Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2023 Jun 5;15(11):2636.
doi: 10.3390/nu15112636.

Post-Recovery Relapse of Children Treated with a Simplified, Combined Nutrition Treatment Protocol in Mali: A Prospective Cohort Study

Suvi T Kangas  1 , Issa Niamanto Coulibaly  2 , Zachary Tausanovitch  1 , Bareye Ouologuem  3 , Bethany Marron  1 , Elizabeth Radin  1 , Christian Ritz  4 , Salimou Dembele  2 , Césaire T Ouédraogo  2 , Jeanette Bailey  1
Affiliations

Post-Recovery Relapse of Children Treated with a Simplified, Combined Nutrition Treatment Protocol in Mali: A Prospective Cohort Study

Suvi T Kangas et al. Nutrients. .

Abstract

The present study aimed to determine the 6-month incidence of relapse and associated factors among children who recovered from acute malnutrition (AM) following mid-upper arm circumference (MUAC)-based simplified combined treatment using the ComPAS protocol. A prospective cohort of 420 children who had reached a MUAC ≥ 125 mm for two consecutive measures was monitored between December 2020 and October 2021. Children were seen at home fortnightly for 6 months. The overall 6-month cumulative incidence of relapse [95%CI] into MUAC < 125 mm and/or edema was 26.1% [21.7; 30.8] and 1.7% [0.6; 3.6] to MUAC < 115 mm and/or edema. Relapse was similar among children initially admitted to treatment with a MUAC < 115 mm and/or oedema and among those with a MUAC ≥ 115 mm but <125 mm. Relapse was predicted by lower anthropometry both at admission to and discharge from treatment, and a higher number of illness episodes per month of follow-up. Having a vaccination card, using an improved water source, having agriculture as the main source of income, and increases in caregiver workload during follow-up all protected from relapse. Children discharged as recovered from AM remain at risk of relapsing into AM. To achieve reduction in relapse, recovery criteria may need to be revised and post-discharge strategies tested.

Keywords: Mali; acute malnutrition; combined protocol; community-based management of acute malnutrition; mid-upper-arm circumference; moderate acute malnutrition; ready-to-use therapeutic food; relapse; severe acute malnutrition; simplified protocol.

PubMed Disclaimer

Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Patient flow chart for inclusion into the relapse study and analysis.
See this image and copyright information in PMC

References

    1. United Nations Children’s Fund (UNICEF) World Health Organization. International Bank for Reconstruction and Development/The World Bank . Levels and Trends in Child Malnutrition: Key Findings of the 2020 Edition of the Joint Child Malnutrition Estimates. World Health Organization; Geneva, Switzerland: 2020.
    1. WHO . Guideline: Updates on the Management of Severe Acute Malnutrition in Infant and Children. World Health Organization; Geneva, Switzerland: 2013. - PubMed
    1. WHO. WFP. UNSCN. UNICEF . Community-Based Management of Severe Acute Malnutrition: A Joint Statement by the World Health Organization, the World Food Programme, the United Nations System Standing Committee on Nutrition and the United Nations Children’s Fund. UNICEF; Geneva, Switzerland: 2007.
    1. World Health Organization . Management of Severe Malnutrition: A Manual for Physicians and Other Senior Health Workers. World Health Organization; Geneva, Switzerland: 1999. 60p
    1. WFP . Technical Specifications for Ready-to-Use Supplementary Food (RUSF) WFP; Rome, Italy: 2016. Specification Reference: MIXRSF000.