Abstract
Objective
To evaluate recovery and survival of severely wasted children without community management of acute malnutrition programme.
Design
Single time point follow-up (24th December 2013–2nd April, 2014) of severely wasted children identified in a communitybased cross-sectional survey (September 2012–October 2013).
Setting
Rural Meerut District, Uttar Pradesh, India.
Participants
409 severely wasted (WHO weight-for-height <-3Z), 6- to 59-month-old children.
Outcome measures
Survival and recovery (weight-for-height ≥- 2Z).
Results
Median (IQR) follow-up contact duration was 7.4 (6.6, 10.1) months. Among 11 deaths, there were 5 (case-fatality 1.2%), 6 (1.5%), 8 (2.0%) and 10 (2.4%) events within 1, 1.5, 4 and 6 months of enrolment, respectively. Ten deaths occurred in children aged between 6 and 24 months. Younger age (P=0.04), poorer household-head occupation (P=0.04) and lower enrolment anthropometry (any variable; P<0.001) were significant predictors of mortality. Children below 18 months of age had higher adjusted mortality risk (HR 4.7; 95% CI 0.95, 22.51; P=0.053). At follow-up, 30% of survivors were still severely wasted, 39% were moderately wasted (weight-for-height −3 to <−2Z) and 31% had recovered spontaneously. Younger age (P<0.001), female gender (P=0.04) and longer follow-up duration (P=0.003) were significant independent predictors of recovery. The adjusted OR (95% CI) for recovery <24 months was 2.81 (1.70, 4.65).
Conclusions
Without community management of acute malnutrition in rural Meerut District, severely wasted children had low (1.2%–2.7%) case-fatality with long-term spontaneous recovery of around 25–30%.
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Sachdev, H.S., Sinha, S., Sareen, N. et al. Survival and recovery in severely wasted under-five children without community management of acute malnutrition programme. Indian Pediatr 54, 817–824 (2017). https://doi.org/10.1007/s13312-017-1142-y
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DOI: https://doi.org/10.1007/s13312-017-1142-y