Follow-Up of Post-Discharge Growth and Mortality after Treatment for Severe Acute Malnutrition (FuSAM Study): A Prospective Cohort Study
Identifieur interne : 002960 ( Ncbi/Merge ); précédent : 002959; suivant : 002961Follow-Up of Post-Discharge Growth and Mortality after Treatment for Severe Acute Malnutrition (FuSAM Study): A Prospective Cohort Study
Auteurs : Marko Kerac [Royaume-Uni, Malawi] ; James Bunn [Malawi, Royaume-Uni] ; George Chagaluka [Malawi] ; Paluku Bahwere [Royaume-Uni, Belgique] ; Andrew Tomkins [Royaume-Uni] ; Steve Collins [Royaume-Uni] ; Andrew Seal [Royaume-Uni]Source :
- PLoS ONE [ 1932-6203 ] ; 2014.
Abstract
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:
DOI: 10.1371/journal.pone.0096030
PubMed: 24892281
PubMed Central: 4043484
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Kerac</name><affiliation wicri:level="3"><nlm:aff id="aff1"><addr-line>Valid International, Oxford, United Kingdom</addr-line></nlm:aff><country xml:lang="fr">Royaume-Uni</country><wicri:regionArea>Valid International, Oxford</wicri:regionArea><placeName><settlement type="city">Oxford</settlement><region type="country">Angleterre</region><region type="comté" nuts="2">Oxfordshire</region></placeName></affiliation><affiliation wicri:level="1"><nlm:aff id="aff2"><addr-line>Department of Paediatrics and Child Health, College of Medicine, Blantyre, Malawi</addr-line></nlm:aff><country xml:lang="fr">Malawi</country><wicri:regionArea>Department of Paediatrics and Child Health, College of Medicine, Blantyre</wicri:regionArea><wicri:noRegion>Blantyre</wicri:noRegion></affiliation><affiliation wicri:level="4"><nlm:aff id="aff3"><addr-line>Institute for Global Health, University College London, London, United Kingdom</addr-line></nlm:aff><country 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type="city">Londres</settlement></placeName><orgName type="university">University College de Londres</orgName></affiliation></author><author><name sortKey="Bunn, James" sort="Bunn, James" uniqKey="Bunn J" first="James" last="Bunn">James Bunn</name><affiliation wicri:level="1"><nlm:aff id="aff2"><addr-line>Department of Paediatrics and Child Health, College of Medicine, Blantyre, Malawi</addr-line></nlm:aff><country xml:lang="fr">Malawi</country><wicri:regionArea>Department of Paediatrics and Child Health, College of Medicine, Blantyre</wicri:regionArea><wicri:noRegion>Blantyre</wicri:noRegion></affiliation><affiliation wicri:level="1"><nlm:aff id="aff5"><addr-line>Liverpool School of Tropical Medicine, Liverpool, United Kingdom</addr-line></nlm:aff><country xml:lang="fr">Royaume-Uni</country><wicri:regionArea>Liverpool School of Tropical Medicine, Liverpool</wicri:regionArea><wicri:noRegion>Liverpool</wicri:noRegion></affiliation></author><author><name sortKey="Chagaluka, George" sort="Chagaluka, George" uniqKey="Chagaluka G" first="George" last="Chagaluka">George Chagaluka</name><affiliation wicri:level="1"><nlm:aff id="aff2"><addr-line>Department of Paediatrics and Child Health, College of Medicine, Blantyre, Malawi</addr-line></nlm:aff><country xml:lang="fr">Malawi</country><wicri:regionArea>Department of Paediatrics and Child Health, College of Medicine, Blantyre</wicri:regionArea><wicri:noRegion>Blantyre</wicri:noRegion></affiliation></author><author><name sortKey="Bahwere, Paluku" sort="Bahwere, Paluku" uniqKey="Bahwere P" first="Paluku" last="Bahwere">Paluku Bahwere</name><affiliation wicri:level="3"><nlm:aff id="aff1"><addr-line>Valid International, Oxford, United Kingdom</addr-line></nlm:aff><country xml:lang="fr">Royaume-Uni</country><wicri:regionArea>Valid International, Oxford</wicri:regionArea><placeName><settlement type="city">Oxford</settlement><region type="country">Angleterre</region><region type="comté" nuts="2">Oxfordshire</region></placeName></affiliation><affiliation wicri:level="3"><nlm:aff id="aff6"><addr-line>Centre of Research in Epidemiology, Biostatistics and Clinical Research, Free University of Brussels, Brussels, Belgium</addr-line></nlm:aff><country xml:lang="fr">Belgique</country><wicri:regionArea>Centre