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Relapse and post-discharge body composition of children treated for acute malnutrition using a simplified, combined protocol

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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.

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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.

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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

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