a sample of 24 045 children aged 0-60 months from 21 datasets of inpatient therapeutic care programmes in 10 countries. We compared the proportion of admissions, the anthropometric profile at admission and the discharge outcomes between infants <6mo and children aged 6-60 months (older children). Infants <6mo accounted for 12% of admissions. The quality of anthropometric data at admission was more problematic in infants <6mo than in older children with a greater proportion of missing data (a 6.9 percentage point difference for length values, 95% CI: 6.0; 7.9, P < 0.01), anthropometric measures that could not be converted to indices (a 15.6 percentage point difference for weight-for-length z-score values, 95% CI: 14.3; 16.9, P < 0.01) and anthropometric indices that were flagged as outliers (a 2.7 percentage point difference for any anthropometric index being flagged as an outlier, 95% CI: 1.7; 3.8, P < 0.01). A high proportion of both infants <6mo and older children were discharged as recovered. Infants <6mo showed a greater risk of death during treatment (risk ratio 1.30, 95% CI: 1.09; 1.56, P < 0.01). Infants <6mo represent an important proportion of admissions to therapeutic feeding programmes, and there are crucial challenges associated with their care. Systematic compilation and analysis of routine data for infants <6mo is necessary for monitoring programme performance and should be promoted as a tool to monitor the impact of new guidelines on care.

Keywords: anthropometry; infant and child nutrition; malnutrition; management of acute malnutrition; mortality; wasting.

Figure 1

Forest plot of the risk ratio (RR) of death during treatment for infants aged <6 months compared with children aged 6–60 months, by country, from a sample of 24 045 children aged 0–60 months from 10 countries (Burundi, Kenya, Liberia, Myanmar, Niger, Democratic Republic of Congo, Somalia, Sudan, Tajikistan and Uganda). Test for heterogeneity χ ² = 67.0 (degrees of freedom = 9; P < 0.01). I‐squared (variation in RR attributable to heterogeneity) = 86.6%. Test of RR = 1: z = 2.96 (P < 0.01).