How do the new WHO discharge criteria for the treatment of severe acute malnutrition affect the performance of therapeutic feeding programmes? New evidence from India

Abstract

Background/Objectives:To assesses how the introduction of new WHO discharge criteria for the treatment of severe acute malnutrition (SAM) may affect the performance of therapeutic feeding programmes in India.Subjects/Methods:The analysis concerns 6041 children admitted to Nutrition Rehabilitation Centers (NRCs) in Jharkhand, Madhya Pradesh and Uttar Pradesh between 1 July 2009 and 31 December 2011.Results:A total of 217 children (3.6%) had bilateral pitting oedema, 1803 (29.8%) had severe wasting with medical complications, 4021 (66.6%) had uncomplicated severe wasting and 4810 (79.7%) were in the age group 6-23 months old. The programme has high survival (>99%), default (≥15%) and discharge (>75%) rates. The use of weight gain ≥15% as recovery criteria (old criteria) translates into recovery rates in NRCs that range from 33.6% for children admitted with weight-for-height z-score (WHZ) ≤-3 to 35.2% for children admitted with mid-upper-arm circumference (MUAC) <115 mm. The use of WHZ ≥-2 as recovery criteria reduces recovery rates by ∼2-fold (17.5%) while the use of MUAC ≥125 mm as recovery criteria reduces recovery rates by 3.5-fold (10%). The new criteria tends to keep longer in the programme children who are younger and/or have poorer anthropometry at admission (that is, more vulnerable).Conclusions:The new WHO discharge criteria reduce the recovery rates currently reported by programmes for the treatment of children with SAM in India. However, their introduction in the programme practice will increase programme impact - particularly if accompanied by a general improvement in the strategy and protocols currently used - as they prioritize the most vulnerable children.