Seasonal effect and long-term nutritional status following exit from a Community-Based Management of Severe Acute Malnutrition program in Bihar, India.
OBJECTIVE
Children aged 6 months to 5 years completing treatment for severe acute malnutrition (SAM) in a Médecins Sans Frontières Community Management of Acute Malnutrition (CMAM) program in Bihar, India, showed high cure rates; however, the program suffered default rates of 38%. This report describes the nutritional status of 1956 children followed up between 3 and 18 months after exiting the program.


METHODS
All children aged 6-59 months discharged as cured with mid-upper arm circumference (MUAC) ⩾120 mm or who defaulted from the program with MUAC <115 mm were traced at 3, 6, 9, 12 and 18 months (±10 days) before three exit reference dates: first at the end of the food insecure period, second after the 2-month food security and third after the 4-month food security.


RESULTS
Overall, 68.7% (n=692) of defaulters and 76.2% (n=1264) of children discharged as cured were traced. Combined rates of non-recovery in children who defaulted with MUAC <115 mm were 41%, 30.1%, 9.9%, 6.1% and 3.6% at 3, 6, 9, 12 and 18 months following exit, respectively. Combined rates of relapse among cured cases (MUAC ⩾120 mm) were 9.1%, 2.9%, 2.1%, 2.8% and 0% at 3, 6, 9, 12 and 18 months following discharge, respectively. Prevalence of undernutrition increased substantially for both groups traced during low food security periods. Odds of death were much higher for children defaulting with MUAC <110 mm when compared with children discharged as cured, who shared the same mortality risk as those defaulting with MUAC 110-<115 mm.


CONCLUSIONS
Seasonal food security predicted short-term nutritional status after exit, with relapse rates and non-recovery from SAM much higher during food insecurity. Mortality outcomes suggest that a MUAC of 110 mm may be considered an appropriate admission point for SAM treatment programs in this context.
Médecins Sans Frontières, New Delhi, India.
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http://orcid.org/0000-0001-7886-8633
S
Burza
Médecins Sans Frontières, New Delhi, India.
R
R
Mahajan
Médecins Sans Frontières, New Delhi, India.
E
E
Marino
Médecins Sans Frontières, New Delhi, India.
T
T
Sunyoto
Médecins Sans Frontières, New Delhi, India.
C
C
Shandilya
Médecins Sans Frontières, New Delhi, India.
M
M
Tabrez
Médecins Sans Frontières, New Delhi, India.
K
K
Kumar
Médecins Sans Frontières, New Delhi, India.
A
A
Jha
Médecins Sans Frontières, New Delhi, India.
P
P
Mathew
Médecins Sans Frontières, Barcelona, Spain.
N
N
Salse
Médecins Sans Frontières, Barcelona, Spain.
C
C
Casademont
Department of Paediatrics, Darbhangha Medical College Hospital (DMCH), Darbhangha, India.
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NK
Mishra
D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D005523:Food Supply; D006760:Hospitalization; D006801:Humans; D007194:India / Q000453:epidemiology; D007223:Infant; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D009752:Nutritional Status; D015995:Prevalence; D012621:Seasons; D000067011:Severe Acute Malnutrition / Q000453:epidemiology* / Q000628:therapy*; D016896:Treatment Outcome