Children in a rural, impoverished African nations often develop moderate acute malnutrition (MAM). Even after receiving supplementary food-and-health assistance, they often relapse into life-threatening conditions, or death, within one year of recovering from MAM.


Nutrition researchers initiated their study with an a1487-member population of children aged 6-62 months that were discharged from a MAM treatment program. The study concluded with1383 participants, a 93% of the original participant population.

The infants and young children from Malawi, a landlocked east African nation, were examined at three-month intervals between April 2014 and June 2015. They came from subsistence-farming families living in areas prone to high rates of diarrhea and malaria during that nation’s rainy season that runs from December through March each year, a period that creates food shortages.After being treated for MAM, the discharged children were divided into control and treatment groups. Members of each group received different packages of nutritional foodstuffs, along with health-related information that was given to their parentsor caretakers.During the rainy season, the researchers also offered extra monthly malaria-prevention outreach.Those in the treatment group were sent home with the same nutritional-and-health package as the control group, but also were provided with extra nutritional supplements, preventive drugs for area diseases and anti-malaria bed netting.

At the three-month examination intervals, each child was assessed for malnutrition to determine the presence of sustained recovery. During examinations, researchers and pediatric nurses examined each participant for edema or swelling due to excess fluid retention, mid-upper arm circumference (MUAC), height and weight. Also, the team inquired about participants’ recent health, food availability, immunization records and bed-netting usage.

To classify whether a child continued to recovery from MAM, the researchers looked at MUAC and stratified their conclusions:

Sustained recovery = 12.5cm or greater MUAC at each of the 12 monthly visits;

Relapse into MAM = 11.5 – 12.4 MUAC; and

Development of severe acute malnutrition = less than 11.5 MUAC or edema in both feet.

The researchers found that 41% of children in both the intervention and control groups relapsed into MAM during the first year after being treated and released from their initial nutrition program, while 51% achieved sustained recovery.The American Journal of Clinical Nutrition published the findings in June 2017. The researchers were from Tufts University in Boston, Massachusetts; Washington University in St. Louis, Missouri; the University of Malawi, in Blantyre, Malawi; Baylor College of Medicine, in Houston, Texas; and Partners in Health located in Harper, Liberia.

The nutritionists acknowledge that further research into malnutrition treatment is needed.They suggest exploring patient-specific malnutrition-treatment strategies.

Limitations of the study stem from problematic incident reporting. In addition, researchers were unable to determine whether a child had lapsed into MAM and then recovered between tri-monthly visits, and were unable to accurately record how frequently those in the intervention group utilized their bed nets and supplemental food packages.


Written By: Susan Mercer Hinrichs, MA, MBA, CPhT


Reference: Effect of a Package of Health and Nutrition Services on Sustained Recovery in Children after Moderate Acute Malnutrition and Factors Related to Sustaining Recovery: ACluster-Randomized Trial

Authors: Heather C. Stobaugh, Lucy B. Bollinger, Sara E. Adams, Audrey H. Crocker, Jennifer B. Grise, Julie A. Kennedy, Chrissie Thakwalakwa, Kenneth M. Maleta, Dennis J. Dietzen, Mary J. Manary and Indi Trehan


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