Institute for Global Health, University College London, London, UK
Clinical Research Programme, Malawi-Liverpool Wellcome Trust, Blantyre, Malawi.
BMJ Glob Health. 2020 Oct;5(10). doi: 10.1136/bmjgh-2020-002613.
Severe acute malnutrition (SAM) and disability are major global health issues. Although they can cause and influence each other, data on their co-existence are sparse. We aimed to describe the prevalence and patterns of disability among a cohort of children with SAM.
A longitudinal cohort study in Malawi followed SAM survivors up to 7 years postdischarge. Clinical and anthropometric profiles were compared with sibling and community controls. Disability at original admission was identified clinically; at 7-year follow-up a standardised screening tool called 'the Washington Group Questionnaire' was used.
60/938 (6.4%) of admissions to SAM treatment had clinically obvious disability at admission. Post-treatment mortality was high, with only 11/60 (18%) surviving till 7-year follow-up. SAM children with a disability at admission had 6.99 (95% CI 3.49 to 14.02; p<0.001) greater risk of dying compared with children without disability. They were also older, less likely to be HIV positive or have oedema and more severely malnourished. Long-term survivors were more stunted, had less catch-up growth, smaller head circumference, weaker hand grip strength and poorer school achievement than non-disabled survivors.The Washington Group Questionnaire confirmed disability in all who had been identified clinically, and identified many who had not been previously flagged.
Disability is common among children affected by SAM. Those with disability-associated SAM have greatly increased risk of dying even if they survive the initial episode of malnutrition. Survivors have poorer growth, physical strength and school achievement. To enable all children to survive and thrive post-SAM, it is vital to focus more on those with disabilities. SAM treatment programmes should consider using not just clinical assessment but structured assessments to better identify at-risk individuals as well as understand the population of children for which they are developing services.
严重急性营养不良（SAM）和残疾是全球主要的健康问题。尽管它们可能相互影响，但有关它们共存的数据却很少。我们旨在描述 SAM 患儿队列中残疾的患病率和模式。
马拉维进行了一项纵向队列研究，对 SAM 幸存者进行了长达 7 年的出院后随访。临床和人体测量特征与兄弟姐妹和社区对照进行了比较。在原始入院时通过临床识别残疾；在 7 年随访时，使用称为“华盛顿小组问卷”的标准化筛查工具。
938 例 SAM 治疗入院患者中有 60 例（6.4%）在入院时存在明显的临床残疾。治疗后死亡率较高，仅有 11/60 例（18%）存活至 7 年随访。与无残疾的儿童相比，入院时患有残疾的 SAM 儿童死亡的风险高 6.99 倍（95%CI 3.49 至 14.02；p<0.001）。他们年龄较大，HIV 阳性或水肿的可能性较小，营养不良更为严重。长期幸存者比无残疾幸存者更矮，生长迟缓，生长追赶不足，头围更小，握力更弱，学业成绩更差。华盛顿小组问卷确认了所有临床上已确定的残疾，并发现了许多以前未被标记的残疾。
残疾在受 SAM 影响的儿童中很常见。即使他们幸存下来最初的营养不良发作，具有残疾相关 SAM 的儿童死亡风险大大增加。幸存者的生长、体力和学业成绩较差。为了使所有 SAM 后幸存的儿童能够生存和茁壮成长，必须更加关注残疾儿童。SAM 治疗计划不仅应考虑使用临床评估，还应考虑使用结构化评估，以更好地识别高危个体，并了解他们正在为其开发服务的人群。