of Research in Epidemiology, Biostatistics and Clinical Research, Free University of Brussels, Brussels</wicri:regionArea><placeName><settlement type="city">Bruxelles</settlement><region nuts="2">Région de Bruxelles-Capitale</region></placeName></affiliation></author><author><name sortKey="Tomkins, Andrew" sort="Tomkins, Andrew" uniqKey="Tomkins A" first="Andrew" last="Tomkins">Andrew Tomkins</name><affiliation wicri:level="4"><nlm:aff id="aff3"><addr-line>Institute for Global Health, University College London, London, United Kingdom</addr-line></nlm:aff><country xml:lang="fr">Royaume-Uni</country><wicri:regionArea>Institute for Global Health, University College London, London</wicri:regionArea><placeName><settlement type="city">Londres</settlement><region type="country">Angleterre</region><region type="région" nuts="1">Grand Londres</region><settlement type="city">Londres</settlement></placeName><orgName type="university">University College de Londres</orgName></affiliation></author><author><name sortKey="Collins, Steve" sort="Collins, Steve" uniqKey="Collins S" first="Steve" last="Collins">Steve Collins</name><affiliation wicri:level="3"><nlm:aff id="aff1"><addr-line>Valid International, Oxford, United Kingdom</addr-line></nlm:aff><country xml:lang="fr">Royaume-Uni</country><wicri:regionArea>Valid International, Oxford</wicri:regionArea><placeName><settlement type="city">Oxford</settlement><region type="country">Angleterre</region><region type="comté" nuts="2">Oxfordshire</region></placeName></affiliation></author><author><name sortKey="Seal, Andrew" sort="Seal, Andrew" uniqKey="Seal A" first="Andrew" last="Seal">Andrew Seal</name><affiliation wicri:level="4"><nlm:aff id="aff3"><addr-line>Institute for Global Health, University College London, London, United Kingdom</addr-line></nlm:aff><country xml:lang="fr">Royaume-Uni</country><wicri:regionArea>Institute for Global Health, University College London, London</wicri:regionArea><placeName><settlement type="city">Londres</settlement><region type="country">Angleterre</region><region type="région" nuts="1">Grand Londres</region><settlement type="city">Londres</settlement></placeName><orgName type="university">University College de Londres</orgName></affiliation></author></analytic><series><title level="j">PLoS ONE</title><idno type="eISSN">1932-6203</idno><imprint><date when="2014">2014</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><sec><title>Background</title><p>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.</p></sec><sec><title>Methods</title><p>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).</p></sec><sec><title>Results</title><p>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).</p></sec><sec><title>Conclusions</title><p>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.</p></sec></div></front><back><div1 type="bibliography"><listBibl><biblStruct><analytic><author><name sortKey="Collins, S" uniqKey="Collins S">S Collins</name></author></analytic></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct><analytic><author><name sortKey="Black, Re" uniqKey="Black R">RE Black</name></author><author><name sortKey="Victora, Cg" uniqKey="Victora C">CG Victora</name></author><author><name sortKey="Walker, Sp" uniqKey="Walker S">SP Walker</name></author><author><name sortKey="Bhutta, Za" uniqKey="Bhutta Z">ZA Bhutta</name></author><author><name sortKey="Christian, P" uniqKey="Christian P">P Christian</name></author></analytic></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct><analytic><author><name sortKey="Collins, S" uniqKey="Collins S">S Collins</name></author><author><name sortKey="Sadler, K" uniqKey="Sadler K">K Sadler</name></author><author><name sortKey="Dent, N" uniqKey="Dent N">N Dent</name></author><author><name sortKey="Khara, T" uniqKey="Khara T">T Khara</name></author><author><name sortKey="Guerrero, S" uniqKey="Guerrero S">S Guerrero</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Bahwere, P" uniqKey="Bahwere P">P Bahwere</name></author><author><name sortKey="Mtimuni, A" uniqKey="Mtimuni A">A