Duration of episodes of untreated Acute Malnutrition in children 6–59 months as observed during monthly growth monitoring sessions in South of Bangladesh

Full text: Background: Planning for management of severe and moderate acute malnutrition programs requires estimation of the caseload of children in need of care. Since incidence of acute malnutrition is not readily available, estimate of caseload is often derived from survey prevalence and the estimated duration of untreated episodes of acute malnutrition. However, information on the duration of acute malnutrition is limited. Sufficient guidance has not been given to planners on how to translate wasting prevalence rates into the probable caseload of a program based on Mid Upper Arm Circumference for admission. Objective: To report the duration of acute malnutrition in children 6 – 59 months as observed during community growth monitoring in the south of Bangladesh. Methodology: The study design was retrospective cohort using administrative data from Terre des hommes' monthly Growth Monitoring Program in Patharghata Union of Barguna District in absence of any community management. Monitoring data were available between November 2011 and December 2012 for 3340 children and on average, 1766 children were measured each month. Of these children only 585 had observations for every time point. During analysis two models were run, one which imputed missing observations based on status before and after the missing observation and one utilizing complete records. Case definition: Based on the World Health Organization's threshold for weight-for-height z-scores and MUAC, the duration of acute malnutrition began when children were identified with acute malnutrition The duration of acute malnutrition ended when children were not identified as suffering with acute malnutrition at any monthly visit. Episodes of acute malnutrition observed during the first and last periods of growth monitoring were excluded from the estimation of duration. Results: The prevalence of global acute malnutrition varied over the year, with a peak in June/July (29.7% & 29.0%) and a low in December/January (15.6% & 15.1%). The overall prevalence rate during the period was 22.4% for global acute malnutrition(GAM) and 3.9% for severe acute malnutrition(SAM). During the period 438 new episodes of severe and 1502 new episodes of moderate acute malnutrition (MAM) were identified for a total of 1600 new episodes. Of the 921 cases of MAM which were completely contained within the period, only 4.7% continued to degrade into a severe episode (SAM) within the next 1 to 6 months. For the cases of MAM which did not degrade into SAM, the duration of MAM for majority of children (65%) was only one month. In total, 80.5% of children recovered within 2 months and 92.9% within 4 months. Discussion: Because only one year of data was available, periods of acute malnutrition greater than one year in duration were not included in this analysis which may have shortened the duration observed. In absence of any feeding programme, counseling to the child's caregiver was provided and this may have shortened the duration observed. The observed duration of episode of acute malnutrition would assist a great deal in estimation of caseload and manage resources accordingly. (author)