Rethinking Recovery: Generating evidence to improve and sustain recovery from moderate acute malnutrition in children
Stobaugh, Heather.
2017
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Abstract: This dissertation focuses on interventions that are intended to
result in improved and sustained recovery from moderate acute malnutrition (MAM) in
children. Research was conducted in southern Malawi with children between ages 6 and 62
months with MAM, defined as having a mid-upper arm circumference (MUAC) 11.5-12.4 cm, and
with children immediately following initial recovery from MA... read moreM. The aim of the research
presented in Chapter 1 was to measure effectiveness and cost-effectiveness of including
whey protein in a ready-to-use supplementary food (RUSF) used to treat MAM. In a
double-blinded, randomized controlled trial comparing a soy RUSF and a whey RUSF, the
proportion of children that recovered from MAM was higher in the group that received whey
RUSF (84%) compared to soy RUSF (81%). The whey RUSF group also demonstrated higher MUAC at
discharge, greater MUAC gain and weight gain during treatment, and higher weight-for-height
Z-score (WHZ) at discharge. A cost-effectiveness analysis revealed that substituting whey
RUSF for soy RUSF resulted in a $0.42 decrease in the total programmatic cost per child
recovered ($54.76 and $54.34 for soy and whey RUSF, respectively). Chapter 2 presents a
cluster randomized controlled trial to measure the effectiveness of a package of health and
nutrition interventions—consisting of a lipid nutrient supplement (LNS), deworming
medication, a zinc supplement, a bed net, and malaria chemoprophylaxis—in improving the
proportion of children who sustain recovery for one year following treatment for MAM. The
proportion of children who sustained recovery for one year was higher in the intervention
group. Larger MUAC at the start of treatment, larger increase in MUAC during treatment, and
higher WHZ at the end of treatment were the strongest predictors of sustained recovery. The
type of food (whey RUSF vs. soy RUSF) consumed during treatment was not predictive of
relapse when controlling for other factors. Nearly all serum C3 levels, a proxy for immune
function, were normal at discharge. Half of all relapses occurred within three months of
initial recovery. Poor linear growth following recovery was found to be significantly
associated with relapse. Chapter 3 consists of a sub-study from the study in Chapter 2. The
aim was to identify household factors, collected in an in-depth household survey,
associated with sustained recovery following MAM treatment. Results showed improved WASH
indicators were associated with a child sustaining recovery, yet indicators relating to
socioeconomic status, food security, and infant and young child feeding practices were not.
In conclusion, this dissertation presents evidence that suggests a uniform approach for
treating all children with MAM may not be appropriate to achieve sustained recovery. Also,
incorporating higher discharge MUAC cut-offs, post-discharge monitoring, earlier
identification of children with MAM, and additional preventive services should be
integrated into MAM treatment to reduce the risk of relapse. Although consuming whey RUSF
compared to soy RUSF resulted in modestly improved recovery rates, the type of treatment
food did not affect relapse rates. Future studies are needed to identify possible
underlying physiological factors that may not have fully recovered at SFP
discharge.
Thesis (Ph.D.)--Tufts University, 2017.
Submitted to the Dept. of Food Policy & Applied Nutrition.
Advisor: Irwin Rosenberg.
Committee: Mark Manary, Beatrice Rogers, and Patrick Webb.
Keywords: Nutrition, and African studies.read less - ID:
- st74d310n
- Component ID:
- tufts:22238
- To Cite:
- DCA Citation Guide EndNote