Mtimuni</name></author><author><name sortKey="Sadler, K" uniqKey="Sadler K">K Sadler</name></author><author><name sortKey="Banda, T" uniqKey="Banda T">T Banda</name></author><author><name sortKey="Collins, S" uniqKey="Collins S">S Collins</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Sadler, K" uniqKey="Sadler K">K Sadler</name></author><author><name sortKey="Kerac, M" uniqKey="Kerac M">M Kerac</name></author><author><name sortKey="Collins, S" uniqKey="Collins S">S Collins</name></author><author><name sortKey="Khengere, H" uniqKey="Khengere H">H Khengere</name></author><author><name sortKey="Nesbitt, A" uniqKey="Nesbitt A">A Nesbitt</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Kerac, M" uniqKey="Kerac M">M Kerac</name></author><author><name sortKey="Bunn, J" uniqKey="Bunn J">J Bunn</name></author><author><name sortKey="Seal, A" uniqKey="Seal A">A Seal</name></author><author><name sortKey="Thindwa, M" uniqKey="Thindwa M">M Thindwa</name></author><author><name sortKey="Tomkins, A" uniqKey="Tomkins A">A Tomkins</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Collins, S" uniqKey="Collins S">S Collins</name></author><author><name sortKey="Yates, R" uniqKey="Yates R">R Yates</name></author></analytic></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct><analytic><author><name sortKey="De Onis, M" uniqKey="De Onis M">M de Onis</name></author><author><name sortKey="Onyango, Aw" uniqKey="Onyango A">AW Onyango</name></author><author><name sortKey="Van Den Broeck, J" uniqKey="Van Den Broeck J">J Van den Broeck</name></author><author><name sortKey="Chumlea, Wc" uniqKey="Chumlea W">WC Chumlea</name></author><author><name sortKey="Martorell, R" uniqKey="Martorell R">R Martorell</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Pocock, Sj" uniqKey="Pocock S">SJ Pocock</name></author><author><name sortKey="Clayton, Tc" uniqKey="Clayton T">TC Clayton</name></author><author><name sortKey="Altman, Dg" uniqKey="Altman D">DG Altman</name></author></analytic></biblStruct><biblStruct></biblStruct><biblStruct><analytic><author><name sortKey="De Onis, M" uniqKey="De Onis M">M de Onis</name></author><author><name sortKey="Garza, C" uniqKey="Garza C">C Garza</name></author><author><name sortKey="Onyango, Aw" uniqKey="Onyango A">AW Onyango</name></author><author><name sortKey="Rolland Cachera, Mf" uniqKey="Rolland Cachera M">MF Rolland-Cachera</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Fergusson, P" uniqKey="Fergusson P">P Fergusson</name></author><author><name sortKey="Tomkins, A" uniqKey="Tomkins A">A Tomkins</name></author><author><name sortKey="Kerac, M" uniqKey="Kerac M">M Kerac</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Thurstans, S" uniqKey="Thurstans S">S Thurstans</name></author><author><name sortKey="Kerac, M" uniqKey="Kerac M">M Kerac</name></author><author><name sortKey="Maleta, K" uniqKey="Maleta K">K Maleta</name></author><author><name sortKey="Banda, T" uniqKey="Banda T">T Banda</name></author><author><name sortKey="Nesbitt, A" uniqKey="Nesbitt A">A Nesbitt</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Groce, Ne" uniqKey="Groce N">NE Groce</name></author><author><name sortKey="Kerac, M" uniqKey="Kerac M">M Kerac</name></author><author><name sortKey="Farkas, A" uniqKey="Farkas A">A Farkas</name></author><author><name sortKey="Schultink, W" uniqKey="Schultink W">W Schultink</name></author><author><name sortKey="Bieler, Rb" uniqKey="Bieler R">RB Bieler</name></author></analytic></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct><analytic><author><name sortKey="Victora, Cg" uniqKey="Victora C">CG Victora</name></author><author><name sortKey="De Onis, M" uniqKey="De Onis M">M de Onis</name></author><author><name sortKey="Hallal, Pc" uniqKey="Hallal P">PC Hallal</name></author><author><name sortKey="Blossner, M" uniqKey="Blossner M">M Blossner</name></author><author><name sortKey="Shrimpton, R" uniqKey="Shrimpton R">R Shrimpton</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Stettler, N" uniqKey="Stettler N">N Stettler</name></author><author><name sortKey="Iotova, V" uniqKey="Iotova