Aims Effectively tackling severe acute malnutrition (SAM) is a global public health priority. Most treatment programmes report short-term outcomes at discharge. There is limited evidence about subsequent mortality and morbidity. The authors aimed to address this research gap by describing longer-term outcomes following SAM treatment.
Methods One year after discharge, the authors attempted to trace all survivors from a large urban, inpatient-based SAM treatment programme. 796/1024 (78%) had been enrolled in a probiotic randomised controlled trial which had no overall effect. Detailed baseline and follow-up data were available.
Results From July 2006 to March 2007, 1024 patients contributed to 1187 admission episodes for SAM treatment. 697/1024 (68.1%) had oedematous malnutrition. 459/1024 (45%) were known HIV seronegative, 445/1024 (43%) known seropositive. Long-term outcomes were determined for 899/1024 (88%). Mortality risk was greatest early in the programme: 238/1024 (23%) children died during initial inpatient treatment, 84/1024 (8%) in the subsequent 90 days and a further 105/1024 (10%) over the subsequent year. Preliminary Cox regression showed that HIV was strongly associated with mortality. Of the total 427 deaths, 274/427 (64%) were known seropositive but only 77/427 (18%) were known seronegative. Low admission weight-for-age, low admission weight-for-height were and age <12 months were also associated with mortality after adjusting for age, sex, height-for-age, mid-upper arm circumference, and admission oedema.
Initial treatment cure (reaching weight-for-height >80% of NCHS median) was associated with long-term survival. Of 471 initial cures, 372/471 (79%) were still alive at 1 year. Total known long-term programme survivors were 472/1024 (46%). At 1 year, mean weight-for-height z-score (WHZ) of those measured was −0.03 (SD 1.2, n=396) compared to baseline WHZ of −2.25 (SD1.3, n=976). Height-for-age (HAZ) remained low: HAZ −3.05 (SD 1.4) at 1 year compared to −3.23 (SD 1.4) at baseline. Putting these in context, mean WHZ of the oldest sibling in the family was −0.23 (SD 0.9, n=59) and HAZ −1.75 (SD 1.7, n=59).
Conclusions In this study, most children who were successfully cured in a SAM treatment programme remained alive 1 year after discharge. Overall mortality was however high. Community-based strategies could play an important role in earlier identification and treatment of high-risk children as well as longer-term support of children discharged from nutrition programmes.