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 MAM. T... read morehe 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
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