V">V Iotova</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Dulloo, Ag" uniqKey="Dulloo A">AG Dulloo</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Fergusson, P" uniqKey="Fergusson P">P Fergusson</name></author><author><name sortKey="Tomkins, A" uniqKey="Tomkins A">A Tomkins</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Pecoul, B" uniqKey="Pecoul B">B Pecoul</name></author><author><name sortKey="Soutif, C" uniqKey="Soutif C">C Soutif</name></author><author><name sortKey="Hounkpevi, M" uniqKey="Hounkpevi M">M Hounkpevi</name></author><author><name sortKey="Ducos, M" uniqKey="Ducos M">M Ducos</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Hennart, P" uniqKey="Hennart P">P Hennart</name></author><author><name sortKey="Beghin, D" uniqKey="Beghin D">D Beghin</name></author><author><name sortKey="Bossuyt, M" uniqKey="Bossuyt M">M Bossuyt</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Van Roosmalen Wiebenga, Mw" uniqKey="Van Roosmalen Wiebenga M">MW van Roosmalen-Wiebenga</name></author><author><name sortKey="Kusin, Ja" uniqKey="Kusin J">JA Kusin</name></author><author><name sortKey="De With, C" uniqKey="De With C">C de With</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Perra, A" uniqKey="Perra A">A Perra</name></author><author><name sortKey="Costello, Am" uniqKey="Costello A">AM Costello</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Bahwere, P" uniqKey="Bahwere P">P Bahwere</name></author><author><name sortKey="Piwoz, E" uniqKey="Piwoz E">E Piwoz</name></author><author><name sortKey="Joshua, Mc" uniqKey="Joshua M">MC Joshua</name></author><author><name sortKey="Sadler, K" uniqKey="Sadler K">K Sadler</name></author><author><name sortKey="Grobler Tanner, Ch" uniqKey="Grobler Tanner C">CH Grobler-Tanner</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Collins, S" uniqKey="Collins S">S Collins</name></author></analytic></biblStruct><biblStruct></biblStruct></listBibl></div1></back></TEI><pmc article-type="research-article"><pmc-dir>properties open_access</pmc-dir>
<front><journal-meta><journal-id journal-id-type="nlm-ta">PLoS One</journal-id><journal-id journal-id-type="iso-abbrev">PLoS ONE</journal-id><journal-id journal-id-type="publisher-id">plos</journal-id><journal-id journal-id-type="pmc">plosone</journal-id><journal-title-group><journal-title>PLoS ONE</journal-title></journal-title-group><issn pub-type="epub">1932-6203</issn><publisher><publisher-name>Public Library of Science</publisher-name><publisher-loc>San Francisco, USA</publisher-loc></publisher></journal-meta><article-meta><article-id pub-id-type="pmid">24892281</article-id><article-id pub-id-type="pmc">4043484</article-id><article-id pub-id-type="publisher-id">PONE-D-13-30322</article-id><article-id pub-id-type="doi">10.1371/journal.pone.0096030</article-id><article-categories><subj-group subj-group-type="heading"><subject>Research Article</subject></subj-group><subj-group subj-group-type="Discipline-v2"><subject>Biology and Life Sciences</subject><subj-group><subject>Nutrition</subject><subj-group><subject>Malnutrition</subject></subj-group></subj-group></subj-group><subj-group subj-group-type="Discipline-v2"><subject>Medicine and Health Sciences</subject><subj-group><subject>Health Care</subject><subj-group><subject>Health Care Policy</subject><subj-group><subject>Health Systems Strengthening</subject></subj-group></subj-group><subj-group><subject>Socioeconomic Aspects of Health</subject></subj-group></subj-group><subj-group><subject>Pediatrics</subject><subj-group><subject>Child Development</subject><subj-group><subject>Child Growth</subject><subj-group><subject>Growth Restriction</subject></subj-group></subj-group></subj-group></subj-group><subj-group><subject>Public and Occupational Health</subject><subj-group><subject>Behavioral and Social Aspects of Health</subject><subject>Global Health</subject></subj-group></subj-group></subj-group><subj-group subj-group-type="Discipline-v2"><subject>Research and Analysis Methods</subject><subj-group><subject>Research Design</subject><subj-group><subject>Clinical