Antimicrobial and micronutrient interventions for the management of infants under six months of age identified with severe malnutrition
Research snapshot1
Infants under 6 months (U6M) contribute a significant proportion of the burden and mortality of severe malnutrition globally, with 3.8 million infants U6M estimated as being severely wasted and 4.7 million moderately wasted. Evidence of underlying aetiology in this population is sparse but it is known that the group includes ex-preterm and low birthweight (LBW) infants. They also represent a unique population given their dependence on breastmilk or a safe, secure alternative. Nutrition agencies and health providers struggle to make programming decisions on interventions for this group based upon the 2013 WHO Guidelines for the ‘Management of Severe Acute Malnutrition in Infants and Young Children’ since there is no published interventional trial data that focusses on this population. This review summarises the evidence-base for a selection of common interventions in order to inform policies for the management of severely malnourished infants U6M. Of the 94 articles identified for inclusion, none focused exclusively on severely malnourished infants U6M. There was, therefore, a lack of direct evidence for this population group. In closely related populations, the evidence-base was also neither strong nor extensive.
Key findings by intervention were:
- Antibiotics: systematic use, as per current WHO guidelines
- Deworming: no evidence of systematic use in infants but some evidence in breastfeeding mothers of malnourished infants
- Vitamin A: use of low-dose supplementation in deficient populations only
- Vitamin D: 6 months supplementation, as per current WHO guidelines for LBW
- Iron: routine use not recommended
- Zinc: supplement as per guidelines for infants with diarrhoea and routine use in regions with zinc deficiency
- Folate: routine use not recommended
- Maternal supplementation: insufficient evidence to justify routine use
- ReSoMal: use in malnourished infants U6M, as per current WHO guidelines
Considerable heterogeneity in terms of the age range of the population studied, an anthropometric definition of malnutrition, the dosage and duration of interventions and the outcomes studied make it challenging to summarise the evidence. However, the results provide an initial evidence-base to inform interim policy and programme decisions and future research agenda. More guidance for programmers based on increased evidence is urgently needed.
Subscribe freely to receive Field Exchange content to your mailbox or front door.
Endnotes
1 Campion-Smith, T. J., Kerac, M., McGrath, M., & Berkley, J. A. (2020). Antimicrobial and micronutrient interventions for the management of infants under 6 months of age identified with severe malnutrition: a literature review. PeerJ, 8, e9175. https://doi.org/10.7717/peerj.9175
More like this
Resource: Antimicrobial and micronutrient interventions for the management of infants under 6 months of age identified with severe malnutrition: a literature review
Background Infants under 6 months (U6M) contribute a significant proportion of the burden and mortality of severe malnutrition globally. Evidence of underlying aetiology in...
FEX: Managing at risk mothers and infants under six months in India – no time to waste
This is a summary of a Field Exchange field article that was included in issue 63 - a special edition on child wasting in South Asia. The original article was authored by...
FEX: Ensuring pregnancy weight gain: An integrated community-based approach to tackle maternal nutrition in India
View this article as a pdf Lisez cet article en français ici By Sreeparna Ghosh Mukherjee, Pia Sen and Dr Nagma Nigar Shah Sreeparna Ghosh Mukherjee is Senior...
FEX: Effects of nutrition interventions during pregnancy on low birth weight
Summary of research1 Location: Global What we know: Low birth weight (LBW) is a major underlying cause of infant mortality and childhood morbidity; LBW is greatly affected by...
FEX: Improving maternal nutrition in South Asia: Implications for child wasting prevention efforts
This is a summary of a Field Exchange 'views' article that was included in issue 63 - a special edition on child wasting in South Asia. The original article was authored by...
FEX: Managing at risk mothers and infants under six months in India – no time to waste
View this article as a pdf Lisez cet article en français ici By Praveen Kumar, Sila Deb, Arjan de Wagt, Piyush Gupta, Nita Bhandari, Neha Sareen and Satinder...
FEX: Integration of management of children with severe acute malnutrition in paediatric inpatient facilities in India
View this article as a pdf Lisez cet article en français ici By Praveen Kumar, Virendra Kumar, Sila Deb, Arpita Pal, Keya Chatterjee, Rajesh Kumar Sinha and Sanjay...
FEX: Improving maternal nutrition in South Asia: Implications for child wasting prevention efforts
View this article as a pdf Lisez cet article en français ici By Zivai Murira and Harriet Torlesse Zivai Murira is Nutrition Specialist at United Nations Children's...
FEX: Editorial
View this article as a pdf In this issue of Field Exchange we are delighted to feature, for the second year running, a special section that shares key outputs of Action...
FEX: Anthropometric indicators to identify a pregnant woman as acutely malnourished and predict adverse birth outcomes
Summary of published research1 Location: Global What we know: There is no consensus on how to identify pregnant women as acutely malnourished and when to enrol them in...
FEX: Development of a maternal service package for mothers of children with severe acute malnutrition admitted to nutrition rehabilitation centres in India
View this article as a pdf Lisez cet article en français ici By Vani Sethi, Praveen Kumar and Arjan De Wagt Vani Sethi PhD is a public health nutritionist in the...
en-net: Vitamin A supplemntation for severe wasting
Is it contraindicated to give Viatamin A for severe wasting during admission given the child didn't received in the last six months? until recently, my information was not to...
Blog post: MAMI reflections on the Lancet Small Vulnerable Newborns series
The recently launched Lancet Small Vulnerable Newborns (SVN) Series comprised three hearty papers of evidence and analyses and a call for action to prevent babies being born...
FEX: The MAMI Project – Key findings and recommendations
Summary of report1 Child malnutrition is a major global public health issue. The burden of acute malnutrition in children 6 months to 5 years is well recognised, and the...
en-net: Zinc supplementation to SAM and/or MAM with acute diarrhoea?
Can we give zinc supplementation to the severely and/or moderately acute malnourished children with acute diarrhoea? The Unicef and WHO document "Diarrhoea treatment guideline...
FEX: The Lancet ‘Small Vulnerable Newborns’ series: Reflections from a ‘MAMI’ perspective
View this article as a pdf Marie McGrath is a Technical Director at ENN and co-Chair of the MAMI Global Network What we know: This year's Lancet series on small vulnerable...
Resource: Anthropometry at birth and at age of routine vaccination to predict mortality in the first year of life: A birth cohort study in Burkina Faso
Abstract Background The World Health Organization currently defines severe acute malnutrition (SAM) in infants aged under 6 months of age using weight-for-length Z score...
FEX: Implementation of WHO Guidelines on the Management of Severe Malnutrition in South Africa and Ghana
Summary of published research1 Dietitian interacting with ward nurse at Mapuleng hospital, Northern Province, South Africa 2002 In the past, Field Exchange has addressed...
en-net: Use of half strength infant formula instead of F75 Formula
Hi All I am currently working as a Dietitian Advisor to the Samoan NHS. A current practice in the Paediatric ward for infants ranging from about 6 months to 2 years,...
FEX: Admission profile and discharge outcomes for infants aged less than six months admitted to inpatient therapeutic care in ten countries
Summary of research* Location: Global (Burundi, DRC, Kenya, Liberia, Myanmar, Niger, Somalia, Sudan, Tajikistan, Uganda) What we know: The burden of acute malnutrition in...
Reference this page
Antimicrobial and micronutrient interventions for the management of infants under six months of age identified with severe malnutrition. Field Exchange 64, January 2021. p71. www.ennonline.net/fex/64/mamiantimicrobialmicronutrient
(ENN_6884)