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. 2024 Jul 30;36(2):73-79.
doi: 10.4314/mmj.v36i2.3. eCollection 2024 Jul.

Trends in severe acute malnutrition admissions, characteristics, and treatment outcomes in Malawi from 2011 through 2019

Allison I Daniel  1   2   3 , Sylvester Kathumba  4 , Collins Mitambo  4 , Dennis Chasweka  5 , Wieger Voskuijl  5   6 , Esther Kamanga  5 , Emmie Mbale  5   7 , Robert Hj Bandsma  1   2   3   8   9 , Isabel Potani  1   2   3
Affiliations

Trends in severe acute malnutrition admissions, characteristics, and treatment outcomes in Malawi from 2011 through 2019

Allison I Daniel et al. Malawi Med J. .

Abstract

Background: Community-based Management of Acute Malnutrition (CMAM) has been successfully implemented across Malawi, yet trends in admissions, characteristics, and treatment outcomes in children with severe acute malnutrition (SAM) have not been examined. The objective was therefore to investigate trends in admissions, characteristics including percentage of children with SAM with HIV and oedema, and treatment outcomes across the decade following implementation of CMAM.

Methods: This research involved a retrospective analysis of existing data routinely collected across Malawi by the Ministry of Health between 2011 and 2019.

Results: These data showed an increase in outpatient therapeutic feeding (OTP) admissions from 30323 children in 2011 to 37655 in 2019 (p=0.045). However, a significant decrease in nutritional rehabilitation unit (NRU) admissions was observed, from 11389 annual admissions in 2011 to 6271 in 2019 (p=0.006). In children identified with SAM, the percentage with oedema decreased in OTPs with an average annual rate of reduction (AARR) of 5.6% (p=0.001) and by 26.2% in NRUs in this timeframe with an AARR of 8.5% (p<0.001). The percentage of children with SAM who had HIV decreased over time in OTPs with an AARR of 16.1% (p=0.001). HIV rates also decreased in NRUs with an AARR of 7.2% (p=0.4), but this difference was not significant. Death rates decreased in OTPs with an AARR of 6.0% (p=0.01). Mortality rates did not change in NRUs over time with an AARR of 0.9% (p=0.5) with the NRU mortality rate in 2019 being 11.0%.

Conclusions: These trends indicate that there has been an increase in OTP admissions and a corresponding decrease in NRU admissions. There have been decreases in the percentage of children with oedematous SAM in OTPs and in NRUs and with HIV in OTPs. Children remain at high risk of mortality in NRUs.

Keywords: Community-based Management of Acute Malnutrition (CMAM); kwashiorkor; nutritional rehabilitation unit (NRU); oedema; severe acute malnutrition (SAM); wasting.

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Figures

Figure 1
Figure 1
Outpatient therapeutic feeding program admissions between 2011 and 2019. Severe acute malnutrition admissions by year at all outpatient therapeutic feeding programs across Malawi. The 2019 data only include new admissions while data from all other years reflect total admissions
Figure 2
Figure 2
Nutritional rehabilitation unit admissions between 2011 and 2019. Severe acute malnutrition admissions by year at all nutritional rehabilitation units across Malawi. The 2019 data only include new admissions while data from all other years reflect total admissions
Figure 3
Figure 3
Trends in the percentage of children with severe acute malnutrition who had oedema in outpatient therapeutic feeding programs (A) and nutritional rehabilitation units (B) between 2011 and 2018
Figure 4
Figure 4
Trends in the percentage of children with severe acute malnutrition who were HIV reactive in outpatient therapeutic feeding programs (A) and nutritional rehabilitation units (B) between 2012 and 2017. HIV: human immunodeficiency virus
Figure 5
Figure 5
Trends in the percentage of female children with severe acute malnutrition in outpatient therapeutic feeding programs (A) and nutritional rehabilitation units (B) between 2012 and 2018
Figure 6
Figure 6
Deaths disaggregated by outpatient therapeutic feeding programs and nutritional rehabilitation units between 2011 and 2019. NRU: nutritional rehabilitation unit; OTP: outpatient therapeutic feeding program
Figure 7
Figure 7
Trends in the mortality rates in children with severe acute malnutrition in outpatient therapeutic feeding programs (A) and nutritional rehabilitation units (B) between 2011 and 2019
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References

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    1. World Health Organization, author. WHO Child Growth Standards and the Identification of Severe Acute Malnutrition in Infants and Children. Geneva: World Health Organization; 2009.
    1. National Statistical Office/Malawi ICF, author. Malawi Demographic and Health Survey 2015-16. Zomba, Malawi: National Statistical Office and ICF; 2017.
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