Research Design</subject><subject>Cohort Studies</subject><subject>Longitudinal Studies</subject><subject>Observational Studies</subject></subj-group></subj-group></subj-group></article-categories><title-group><article-title>Follow-Up of Post-Discharge Growth and Mortality after Treatment for Severe Acute Malnutrition (FuSAM Study): A Prospective Cohort Study</article-title><alt-title alt-title-type="running-head">Follow-Up after Treatment for Severe Acute Malnutrition</alt-title></title-group><contrib-group><contrib contrib-type="author"><name><surname>Kerac</surname><given-names>Marko</given-names></name><xref ref-type="aff" rid="aff1"><sup>1</sup></xref><xref ref-type="aff" rid="aff2"><sup>2</sup></xref><xref ref-type="aff" rid="aff3"><sup>3</sup></xref><xref ref-type="aff" rid="aff4"><sup>4</sup></xref><xref ref-type="corresp" rid="cor1"><sup>*</sup></xref></contrib><contrib contrib-type="author"><name><surname>Bunn</surname><given-names>James</given-names></name><xref ref-type="aff" rid="aff2"><sup>2</sup></xref><xref ref-type="aff" rid="aff5"><sup>5</sup></xref></contrib><contrib contrib-type="author"><name><surname>Chagaluka</surname><given-names>George</given-names></name><xref ref-type="aff" rid="aff2"><sup>2</sup></xref></contrib><contrib contrib-type="author"><name><surname>Bahwere</surname><given-names>Paluku</given-names></name><xref ref-type="aff" rid="aff1"><sup>1</sup></xref><xref ref-type="aff" rid="aff6"><sup>6</sup></xref></contrib><contrib contrib-type="author"><name><surname>Tomkins</surname><given-names>Andrew</given-names></name><xref ref-type="aff" rid="aff3"><sup>3</sup></xref></contrib><contrib contrib-type="author"><name><surname>Collins</surname><given-names>Steve</given-names></name><xref ref-type="aff" rid="aff1"><sup>1</sup></xref></contrib><contrib contrib-type="author"><name><surname>Seal</surname><given-names>Andrew</given-names></name><xref ref-type="aff" rid="aff3"><sup>3</sup></xref></contrib></contrib-group><aff id="aff1"><label>1</label><addr-line>Valid International, Oxford, United Kingdom</addr-line></aff><aff id="aff2"><label>2</label><addr-line>Department of Paediatrics and Child Health, College of Medicine, Blantyre, Malawi</addr-line></aff><aff id="aff3"><label>3</label><addr-line>Institute for Global Health, University College London, London, United Kingdom</addr-line></aff><aff id="aff4"><label>4</label><addr-line>Leonard Cheshire Disability and Inclusive Development Centre, University College London, London, United Kingdom</addr-line></aff><aff id="aff5"><label>5</label><addr-line>Liverpool School of Tropical Medicine, Liverpool, United Kingdom</addr-line></aff><aff id="aff6"><label>6</label><addr-line>Centre of Research in Epidemiology, Biostatistics and Clinical Research, Free University of Brussels, Brussels, Belgium</addr-line></aff><contrib-group><contrib contrib-type="editor"><name><surname>Bejon</surname><given-names>Philip</given-names></name><role>Editor</role><xref ref-type="aff" rid="edit1"></xref></contrib></contrib-group><aff id="edit1"><addr-line>Kenya Medical Research Institute (KEMRI), Kenya</addr-line></aff><author-notes><corresp id="cor1">* E-mail: <email>marko.kerac@gmail.com</email></corresp><fn fn-type="conflict"><p><bold>Competing Interests: </bold>Valid International (PB - current; SC - current; MK 2005-2008) provides consultancy services on the rollout of Community-based Management of Acute Malnutrition. All other authors have declared that no competing interests exist. At the time of the study, PB and MK (part time, till 2008 only) were employees of Valid International. SC is the unpaid director of Valid Nutrition. Valid International is the sister company of Valid Nutrition that promotes the development and promotion of RUTF. This does not alter our adherence to all the PLoS ONE policies on sharing data and materials.</p></fn><fn fn-type="con"><p>Conceived and designed the experiments: MK JB GC. Performed the experiments: MK JB GC. Analyzed the data: MK JB AS. Wrote the paper: MK JB GC PB SC AT AS. Substantial contribution to interpretation of data: MK JB GC PB SC AT AS. Revised the article critically for important intellectual content: MK JB GC PB SC AT AS. Final approval of the version to be published: MK JB GC PB SC AT AS.