This study compared a standard nutritional program for the treatment of uncomplicated SAM using WHZ and / or MUAC for admission and discharge to a MUAC-only program where MUAC was used as the sole anthropometric endpoint for admission and discharge. . The MUAC only program used a MUAC cutoff rate than the standard program.
In this context, the use of different anthropometric admission criteria led to the admission of children of different nutritional profiles in the two outpatient therapeutic feeding centers, in accordance with previous reports. [10,11,12,13]. The children included in the PB program only were smaller and more often puny, but presented less morbidities on admission. According to the admission criteria for the PB program only, the children included in Sabon Guida had a higher mean MUAC and WHZ, with a substantial proportion of children enrolled suffering from moderate acute malnutrition (> 25% with a MUAC between 115 and 119 mm and a WHZ between – 2 and â¥ – 3 on admission) and would not have been part of a standard program. It can be expected that the more favorable anthropometric profile of the children included in the MUAC program alone would contribute to better nutritional recovery, as seen elsewhere. [15, 18, 20]. Although we observed greater recovery in the PB program only compared to the standard program (70.1% vs. 51.6%), the difference in recovery remained after statistical adjustment for MUAC and WHZ at admission. Differential recovery may therefore be due to differences in the ease of reaching the respective definitions of recovery which differed by site (e.g. MUAC â¥ 125 mm at 2 consecutive visits in the MUAC program only vs MUAC 125 mm and WHZ â¥ – 2 to 2 consecutive visits in the standard program), but more research is needed.
Overall, the risk of non-response was high in this study. One-fifth of the children in the PB-only program and one-third of the children in the standard program did not meet the criteria for discharge from their respective centers after completing eight weeks of treatment. The high burden of non-response should be of particular concern as the majority of these children were SAM, frequently with MUAC
The risk of death and failure was lower than international recommendations , but the risk of default was notably twice as high in the standard program as in the MUAC program alone. Qualitative interviews among standard program caregivers support a variety of barriers to accessing care (e.g. financial constraints, geography, insecurity) but also highlight areas for program improvement (e.g. example, improved staff communication and relationships with caregivers), which may have varied depending on the site.
Among children who recovered and were admitted with 115 mm MUAC, the mean duration of treatment tended to be shorter in the MUAC program only. This result can be associated with the exit criteria of the PB program only, not requiring in addition WHZ â¥ – 2 during two consecutive visits. The mean daily weight gain (g / kg / day) was higher in the standard program than in the MUAC program alone, which can be expected given the more severe WHZ at admission [15, 18] .
In a previous analysis, we reported on the results of the program obtained using an anthropometric discharge based on PB in Burkina Faso. . This previous study showed overall favorable results for the program using MUAC â¥124 mm as the sole anthropometric endpoint of discharge versus proportional weight gain, but did not include post-discharge follow-up. In the present study which included a follow-up three months after discharge, we found that readmission was more frequently observed in the PB-only program compared to the standard program where WHZ and / or PB were used as anthropometric criteria for discharge. This can be partly attributed to the fact that readmission was based on the broader eligibility criteria of a MUAC
While increasing the MUAC eligibility threshold for admission from 115 to 120 mm was intended to increase the sensitivity of the admission criterion, we anticipated that a number of children would be found to be newly ineligible for treatment in the future. under the PB program only, because PB and WHZ are known to identify different children. Contrary to what has been reported elsewhere [22, 23], we found a very small number of children excluded from treatment using a PB-only model with admission defined by MUAC m= 63 not eligible against 1019 children admitted to the same site). After 12 weeks of home follow-up, the majority of these children (69.8%) did not deteriorate (i.e. BP 120 mm) despite the fact that they did not immediately receive treatment. within the framework of the PB program only.