title: Admission profile and discharge outcomes for infants aged less than 6 months admitted to inpatient therapeutic care in 10 countries. A secondary data analysis.
abstract: Evidence on the management of acute malnutrition in infants aged less than 6 months (infants <6mo) is scarce. To understand outcomes using current protocols, we analysed a sample of 24 045 children aged 0-60 months from 21 datasets of inpatient therapeutic care programmes in 10 countries. We compared the proportion of admissions, the anthropometric profile at admission and the discharge outcomes between infants <6mo and children aged 6-60 months (older children). Infants <6mo accounted for 12% of admissions. The quality of anthropometric data at admission was more problematic in infants <6mo than in older children with a greater proportion of missing data (a 6.9 percentage point difference for length values, 95% CI: 6.0; 7.9, P < 0.01), anthropometric measures that could not be converted to indices (a 15.6 percentage point difference for weight-for-length z-score values, 95% CI: 14.3; 16.9, P < 0.01) and anthropometric indices that were flagged as outliers (a 2.7 percentage point difference for any anthropometric index being flagged as an outlier, 95% CI: 1.7; 3.8, P < 0.01). A high proportion of both infants <6mo and older children were discharged as recovered. Infants <6mo showed a greater risk of death during treatment (risk ratio 1.30, 95% CI: 1.09; 1.56, P < 0.01). Infants <6mo represent an important proportion of admissions to therapeutic feeding programmes, and there are crucial challenges associated with their care. Systematic compilation and analysis of routine data for infants <6mo is necessary for monitoring programme performance and should be promoted as a tool to monitor the impact of new guidelines on care.
authors.affiliation: UCL Institute for Global Health, 30 Guilford Street, London, WC1N 1EH, UK.
authors.forename: Carlos S
authors.identifier: 0000-0002-2461-9954
authors.initials: CS
authors.lastname: Grijalva-Eternod
authors.affiliation: Department of Population Health, London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT, UK.|Department of Epidemiology & Public Health, Leonard Cheshire Leonard Cheshire Disability and Inclusive Development Centre, 1-19 Torrington Place, London, WC1E 6BT, UK.
authors.forename: Marko
authors.initials: M
authors.lastname: Kerac
authors.affiliation: ENN, 32 Leopold Street, Oxford, OX4 1TW, UK.
authors.forename: Marie
authors.initials: M
authors.lastname: McGrath
authors.affiliation: Action Contre la Faim (at the time of data submission), 14/16 Boulevard Douaumont, CS 80060 75854, Paris Cedex 17, France.|United Nations High Commissioner for Refugees, Geneva, Switzerland.
authors.forename: Caroline
authors.initials: C
authors.lastname: Wilkinson
authors.affiliation: Action Contre la Faim, 14/16 Boulevard Douaumont, CS 80060 75854, Paris Cedex 17, France.
authors.forename: June C
authors.initials: JC
authors.lastname: Hirsch
authors.affiliation: Medical Department, Médecins Sans Frontières, 46, Rue de l'Arbre Bénit, 1050, Bruxelles, France.
authors.forename: Pascale
authors.initials: P
authors.lastname: Delchevalerie
authors.affiliation: UCL Institute for Global Health, 30 Guilford Street, London, WC1N 1EH, UK.
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Seal
mesh_terms: D000886:Anthropometry; D002675:Child, Preschool; D005260:Female; D006760:Hospitalization; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D015596:Nutrition Assessment; D009752:Nutritional Status; D010351:Patient Discharge; D000067011:Severe Acute Malnutrition / Q000628:therapy*; D016896:Treatment Outcome
keywords: anthropometry; infant and child nutrition; malnutrition; management of acute malnutrition; mortality; wasting