How age and sex affect treatment outcomes for children with severe malnutrition: A multi-country secondary data analysis

Susan Thurstans¹, Charles Opondo^{2

3}, Jeanette Bailey⁴, Heather Stobaugh⁵, Fabrizio Loddo⁶, Stephanie V Wrottesley⁷, Andy Seal⁸, Mark Myatt⁹, André Briend^{10

11}, Michel Garenne^{12

13

14

15}, Andrew Mertens¹⁶, Jonathan Wells¹⁷, Rebecca Sear¹, Marko Kerac^{1

18}

Affiliations

¹ Department of Population Health, London School of Hygiene and Tropical Medicine, London, UK.
² Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, UK.
³ National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK.
⁴ International Rescue Committee, New York, USA.
⁵ Action Against Hunger, New York, USA.
⁶ Médecins Sans Frontières, Paris, France.
⁷ Emergency Nutrition Network, Oxford, UK.
⁸ UCL Institute for Global Health, London, UK.
⁹ Brixton Health, Llwyngwril, Gwynedd, UK.
¹⁰ Tampere Center for Child, Adolescent and Maternal Health Research, Tampere University and Tampere University Hospital, Tampere, Finland.
¹¹ Department of Nutrition, Exercise and Sports, University of Copenhagen, Copenhagen, Denmark.
¹² Institut de Recherche pour le Développement, UMI Résiliences, Bondy, France.
¹³ Department of Statistics and Population Studies, University of the Western Cape, Cape Town, South Africa.
¹⁴ FERDI, Université d'Auvergne, Clermont-Ferrand, France.
¹⁵ MRC/Wits Rural Public Health and Health Transitions Research Unit, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
¹⁶ University of California, Berkeley School of Public Health, Berkeley, California, USA.
¹⁷ Population, Policy and Practice Research and Teaching Department, UCL Great Ormond Street Institute of Child Health, London, UK.
¹⁸ Maternal, Adolescent, Reproductive & Child Health Centre (MARCH), London School of Hygiene & Tropical Medicine, London, UK.

PMID: 38048342
PMCID: PMC11168354
DOI: 10.1111/mcn.13596

How age and sex affect treatment outcomes for children with severe malnutrition: A multi-country secondary data analysis

Susan Thurstans et al. Matern Child Nutr. 2024 Jul.

. 2024 Jul;20(3):e13596.

doi: 10.1111/mcn.13596. Epub 2023 Dec 4.

Authors

Affiliations

¹ Department of Population Health, London School of Hygiene and Tropical Medicine, London, UK.
² Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, UK.
³ National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK.
⁴ International Rescue Committee, New York, USA.
⁵ Action Against Hunger, New York, USA.
⁶ Médecins Sans Frontières, Paris, France.
⁷ Emergency Nutrition Network, Oxford, UK.
⁸ UCL Institute for Global Health, London, UK.
⁹ Brixton Health, Llwyngwril, Gwynedd, UK.
¹⁰ Tampere Center for Child, Adolescent and Maternal Health Research, Tampere University and Tampere University Hospital, Tampere, Finland.
¹¹ Department of Nutrition, Exercise and Sports, University of Copenhagen, Copenhagen, Denmark.
¹² Institut de Recherche pour le Développement, UMI Résiliences, Bondy, France.
¹³ Department of Statistics and Population Studies, University of the Western Cape, Cape Town, South Africa.
¹⁴ FERDI, Université d'Auvergne, Clermont-Ferrand, France.
¹⁵ MRC/Wits Rural Public Health and Health Transitions Research Unit, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
¹⁶ University of California, Berkeley School of Public Health, Berkeley, California, USA.
¹⁷ Population, Policy and Practice Research and Teaching Department, UCL Great Ormond Street Institute of Child Health, London, UK.
¹⁸ Maternal, Adolescent, Reproductive & Child Health Centre (MARCH), London School of Hygiene & Tropical Medicine, London, UK.

PMID: 38048342
PMCID: PMC11168354
DOI: 10.1111/mcn.13596

Abstract

Age and sex influence the risk of childhood wasting. We aimed to determine if wasting treatment outcomes differ by age and sex in children under 5 years, enroled in therapeutic and supplementary feeding programmes. Utilising data from stage 1 of the ComPAS trial, we used logistic regression to assess the association between age, sex and wasting treatment outcomes (recovery, death, default, non-response, and transfer), modelling the likelihood of recovery versus all other outcomes. We used linear regression to calculate differences in mean length of stay (LOS) and mean daily weight gain by age and sex. Data from 6929 children from Kenya, Chad, Yemen and South Sudan was analysed. Girls in therapeutic feeding programmes were less likely to recover than boys (pooled odds ratio [OR]: 0.84, 95% confidence interval [CI]: 0.72-0.97, p = 0.018). This association was statistically significant in Chad (OR: 0.61, 95% CI: 0.39-0.95, p = 0.030) and Yemen (OR: 0.47, 95% CI: 0.27-0.81, p = 0.006), but not in Kenya and South Sudan. Multinomial analysis, however, showed no difference in recovery between sexes. There was no difference between sexes for LOS, but older children (24-59 months) had a shorter mean LOS than younger children (6-23 months). Mean daily weight gain was consistently lower in boys compared with girls. We found few differences in wasting treatment outcomes by sex and age. The results do not indicate a need to change current programme inclusion requirements or treatment protocols on the basis of sex or age, but future research in other settings should continue to investigate the aetiology of differences in recovery and implications for treatment protocols.

Keywords: malnutrition; sex; treatment; undernutrition; wasting.

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Conflict of interest statement

The authors declare no conflicts of interest.

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References

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How age and sex affect treatment outcomes for children with severe malnutrition: A multi-country secondary data analysis

Affiliations

How age and sex affect treatment outcomes for children with severe malnutrition: A multi-country secondary data analysis

Authors

Affiliations

Abstract

Conflict of interest statement

Figures

References

MeSH terms

LinkOut - more resources

Full Text Sources