Predictors of time to recovery and non-response during outpatient treatment of severe acute malnutrition

被引:3
|
作者
Kangas, Suvi T. [1 ,2 ]
Salpeteur, Cecile [2 ]
Nikiema, Victor [3 ]
Ritz, Christian [1 ]
Friis, Henrik [1 ]
Briend, Andre [1 ,4 ]
Kaestel, Pernille [1 ]
机构
[1] Univ Copenhagen, Dept Nutr Exercise & Sports, Copenhagen, Denmark
[2] Act Hunger ACF, Expertise & Advocacy Dept, Paris, France
[3] Act Hunger ACF Mission Burkina Faso, Nutr & Hlth Dept, Paris, France
[4] Tampere Univ, Univ Tampere, Sch Med, Ctr Child Hlth Res, Tampere, Finland
来源
PLOS ONE | 2022年 / 17卷 / 05期
关键词
UNDERNUTRITION; MANAGEMENT; PROTOCOL; CHILDREN; INCOME; FOOD;
D O I
10.1371/journal.pone.0267538
中图分类号
O [数理科学和化学]; P [天文学、地球科学]; Q [生物科学]; N [自然科学总论];
学科分类号
07 ; 0710 ; 09 ;
摘要
Background Every year, over 4 million children are treated for severe acute malnutrition with varying program performance. This study sought to explore the predictors of time to recovery from and non-response to outpatient treatment of SAM. Methods Children with weight-for-height z-score (WHZ) <-3 and/or mid-upper arm circumference (MUAC) <115 mm, without medical complications were enrolled in a trial (called MANGO) from outpatient clinics in Burkina Faso. Treatment included a weekly ration of ready-to-use therapeutic foods. Recovery was declared with WHZ >=-2 and/or MUAC >= 125 mm, for two weeks without illness. Children not recovered by 16 weeks were considered as non-response to treatment. Predictors studied included admission characteristics, morbidity and compliance during treatment and household characteristics. Cox proportional hazard models were fitted and restricted mean time to recovery calculated. Logistic regression was used to analyse non-response to treatment. Results Fifty-five percent of children recovered and mean time to recovery was eight weeks while 13% ended as non-response to treatment. Independent predictors of longer time to recovery or non-response included low age, being admitted with WHZ < 3, no illness nor anaemia at admission, illness episodes during treatment, skipped or missed visits, low maternal age and not practising open defecation. Eighty-four percent of children had at least one and 59% at least two illness episodes during treatment. This increased treatment duration by 1 to 4 weeks. Thirty-five percent of children missed at least one treatment visit. One missed visit predicted 3 weeks longer and two or more missed visits 5 weeks longer treatment duration. Conclusions Both longer time to recovery and higher non-response to treatment seem most strongly associated with illness episodes and missed visits during treatment. This indicates that prevention of illnesses would be key to shortening the treatment duration and that there is a need to seek ways to facilitate adherence.
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页数:19
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