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Abstract
Aim To describe what proportion of acutely malnourished children, aged 0 to <60 months, admitted to receive care at therapeutic feeding programmes (TFP) are infants aged <6 months (hereafter young infants) and to compare their programme discharge outcomes with older children aged 6 to <60 months (hereafter children).
Methods A total of 33 programme databases, from 12 countries, collected between 2002 and 2008, with a total of 118 180 individuals (range 59–22 473 per data set), were obtained for analysis as part of the Management of Acute Malnutrition in Infants project. The authors excluded data from 93 511 individuals because they were either duplicates (1389), had age data missing or were ≥60 months (15 643), had sex data missing (15), had programme care type data missing (971) or did not received TFP care (75 493); leaving a final sample of 24 669 individuals. TFP treatment models included day centres (DC), home treatment (HT), stabilisation centres and therapeutic feeding centres.
Results Overall, young infants accounted for 16.2% (n=4002) of admissions, ranging from 10.2% to 26.4% in HT and DC programmes, respectively. Prevalence of oedematous malnutrition was lower in young infants than in children (p<0.001; see figure 1). Programme prevalence of oedema in young infants did not correlate with the prevalence of oedema in children. Comparing overall programme outcomes, 75.0% and 4.7% of young infants were discharged as “cured” or “died”, respectively; while for children were 74.0% and 4.0%, respectively. The risk of death varied by TFP model and was overall greater for young infants than for children (p<0.01; see figure 1).
Forest plots of the risk ratio of presenting oedema at admission and dying at discharge for young infants compared to children by TFP model. Square size is proportional to numbers of individuals within a given programme. DC, day centres; HT, home treatment; SC, stabilisation centres; TFC, therapeutic feeding centres.
Conclusions In this study, young infants account for an important proportion of TFP admissions for the treatment of acute malnutrition. Malnutrition profile differed to that in children, with significantly less oedema. Worse infant outcomes suggest the need to improve infant-specific management: neither infants nor children met SPHERE standards for cure (>80% programme cure). There were significantly more infant deaths. Future research is needed to determine whether our findings are representative of all acutely malnourished young infants.