Relapse and post-discharge body composition of children treated for acute malnutrition using a simplified, combined protocol
Research snapshot1
Severe and moderate acute malnutrition (SAM and MAM) affect more than 50 million children worldwide. Despite gains in the treatment of SAM in the past decade, there is no current consensus on how best to manage children with MAM. Furthermore, treatment coverage for SAM and MAM remains low, with 80% of children not accessing care. One option to overcome these challenges is to combine the treatment of SAM and MAM into one simplified protocol.
The ComPAS trial (Combined Protocol for Acute Malnutrition Study) was a single-blinded, cluster randomised, controlled, non-inferiority trial to compare the recovery rates of a combined protocol for uncomplicated SAM and MAM in children 6-59 months of age against standard treatment.2 The combined protocol used a simplified dosage and provided two sachets of ready to use therapeutic food (RUTF) per day for SAM3 children and one sachet per day for MAM4 children. Results demonstrate non-inferior recovery of the combined protocol compared to standard care. To further inform policy, this study assessed the four months post-discharge outcomes of SAM and MAM children treated in Kenya.
The study recruited 850 children from 12 clinics (six using combined and six using standard protocol). The study found children treated with the combined protocol had similar anthropometry, fat-free mass, fat mass, skinfold thickness z-scores and frequency of common illnesses four months post-discharge compared to the standard protocol. Mean subscapular skinfold z-scores were close to the global norm and there was also no significant difference in the odds of relapse between protocols.
These results add further evidence that a combined protocol is as effective as standard care. This is an important finding as a simplified, combined approach could stretch existing resources further and treat more children.
1Lelijveld N, Musyoki E, Adongo W S, Mayberry A, Jonathan C W, Opondo C, Kerac M, Bailey J (2021) Relapse and post-discharge body composition of children treated for acute malnutrition using a simplified, combined protocol: A nested cohort from the ComPAS RCT. PLOS ONE. 2021; 16(2): e0245477. https://doi.org/10.1371/journal.pone.0245477
2Weight-based dose of RUTF for children with SAM and RUSF for children with MAM.
3Defined as MUAC < 11.5cm and/or mild or moderate oedema.
4Defined as MUAC between 11.5 and <12.5cm and no oedema.
More like this
FEX: ComPAS trial in South Sudan and Kenya: Headline findings and experiences
View this article as a pdf Lisez cet article en français ici By Bethany Marron, Pamela Onyo, Eunice N Musyoki, Susan Were Adongo and Jeanette Bailey Bethany Marron is...
FEX: OptiMA study in Burkina Faso: Emerging findings and additional insights
View this article as a pdf Lisez cet article en français ici By Kevin PQ Phelan Kevin PQ Phelan is Nutrition Advisor at ALIMA, the Alliance for International Medical...
FEX: Previous Field Exchange content on continuum of acute malnutrition care
View this article as a pdf Content previously published in Field Exchange is also relevant to this issue's focus on continuity of care for acutely malnourished children. You...
FEX: En-net summary
View this article as a pdf En-net1 is a free, open resource for frontline nutrition practitioners to gain access to prompt technical advice for operational challenges where...
FEX: Defining and treating “high-risk” moderate acute malnutrition using expanded admission criteria (Hi-MAM Study): A cluster-randomised controlled trial protocol
View this article as a pdf By Natasha Lelijveld, David Taylor Hendrixson, Claire Godbout, Alyssa Los, Jukka M Leppänen, Aminata Koroma and Mark Manary Natasha Lelijveld...
en-net: How long to continue RUTF for SAM children enrolled in OTP?
Dear all, I would like to know for how long RUTF should be continued in SAM children in the absence of SFP? Protocol says that the discharge criteria for SAM is W/H - W/L...
FEX: The “ComPAS” trial combined treatment model for acute malnutrition: study protocol for the economic evaluation
Research snapshot1 Acute malnutrition is currently divided into severe (SAM) and moderate (MAM), based on level of wasting. SAM and MAM currently have separate treatment...
FEX: Substandard discharge rules in current severe acute malnutrition management protocols: An overlooked source of ineffectiveness for programmes?
View this article as a pdf Lisez cet article en français ici By Benjamin Guesdon and Dominique Roberfroid Benjamin Guesdon is a nutrition and health research advisor...
FEX: Combined protocol for SAM/MAM treatment: The ComPAS study
By Jeanette Bailey, Rachel Chase, Marko Kerac, André Briend, Mark Manary, Charles Opondo, Maureen Gallagher and Anna Kim Jeanette Bailey is the Project Director for...
FEX: Cost-efficiency of a simplified protocol for wasting treatment in Mali
View this article as a pdf Lisez cet article en français ici Derek Lee is a Best Use of Resources Advisor for Nutrition at International Rescue Committee...
FEX: Response to malnutrition treatment in low weight-for-age children: secondary analyses of ComPAS trial data
View this article as a pdf Research summary1 Location: Kenya and South Sudan What we know: Children who are concurrently wasted and stunted (WaSt) have a very high mortality...
FEX: Report on innovations in CMAM
By Anne Marie Kueter, Claudine Prudhon, Emily Keane and Megan Gayford The implementation of community-based management of acute malnutrition (CMAM) as the standard model of...
FEX: Post-recovery relapse and a simplified protocol: A study of children in Mali
View this article as a pdf Lisez cet article en français ici This is a summary of the following paper: Kangas S, Coulibaly I, Tausanovitch Z et al. (2023)...
FEX: Implementation of a field study of body composition among infants and young children in sub-Saharan Africa
View this article as a pdf By Ezekiel Mupere, John Mukisa, Lynnth Turyagyenda, Peace Aber, Luke S Uebelhoer, Celine Bourdon, Robert Bandsma, Emmanuel Chimwezi, Jonathan C...
FEX: Management of severe acute malnutrition by community health workers: Early results of Action Against Hunger research
View this article as a pdf Lisez cet article en français ici By Pilar Charle-Cuellar, Noemi Lopez-Ejeda, Magloire Bunkembo, Abdias Ogobara Dougnon and Hassane Toukou...
FEX: Effectiveness of a simplified protocol in Mali: An observational study
View this article as a pdf This is a summary of the following paper: Kangas S, Marron B, Tausanovitch Z et al (2022) Effectiveness of acute malnutrition treatment at health...
en-net: Does Low MUAC treated with RUTF result in children becoming obese?
Using MUAC to identify SAM cases tends to identify more younger and stunted children compared to WHZ. Concerns have been expressed that stunted children with low MUAC may have...
FEX: Integrated protocol for severe and moderate acute malnutrition in Sierra Leone
Summary of research1 Location: Sierra Leone What we know: Impliementing separate protocols for MAM and SAM treatment can be administratively cumbersome in emergency...
FEX: Community health worker-led treatment for uncomplicated wasting: insights from the RISE study
View this article as a pdf Lisez cet article en français ici By Bethany Marron on behalf of the RISE study consortium Bethany Marron is a nutrition advisor and former...
FEX: Wasting treatment: The effectiveness and coverage of a simplified protocol in Niger
This is a summary of the following paper: Charle-Cuéllar P, Lopez-Ejeda N, Gado A et al (2023) Effectiveness and Coverage of Severe Acute Malnutrition Treatment with a...
Reference this page
Relapse and post-discharge body composition of children treated for acute malnutrition using a simplified, combined protocol. Field Exchange 65, May 2021. p69. www.ennonline.net/fex/65/simplifiedprotocolsbodycomposition
(ENN_7116)