Bringing new evidence on undernutrition and mortality risk into practice- Protocol for a prospective cohort study

The ENN coordinated Wasting and Stunting Technical Interest Group (WaSt TIG) have been investigating the relationship between wasting and stunting since 2014 examining whether the current separation between these manifestations of undernutrition within research, programmes, policy, and funding is justified. Recently published analyses by the group (illustrated below) have highlighted the very high risk of death in children who are simultaneously (concurrently) wasted and stunted (WaSt). The level of mortality risk is comparable with that of a child with severe acute malnutrition who would normally be therapeutically treated. Analysis carried out using cohort study data from Senegal indicates that weight-for-age (WFA) and MUAC when used independently identify all children with nutritional deficits who are at risk of near-term mortality including those who are simultaneously wasted and stunted, severely wasted (by either MUAC or WHZ), and severely stunted. This finding has since been confirmed using data from a further twelve cohorts of children that cover a range of contexts (Africa, the Americas, Asia and the Pacific) as well as different timeframes (publication in progress). Although WFA has been eclipsed in recent years by separate measures of wasting and stunting, it has remained in use in many child health and growth monitoring and promotion systems. There is, therefore, an opportunity to test how WFA may be usefully re-integrated into programme approaches (e.g. CMAM) for child survival and development.

This study aims to test whether WFA and MUAC can be effectively utilised in existing programmes to capture these children with single and dual deficits and reach considerably more children at a high risk of death. It addresses question two in ENN’s 2019 research announcement:

What intensity, duration of treatment, and discharge criteria are appropriate for children identified using the combinations of the indicators/thresholds identified (WFA < -3 or MUAC < 115mm)?