Global Academy of Agriculture and Food Systems, University of Edinburgh, Edinburgh, United Kingdom.
Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.
Matern Child Nutr. 2022 Oct;18(4):e13400. doi: 10.1111/mcn.13400. Epub 2022 Jul 21.
This study aimed to quantify the burden of relapse following successful treatment for uncomplicated severe acute malnutrition (SAM) and to identify associated risk factors in rural Niger. We used data from 1490 children aged 6-59 months discharged as recovered from an outpatient nutritional programme for SAM and followed for up to 12 weeks after admission. Postdischarge SAM relapse was defined as weight-for-height Z-score <-3, mid-upper arm circumference (MUAC) <115 mm or bipedal oedema after having been discharged as recovered. Postdischarge hospitalisation was defined as admission to inpatient SAM treatment or hospitalisation for any cause after having been discharged as recovered. We used multivariate log-binomial models to identify independent risk factors. After programmatic discharge, 114 (8%) children relapsed to SAM and 89 (6%) were hospitalised. Factors associated with SAM relapse were discharge during the lean season (relative risk [RR] = 1.80 [95% confidence interval [CI] = 1.22-2.67]) and larger household size (RR = 1.56 [95% CI = 1.01-2.41]), whereas older child age (RR = 0.94 [95% CI = 0.88-1.00]), higher child MUAC at discharge (RR = 0.93 [95% CI = 0.87-1.00]) and maternal literacy (RR = 0.54 [95% CI = 0.29-0.98]) were protective factors. Discharge during the lean season (RR = 2.27 [95% CI = 1.46-3.51]) was independently associated with postdischarge hospitalisation. Future nutritional programmes in the context of Niger may consider modification of anthropometric discharge criteria or the provision of additional home support or follow-up during the lean season as potential interventions to prevent relapse. More research including postdischarge follow-up is needed to better understand the sustainability of treatment outcomes after discharge and the type of intervention that may best sustain recovery over time. Clinical Trial Registration: ClinicalTrials.gov number, NCT01613547.
这项研究旨在量化成功治疗无并发症严重急性营养不良 (SAM) 后的复发负担，并确定尼日尔农村的相关风险因素。我们使用了 1490 名 6-59 个月大的儿童的数据，这些儿童从门诊营养计划中因 SAM 而康复出院，并在出院后最多随访 12 周。出院后 SAM 复发定义为体重身高 Z 评分 <-3，中上臂围 (MUAC) <115mm 或出院后恢复时出现双足水肿。出院后住院定义为因 SAM 住院治疗或因任何原因出院后住院。我们使用多变量对数二项式模型来确定独立的风险因素。在方案性出院后，有 114 名（8%）儿童复发 SAM，89 名（6%）儿童住院。与 SAM 复发相关的因素是在淡季出院（相对风险 [RR] = 1.80 [95%置信区间 [CI] = 1.22-2.67]）和更大的家庭规模（RR = 1.56 [95% CI = 1.01-2.41]），而较大的儿童年龄（RR = 0.94 [95% CI = 0.88-1.00]）、出院时较高的儿童 MUAC（RR = 0.93 [95% CI = 0.87-1.00]）和母亲的文化程度（RR = 0.54 [95% CI = 0.29-0.98]）是保护因素。淡季出院（RR = 2.27 [95% CI = 1.46-3.51]）与出院后住院独立相关。尼日尔未来的营养计划可能需要考虑修改人体测量学出院标准，或在淡季提供额外的家庭支持或随访，作为预防复发的潜在干预措施。需要进行更多的研究，包括出院后的随访，以更好地了解出院后治疗结果的可持续性，以及随着时间的推移可能最能维持恢复的干预类型。临床试验注册：ClinicalTrials.gov 编号，NCT01613547。
