King Sarah, Marshak Anastasia, D'Mello-Guyett Lauren, Yakowenko Ellyn, Chabi Sherifath Mama, Samake Salimata, Bunkembo Magloire, Diarra Samou, Mohamud Feysal Abdisalan, Sheikh Omar Mohamed, Lamwaka Nancy Grace, Gose Mesfin, Ayoub Khamisa, Hersi Olad Ahmed, Bagayoko Aliou, Trehan Indi, Cumming Oliver, Stobaugh Heather
Action Against Hunger, New York, NY, USA; US Centers for Disease Control and Prevention, Atlanta, GA, USA.
Feinstein International Center, Tufts University, Boston, MA, USA.
Lancet Glob Health. 2025 Jan;13(1):e98-e111. doi: 10.1016/S2214-109X(24)00415-7.
Community-based management of acute malnutrition is an effective treatment model for severe acute malnutrition. However, sparse evidence exists on post-discharge outcomes and the sustainability of recovery. This study aimed to evaluate the risk and determinants of relapse following severe acute malnutrition recovery in high-burden settings.
This multi-country prospective cohort study followed children who had recovered from severe acute malnutrition and their non-malnourished peers in parallel for 6 months in Mali (nine sites), South Sudan (six sites), and Somalia (one site). Nutritional status was assessed by research staff at nutrition clinics monthly to obtain the proportion of children exposed to severe acute malnutrition who relapsed to acute malnutrition and the relative risk of developing acute malnutrition for exposed versus non-exposed (ie, previously non-malnourished) children. Exposed children were eligible if they had been discharged from community-based management of acute malnutrition programmes while aged 6-47 months. Non-exposed children were eligible if they had not had an episode of acute malnutrition in the previous year; non-exposed children were matched to exposed children by age, sex, and community. Acute malnutrition was defined as having a mid-upper arm circumference of less than 125 mm, a weight-for-height Z score of less than -2, or nutritional oedema. The primary outcome was the cumulative incidence of acute malnutrition at 6 months in the exposed and non-exposed cohorts. Relapse was defined as an episode of acute malnutrition among exposed children during the 6-month follow-up period.
Between April 9, 2021, and June 2, 2022, 2749 children were enrolled (1689 exposed and 1060 non-exposed). After 6 months, 30% (95% CI 25-34) of children previously exposed to severe acute malnutrition relapsed in Mali, 63% (95% CI 59-67) in South Sudan, and 22% (95% CI 19-25) in Somalia. Depending on the context, exposed children were 1·2-6·2 times more likely to have acute malnutrition compared with non-exposed children. Higher anthropometric measurements at discharge were protective against relapse; however, few other child-level or household-level factors at the time of discharge were associated with subsequent relapse. After discharge, children experiencing food insecurity or morbidity at time of follow-up were more likely to relapse than those who were not experiencing these factors.
Following severe acute malnutrition recovery, children have a significant risk of relapsing within 6 months, highlighting the particular vulnerability of this population. Although the community-based management of acute malnutrition model proves highly effective in saving lives, high relapse indicates the need for additional services during and following treatment to better sustain recovery.
The United States Agency for International Development.
基于社区的急性营养不良管理是治疗重度急性营养不良的有效模式。然而，关于出院后结局及康复可持续性的证据稀少。本研究旨在评估高负担地区重度急性营养不良康复后复发的风险及决定因素。
这项多国前瞻性队列研究在马里（9个地点）、南苏丹（6个地点）和索马里（1个地点）对从重度急性营养不良中康复的儿童及其非营养不良的同龄人进行了为期6个月的平行随访。营养诊所的研究人员每月评估营养状况，以得出曾患重度急性营养不良的儿童中复发为急性营养不良的比例，以及暴露组（即曾患急性营养不良）与非暴露组（即之前未患营养不良）儿童发生急性营养不良的相对风险。暴露组儿童若在6至47月龄时从基于社区的急性营养不良项目出院则符合入选标准。非暴露组儿童若在前一年未发生过急性营养不良发作则符合入选标准；非暴露组儿童按年龄、性别和社区与暴露组儿童匹配。急性营养不良的定义为上臂中部周长小于125毫米、身高别体重Z评分小于-2或有营养性水肿。主要结局是暴露组和非暴露组队列在6个月时急性营养不良的累积发病率。复发定义为暴露组儿童在6个月随访期内发生的急性营养不良发作。
在2021年4月9日至2022年6月2日期间，共纳入2749名儿童（1689名暴露组儿童和1060名非暴露组儿童）。6个月后，曾患重度急性营养不良的儿童中，马里的复发率为30%（95%CI 25-34），南苏丹为63%（95%CI 59-67），索马里为22%（95%CI 19-25）。根据具体情况，暴露组儿童发生急性营养不良的可能性是非暴露组儿童的1.2至6.2倍。出院时较高的人体测量值可预防复发；然而，出院时很少有其他儿童层面或家庭层面的因素与随后的复发相关。出院后，随访时经历粮食不安全或发病的儿童比未经历这些因素的儿童更易复发。
重度急性营养不良康复后，儿童在6个月内有显著的复发风险，突出了该人群的特殊脆弱性。尽管基于社区的急性营养不良管理模式在挽救生命方面证明非常有效，但高复发率表明在治疗期间及之后需要额外的服务，以更好地维持康复。
美国国际开发署
