How do children with severe underweight and wasting respond to treatment? A pooled secondary data analysis to inform future intervention studies
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How do children with severe underweight and wasting respond to treatment? A pooled secondary data analysis to inform future intervention studies. / Odei Obeng-Amoako, Gloria A; Stobaugh, Heather; Wrottesley, Stephanie V; Khara, Tanya; Binns, Paul; Trehan, Indi; Black, Robert E; Webb, Patrick; Mwangome, Martha; Bailey, Jeanette; Bahwere, Paluku; Dolan, Carmel; Boyd, Erin; Briend, André; Myatt, Mark A; Lelijveld, Natasha.
In: Maternal and Child Nutrition, Vol. 19, No. 1, e13434, 2023.Research output: Contribution to journal › Journal article › Research › peer-review
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TY - JOUR
T1 - How do children with severe underweight and wasting respond to treatment? A pooled secondary data analysis to inform future intervention studies
AU - Odei Obeng-Amoako, Gloria A
AU - Stobaugh, Heather
AU - Wrottesley, Stephanie V
AU - Khara, Tanya
AU - Binns, Paul
AU - Trehan, Indi
AU - Black, Robert E
AU - Webb, Patrick
AU - Mwangome, Martha
AU - Bailey, Jeanette
AU - Bahwere, Paluku
AU - Dolan, Carmel
AU - Boyd, Erin
AU - Briend, André
AU - Myatt, Mark A
AU - Lelijveld, Natasha
N1 - © 2022 The Authors. Maternal & Child Nutrition published by John Wiley & Sons Ltd.
PY - 2023
Y1 - 2023
N2 - Children with weight-for-age z-score (WAZ) <-3 have a high risk of death, yet this indicator is not widely used in nutrition treatment programming. This pooled secondary data analysis of children aged 6-59 months aimed to examine the prevalence, treatment outcomes, and growth trajectories of children with WAZ <-3 versus children with WAZ ≥-3 receiving outpatient treatment for wasting and/or nutritional oedema, to inform future protocols. Binary treatment outcomes between WAZ <-3 and WAZ ≥-3 admissions were compared using logistic regression. Recovery was defined as attaining mid-upper-arm circumference ≥12.5 cm and weight-for-height z-score ≥-2, without oedema, within a period of 17 weeks of admission. Data from 24,829 children from 9 countries drawn from 13 datasets were included. 55% of wasted children had WAZ <-3. Children admitted with WAZ <-3 compared to those with WAZ ≥-3 had lower recovery rates (28.3% vs. 48.7%), higher risk of death (1.8% vs. 0.7%), and higher risk of transfer to inpatient care (6.2% vs. 3.8%). Growth trajectories showed that children with WAZ <-3 had markedly lower anthropometry at the start and end of care, however, their patterns of anthropometric gains were very similar to those with WAZ ≥-3. If moderately wasted children with WAZ <-3 were treated in therapeutic programmes alongside severely wasted children, we estimate caseloads would increase by 32%. Our findings suggest that wasted children with WAZ <-3 are an especially vulnerable group and those with moderate wasting and WAZ <-3 likely require a higher intensity of nutritional support than is currently recommended. Longer or improved treatment may be necessary, and the timeline and definition of recovery likely need review.
AB - Children with weight-for-age z-score (WAZ) <-3 have a high risk of death, yet this indicator is not widely used in nutrition treatment programming. This pooled secondary data analysis of children aged 6-59 months aimed to examine the prevalence, treatment outcomes, and growth trajectories of children with WAZ <-3 versus children with WAZ ≥-3 receiving outpatient treatment for wasting and/or nutritional oedema, to inform future protocols. Binary treatment outcomes between WAZ <-3 and WAZ ≥-3 admissions were compared using logistic regression. Recovery was defined as attaining mid-upper-arm circumference ≥12.5 cm and weight-for-height z-score ≥-2, without oedema, within a period of 17 weeks of admission. Data from 24,829 children from 9 countries drawn from 13 datasets were included. 55% of wasted children had WAZ <-3. Children admitted with WAZ <-3 compared to those with WAZ ≥-3 had lower recovery rates (28.3% vs. 48.7%), higher risk of death (1.8% vs. 0.7%), and higher risk of transfer to inpatient care (6.2% vs. 3.8%). Growth trajectories showed that children with WAZ <-3 had markedly lower anthropometry at the start and end of care, however, their patterns of anthropometric gains were very similar to those with WAZ ≥-3. If moderately wasted children with WAZ <-3 were treated in therapeutic programmes alongside severely wasted children, we estimate caseloads would increase by 32%. Our findings suggest that wasted children with WAZ <-3 are an especially vulnerable group and those with moderate wasting and WAZ <-3 likely require a higher intensity of nutritional support than is currently recommended. Longer or improved treatment may be necessary, and the timeline and definition of recovery likely need review.
KW - Faculty of Science
KW - Anthropometry
KW - Child nutrition
KW - Malnutrition
KW - Stunting
KW - Underweight
KW - Wasting
U2 - 10.1111/mcn.13434
DO - 10.1111/mcn.13434
M3 - Journal article
C2 - 36262055
VL - 19
JO - Maternal and Child Nutrition
JF - Maternal and Child Nutrition
SN - 1740-8695
IS - 1
M1 - e13434
ER -
ID: 327130037