Treatment of severe and moderate acute malnutrition in low- and middle-income settings
Community-based treatment is backed by substantive programmatic evidence; however, there are clear gaps in the availability of well-designed studies evaluating the effectiveness of interventions to manage severe acute malnutrition (SAM) and moderate acute malnutrition (MAM) in a range of contexts. To close the gap between research and practice, further studies are needed that compare approaches to managing SAM and MAM, taking local context into consideration.
SAM and MAM affect around fifty-two million children under five, globally. World Health Organization (WHO) protocol for inpatient management and community-based management with ready-to-use-therapeutic food (RUTF) have become much utilized interventions for the treatment of SAM and MAM. This review aimed to assess the effectiveness of these interventions, through meta-analysis and a Delphi process. Fourteen studies were included in the meta-analysis quality was assessed using CHERG adaptation of GRADE criteria. A Delphi process was undertaken to complement the systematic review. Results showed case fatality rates for inpatient treatment of SAM using the WHO protocol ranged from 3.4% to 35%. For community-based treatment of SAM, children given RUTF were 51% more likely to achieve nutritional recovery than the standard care group. For the treatment of MAM, children in the RUSF group were significantly more likely to recover. Weight gain in the intervention group was higher overall. Heterogeneity in many outcomes and an inability to separate intervention effects and commodity effects, led to analysis limitations. The Delphi process showed that adhering to standardized protocols for the treatment of SAM and MAM, should improve mortality and recovery rates, however no concrete conclusion on this was reached.