Follow-up of post-discharge growth and mortality after treatment for severe acute malnutrition (FuSAM study): a prospective cohort study.
Management of Severe Acute Malnutrition (SAM) plays a vital role in achieving global child survival targets. Effective treatment programmes are available but little is known about longer term outcomes following programme discharge.From July 2006 to March 2007, 1024 children (median age 21.5 months,...
Main Authors: | , , , , , , |
---|---|
Format: | Article |
Language: | English |
Published: |
Public Library of Science (PLoS)
2014-01-01
|
Series: | PLoS ONE |
Online Access: | http://europepmc.org/articles/PMC4043484?pdf=render |
id |
doaj-c60c410101064b7ba0749c1bba1e7de3 |
---|---|
record_format |
Article |
spelling |
doaj-c60c410101064b7ba0749c1bba1e7de32020-11-25T02:19:47ZengPublic Library of Science (PLoS)PLoS ONE1932-62032014-01-0196e9603010.1371/journal.pone.0096030Follow-up of post-discharge growth and mortality after treatment for severe acute malnutrition (FuSAM study): a prospective cohort study.Marko KeracJames BunnGeorge ChagalukaPaluku BahwereAndrew TomkinsSteve CollinsAndrew SealManagement of Severe Acute Malnutrition (SAM) plays a vital role in achieving global child survival targets. Effective treatment programmes are available but little is known about longer term outcomes following programme discharge.From July 2006 to March 2007, 1024 children (median age 21.5 months, IQR 15-32) contributed 1187 admission episodes to an inpatient-based SAM treatment centre in Blantyre, Malawi. Long term outcomes, were determined in a longitudinal cohort study, a year or more after initial programme discharge. We found information on 88%(899/1024).In total, 42%(427/1024) children died during or after treatment. 25%(105/427) of deaths occurred after normal programme discharge, >90 days after admission. Mortality was greatest among HIV seropositive children: 62%(274/445). Other risk factors included age <12 months; severity of malnutrition at admission; and disability. In survivors, weight-for-height and weight-for-age improved but height-for-age remained low, mean -2.97 z-scores (SD 1.3).Although SAM mortality in this setting was unacceptably high, our findings offer important lessons for future programming, policy and research. First is the need for improved programme evaluation: most routine reporting systems would have missed late deaths and underestimated total mortality due to SAM. Second, a more holistic view of SAM is needed: while treatment will always focus on nutritional interventions, it is vital to also identify and manage underlying clinical conditions such as HIV and disability. Finally early identification and treatment of SAM should be emphasised: our results suggest that this could improve longer term as well as short term outcomes. As international policy and programming becomes increasingly focused on stunting and post-malnutrition chronic disease outcomes, SAM should not be forgotten. Proactive prevention and treatment services are essential, not only to reduce mortality in the short term but also because they have potential to impact on longer term morbidity, growth and development of survivors.http://europepmc.org/articles/PMC4043484?pdf=render |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Marko Kerac James Bunn George Chagaluka Paluku Bahwere Andrew Tomkins Steve Collins Andrew Seal |
spellingShingle |
Marko Kerac James Bunn George Chagaluka Paluku Bahwere Andrew Tomkins Steve Collins Andrew Seal Follow-up of post-discharge growth and mortality after treatment for severe acute malnutrition (FuSAM study): a prospective cohort study. PLoS ONE |
author_facet |
Marko Kerac James Bunn George Chagaluka Paluku Bahwere Andrew Tomkins Steve Collins Andrew Seal |
author_sort |
Marko Kerac |
title |
Follow-up of post-discharge growth and mortality after treatment for severe acute malnutrition (FuSAM study): a prospective cohort study. |
title_short |
Follow-up of post-discharge growth and mortality after treatment for severe acute malnutrition (FuSAM study): a prospective cohort study. |
title_full |
Follow-up of post-discharge growth and mortality after treatment for severe acute malnutrition (FuSAM study): a prospective cohort study. |
title_fullStr |
Follow-up of post-discharge growth and mortality after treatment for severe acute malnutrition (FuSAM study): a prospective cohort study. |
title_full_unstemmed |
Follow-up of post-discharge growth and mortality after treatment for severe acute malnutrition (FuSAM study): a prospective cohort study. |
title_sort |
follow-up of post-discharge growth and mortality after treatment for severe acute malnutrition (fusam study): a prospective cohort study. |
publisher |
Public Library of Science (PLoS) |
series |
PLoS ONE |
issn |
1932-6203 |
publishDate |
2014-01-01 |
description |
Management of Severe Acute Malnutrition (SAM) plays a vital role in achieving global child survival targets. Effective treatment programmes are available but little is known about longer term outcomes following programme discharge.From July 2006 to March 2007, 1024 children (median age 21.5 months, IQR 15-32) contributed 1187 admission episodes to an inpatient-based SAM treatment centre in Blantyre, Malawi. Long term outcomes, were determined in a longitudinal cohort study, a year or more after initial programme discharge. We found information on 88%(899/1024).In total, 42%(427/1024) children died during or after treatment. 25%(105/427) of deaths occurred after normal programme discharge, >90 days after admission. Mortality was greatest among HIV seropositive children: 62%(274/445). Other risk factors included age <12 months; severity of malnutrition at admission; and disability. In survivors, weight-for-height and weight-for-age improved but height-for-age remained low, mean -2.97 z-scores (SD 1.3).Although SAM mortality in this setting was unacceptably high, our findings offer important lessons for future programming, policy and research. First is the need for improved programme evaluation: most routine reporting systems would have missed late deaths and underestimated total mortality due to SAM. Second, a more holistic view of SAM is needed: while treatment will always focus on nutritional interventions, it is vital to also identify and manage underlying clinical conditions such as HIV and disability. Finally early identification and treatment of SAM should be emphasised: our results suggest that this could improve longer term as well as short term outcomes. As international policy and programming becomes increasingly focused on stunting and post-malnutrition chronic disease outcomes, SAM should not be forgotten. Proactive prevention and treatment services are essential, not only to reduce mortality in the short term but also because they have potential to impact on longer term morbidity, growth and development of survivors. |
url |
http://europepmc.org/articles/PMC4043484?pdf=render |
work_keys_str_mv |
AT markokerac followupofpostdischargegrowthandmortalityaftertreatmentforsevereacutemalnutritionfusamstudyaprospectivecohortstudy AT jamesbunn followupofpostdischargegrowthandmortalityaftertreatmentforsevereacutemalnutritionfusamstudyaprospectivecohortstudy AT georgechagaluka followupofpostdischargegrowthandmortalityaftertreatmentforsevereacutemalnutritionfusamstudyaprospectivecohortstudy AT palukubahwere followupofpostdischargegrowthandmortalityaftertreatmentforsevereacutemalnutritionfusamstudyaprospectivecohortstudy AT andrewtomkins followupofpostdischargegrowthandmortalityaftertreatmentforsevereacutemalnutritionfusamstudyaprospectivecohortstudy AT stevecollins followupofpostdischargegrowthandmortalityaftertreatmentforsevereacutemalnutritionfusamstudyaprospectivecohortstudy AT andrewseal followupofpostdischargegrowthandmortalityaftertreatmentforsevereacutemalnutritionfusamstudyaprospectivecohortstudy |
_version_ |
1724874495679791104 |