New approach to simplifying and optimising acute malnutrition treatment in children aged 6 to 59 months: The OptiMA single-arm proof-of-concept trial in Burkina Faso
Research snapshot1
OptiMA (Optimizing treatment for acute MAlnutrition) is a simplified protocol that aims to treat both moderate and severe acute malnutrition (MAM and SAM), determined through early household detection by the presence of oedema and/or mid-upper arm circumference (MUAC) <125 mm, with progressively reduced doses of a single-product, ready-to-use therapeutic food (RUTF). OptiMA was implemented from January 2017 to March 2018 in a ‘real-life’ setting by the personnel of the Ministry of Health of Burkina Faso in all 54 health centres of Yako district, with operational support from a national and international non-governmental consortium and an established UNICEF-supported RUTF supply chain. Almost 5,000 children were included for analysis. Overall recovery rate was 86.3%, exceeding the SPHERE standard for both SAM and MAM programmes. Recovery was lowest among children who were most malnourished at admission, with 70.4% of the children admitted with MUAC<115 mm or oedema recovering. Mortality rate was low (0.4%), while defaults, non-response and transfers represented 4.7%, 3.4% and 0.2%, respectively. Programme outcomes stratified by MUAC and weight-for-height z-score (WHZ) at admission revealed that children with both MUAC<115mm and WHZ<-3 had the lowest recovery (64.3%) and highest non-response (12.5%) and mortality (1.7%) rates. Current SAM programmes typically plan for RUTF consumption of between 120-150 sachets per child treated, while MAM programmes plan for between 60 and 90 sachets of ready-to-use supplementary food (RUSF) per child. Although comparisons of average rations must consider variations in discharge criteria (under OptiMA, discharge was stringent at two consecutives measures of MUAC >125 mm), the overall RUTF consumption of an average of 60.8 sachets per child per course of treatment was highly encouraging. Further study will be needed to determine if increasing RUTF dosage for children admitted with MUAC<115mm will improve recovery and non-response, even if multivariate analysis reveals other factors that appear to influence recovery rate.
Endnotes
1Daures, M., Phelan, K., Issoufou, M., Kouanda, S., Sawadogo, O., Issaley, K., Cazes C., Séri B., Ouaro B., Akpakpo B., Mendiboure V., Shepherd S., Becquet, R. (n.d.). New approach to simplifying and optimizing acute malnutrition treatment in children aged 6 to 59 months: The OptiMA single-arm proof-of-concept trial in Burkina Faso. British Journal of Nutrition, 1-31. doi:10.1017/S0007114519003258