Maternal and Child Nutrition (Oct 2024)

Effectiveness of acute malnutrition treatment with a simplified, combined protocol in Central African Republic: An observational cohort study

  • Grace Heymsfield,
  • Zachary Tausanovitch,
  • Loubah Gondjé Christian,
  • M'bary Siolo Mada Bebelou,
  • Benedict Tabiojong Mbeng,
  • Anne Marie Dembele,
  • Annie Fossi,
  • Théophile Bansimba,
  • Issa Niamanto Coulibaly,
  • Victor Nikièma,
  • Suvi T. Kangas

DOI
https://doi.org/10.1111/mcn.13691
Journal volume & issue
Vol. 20, no. 4
pp. n/a – n/a

Abstract

Read online

Abstract A simplified, combined protocol admitting children with a mid‐upper‐arm circumference (MUAC) of <125 mm or oedema to malnutrition treatment with ready‐to‐use therapeutic food (RUTF) uses two sachets of RUTF per day of those with MUAC < 115 mm and/or oedema and one sachet of RUTF per day for those with MUAC 115–<125 mm. This treatment previously demonstrated noninferior programmatic outcomes compared with standard treatment and high recovery in a routine setting. We aimed to observe the protocol's effectiveness in a routine setting at scale, in two health districts of the Central African Republic through an observational cohort study. The pilot enrolled children for 1 year in consortium by the Ministry of Health and nongovernmental partners. A total of 7909 children were admitted to the simplified, combined treatment. Treatment resulted in an 81.2% overall recovery, with a mean length of stay (LOS) of 38.7 days and a mean RUTF consumption of 43.4 sachets per child treated. Among children admitted with MUAC < 115 mm or oedema, 67.9% recovered with a mean LOS of 48.1 days and consumed an average of 70.9 RUTF sachets. Programme performance differed between the two districts, with an overall defaulting rate of 31.1% in the Kouango‐Grimari health district, compared to 8.2% in Kemo. Response to treatment by children admitted with severe acute malnutrition (SAM) by MUAC and SAM by oedema was similar. The simplified, combined protocol resulted in a satisfactory overall recovery and low RUTF consumption per child treated, with further need to understand defaulting in the context.

Keywords