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Long-term outcomes for children with disability and severe acute malnutrition in Malawi

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Research snapshot1

Despite broad understanding that severe acute malnutrition (SAM) and disability can cause and influence one another, there is limited information on their co-existence in low-income settings and linkages are seldom considered by those working in programmes. This study aimed to describe the prevalence, characteristics and outcomes of disability among children with SAM from a hospital in Blantyre, Malawi, using data from two longitudinal cohort studies, following up survivors who had been treated for SAM one and seven years after discharge. Disability at admission was originally identified clinically and at the seven-year follow-up using a standardised screening tool, the ‘Washington Group Questionnaire’. Clinical and anthropometric profiles were compared with sibling and community controls.

According to clinical assessment at admission, 6.4% (60/938) of SAM children had an obvious disability. At the seven-year follow-up, 18% (11/60) of these children were still known to be alive. SAM children with a clinically identified disability at admission had a 6.99 times greater risk of dying by seven-years post-discharge compared to those admitted without disability (relative risk adjusted for age, sex and HIV status 6.99, 95% CI 3.49 to 14.02, p<0.001). Children with some types of disability were at particular risk of death: by the seven-year follow up, 7.82% of children with cerebral palsy had died. Children with a clinically obvious disability were older on average, less likely to be HIV positive and to have oedema but more likely to be severely malnourished than children without disability at admission. At the seven-year follow-up, those children were more stunted, had less catch-up growth, smaller head circumference, weaker hand grip strength and poorer school achievement compared to non-disabled survivors. The use of the Washington Group Questionnaire confirmed disability in all children identified with disability at admission plus many more children not previously identified.

The authors conclude that SAM children with disability face a much greater risk of mortality than non-disabled children one and seven-years post-discharge. To help children survive and thrive after SAM treatment, it is vital that those with an underlying disability are identified and supported. SAM treatment programmes should also consider structured screening tools to better identify children at risk.   

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Endnotes

1 Lelijveld N, Groce N, Patel S, et al Long-term outcomes for children with disability and severe acute malnutrition in Malawi BMJ Global Health 2020;5:e002613.

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Long-term outcomes for children with disability and severe acute malnutrition in Malawi. Field Exchange 64, January 2021. p71. www.ennonline.net/fex/64/disabilitysammalawi

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