Incidence of severe acute malnutrition after treatment: A prospective matched cohort study in Nigeria

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Research snapshot¹

Treatment programmes for severe acute malnutrition (SAM) tend to focus on initial recovery with limited evidence on post discharge outcomes such as relapse and the remaining risk to children discharged as cured from outpatient facilities (OTP). This paper examines the persistent and excess risk of SAM among children treated in a community-based management of acute malnutrition (CMAM) programme in northern Nigeria and identifies the factors associated with the risk of relapse.

Persistent risk was assessed by measuring the six-month incidence rate of relapse among children discharged as cured from OTPs and excess risk was assessed by comparing this rate of relapse with a six-month incidence rate of SAM in a cohort of matched community controls. A total of 553 OTP-cured children and 526 matched community control children were enrolled on the study conducted from September 2018 to May 2019 in five rural local government areas (LGAs) in Sokoto State. Each community control child was matched to an OTP-cured child based on residence, age, sex, age of mother and level of education. Both cohorts were followed-up with outcomes and covariates measured fortnightly in up to 12 home visits.

Throughout the study, 24% of OTP cured children experienced relapse, compared to 0.6% community control children who developed SAM. The relapse incidence rate in the OTP-cured cohort was 0.204 per 100-child days compared to 0.004 per 100 child-days in the community cohort, meaning that SAM incidence rates were 52 times higher in the OTP-cured cohort. Most relapse cases occurred within the first 60 days post OTP-discharge. When assessing risk factors of relapse, it was found that being female, having a lower length/height for age at admission, a lower mid-upper arm circumference (MUAC) at admission and a household head without stable employment throughout the year were all related to a higher likelihood of relapse.

The authors conclude that OTP-cured children remain at a significantly excess risk of SAM and follow-up care should be strengthened using key observable characteristics such as sex or MUAC at admission to identify high risk cases.   

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