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 ... read moreMAM. 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:
- TARC Citation Guide EndNote
