Severe acute malnutrition and post-treatment outcomes among children in Uganda

Severe Acute Malnutrition (SAM) is reported to affect 19 million children under five years worldwide. About 5% of children younger than five years in Uganda are wasted and 2% of these children are said to be severely wasted. Community based management of Acute Malnutrition is endorsed by UN as the public health approach to treatment of SAM. Studies suggest that children who are previously cured of SAM remain at risk of relapse of SAM, morbidity, mortality and growth faltering. There is no systematic follow up and monitoring of children treated and discharged from SAM treatment. The shift from hospital based to community based SAM treatment requires estimation of SAM burden for planning purposes. The current guideline for estimating incidence rate is the use of a universal incidence correction factor multiplied by prevalence rate. This incidence rate is then use to estimate SAM burden. This approach could under- or overestimate SAM burden thus affecting effective programme planning because of context specific factors. The aim of this literature review is to highlight the challenges of the current guidelines for estimating SAM incidence and SAM burden and their implications for programme planning. This review elucidates the post-treatment outcomes among children aged 6-59 months and the long term effects of SAM treatment on children in developing countries. This review also highlights programmatic and research gaps if addressed would enhance the operational response to SAM in developing countries. Research method for this study was a literature review and content analysis. Published articles on SAM incidence, post-treatment outcomes estimation of SAM incidences and burden were identified on Pubmed, Google search, Google scholar and websites of the Nutrition field exchange networks like CMAM forum and ENN. Publications on WHO and UNICEF websites were also reviewed. Experts were contacted to identify published and unpublished references. The review found that HIV infection, discharge from treatment when not fully recovered, not fully vaccinated for age, low dietary intake of oil, seasonality of food insecurity and severity of SAM at admission increased risk of post-treatment relapse, death and morbidity. Children with history of SAM treatment had linear growth deficits, functional deficit of weaker hand grip and less able to perform an exercise test compared with their control. These children have a high risk of Non-Communicable Diseases. The literature also revealed no prospective studies have been conducted on SAM incidence; however few secondary analyses have been conducted to determine SAM incidence. A meta-analysis showed that incidence correction factor varied across three West African countries; thus the recommended incidence correction factor of 1.6 could not be generalised to every context. Context specific estimation of SAM burden is needed to address operational needs. The relationship between wasting and stunting and the indicative risk of NCD is a great concern which needs further investigations.