Anthropometry at discharge and risk of relapse in children treated for severe acute malnutrition: a prospective cohort study in rural Nepal

Abstract

Background: There is a dearth of evidence on what should be the optimal criteria for discharging children from severe acute malnutrition (SAM) treatment. Programs discharging children while they are still presenting varying levels of weight-for-height (WHZ) or mid-upper-arm circumference (MUAC) deficits, such as those implemented under the current national protocol in Nepal, are opportunities to fill this evidence gap. Methods: We followed a cohort of children discharged as cured from SAM treatment in Parasi district, Nepal. Relapse as SAM, defined as the occurrence of WHZ < 115 mm or nutritional edema, was investigated through repeated home visits, during six months after discharge. We assessed the contribution of remaining anthropometric deficits at discharge to relapse risk through Cox regressions. Results: Relapse as SAM during follow-up was observed in 33 % of the cohort (35/108). Being discharged before reaching the internationally recommended criteria was overall associated with a large increase in the risk of relapse (HR = 3.3; p = 0.006). Among all anthropometric indicators at discharge, WHZ < 125 mm significantly raised it only in the older children. WHZ