</p></fn></author-notes><pub-date pub-type="collection"><year>2014</year></pub-date><pub-date pub-type="epub"><day>3</day><month>6</month><year>2014</year></pub-date><volume>9</volume><issue>6</issue><elocation-id>e96030</elocation-id><history><date date-type="received"><day>23</day><month>7</month><year>2013</year></date><date date-type="accepted"><day>3</day><month>4</month><year>2014</year></date></history><permissions><copyright-year>2014</copyright-year><copyright-holder>Kerac et al</copyright-holder><license><license-p>This is an open-access article distributed under the terms of the <ext-link ext-link-type="uri" xlink:href="http://creativecommons.org/licenses/by/4.0/">Creative Commons Attribution License</ext-link>, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.</license-p></license></permissions><abstract><sec><title>Background</title><p>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.</p></sec><sec><title>Methods</title><p>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).</p></sec><sec><title>Results</title><p>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).</p></sec><sec><title>Conclusions</title><p>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.</p></sec></abstract><funding-group><funding-statement>UNICEF Malawi funded this study. Valid International provided support in the form of salaries for authors MK (from end 2005 to Jan 2008 only - the ‘baseline’ period of this study) PB, and SC but did not have any additional role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript. The specific roles of these authors are articulated in the ‘author contributions’ section. MK gratefully acknowledges NIHR for funding his current UCL Academic Clinical Lecturer post.</funding-statement></funding-group><counts><page-count count="10"></page-count></counts></article-meta></front></pmc><affiliations><list><country><li>Belgique</li><li>Malawi</li><li>Royaume-Uni</li></country><region><li>Angleterre</li><li>Grand Londres</li><li>Oxfordshire</li><li>Région de Bruxelles-Capitale</li></region><settlement><li>Bruxelles</li><li>Londres</li><li>Oxford</li></settlement><orgName><li>University College de Londres</li></orgName></list><tree><country name="Royaume-Uni"><region name="Angleterre"><name sortKey="Kerac, Marko" sort="Kerac, Marko" uniqKey="Kerac M" first="Marko" last="Kerac">Marko Kerac</name></region><name sortKey="Bahwere, Paluku" sort="Bahwere, Paluku" uniqKey="Bahwere P" first="Paluku" last="Bahwere">Paluku Bahwere</name><name sortKey="Bunn, James" sort="Bunn, James" uniqKey="Bunn J" first="James" last="Bunn">James Bunn</name><name sortKey="Collins, Steve" sort="Collins, Steve" uniqKey="Collins S" first="Steve" last="Collins">Steve Collins</name><name sortKey="Kerac, Marko" sort="Kerac, Marko" uniqKey="Kerac M" first="Marko" last="Kerac">Marko Kerac</name><name sortKey="Kerac, Marko" sort="Kerac, Marko" uniqKey="Kerac M" first="Marko" last="Kerac">Marko Kerac</name><name sortKey="Seal, Andrew" sort="Seal, Andrew" uniqKey="Seal A" first="Andrew" last="Seal">Andrew Seal</name><name sortKey="Tomkins, Andrew" sort="Tomkins, Andrew" uniqKey="Tomkins A" first="Andrew" last="Tomkins">Andrew Tomkins</name></country><country name="Malawi"><noRegion><name sortKey="Kerac, Marko" sort="Kerac, Marko" uniqKey="Kerac M" first="Marko" last="Kerac">Marko Kerac</name></noRegion><name sortKey="Bunn, James" sort="Bunn, James" uniqKey="Bunn J" first="James" last="Bunn">James Bunn</name><name sortKey="Chagaluka, George" sort="Chagaluka, George" uniqKey="Chagaluka G" first="George" last="Chagaluka">George Chagaluka</name></country><country name="Belgique"><region name="Région de Bruxelles-Capitale"><name sortKey="Bahwere, Paluku" sort="Bahwere, Paluku" uniqKey="Bahwere P" first="Paluku" last="Bahwere">Paluku Bahwere</name></region></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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