Moderate Acute Malnutrition Treatment among Children 6-23 Months and 24-59 Months Aged

Full text: The prevalence of acute malnutrition in Mali has slightly decreased between 2012 and 2013 in southern areas from 8.9 to 8.6 percent.The youngest children 6-23 months are seriously affected as 12.6% according the SMART nutrition survey in 2013. The aim of this study was to show how seasonality impacts relapse rates among youngest moderately malnourished children aged 6-23 month compare to 24-59 months. The World Food Programme in Mali set up Targeted Supplementary Feeding Programme (TSFP) in 1032 community health facilities to address the burden of MAM. This TSFP includes treatment of MAM with 92g of Plumpy'SupTM per days during 60 days. The entry criteria according to national protocol was Mid Upper Arm Circumference less than 125mm (MUAC<125mm) and Weight for Height Z-Score less than -2 (WHZ<-2). The exit criteria is according the same parameter MUAC> = 125 mm or WHZ > = -1.5 during two consecutives visits. In addition, the programme is accompanied with community based activities such as active screening and culinary demonstration for women groups and sensitization. As a result, after 10 months of implementation, 41604 children 6-23 months aged have been admitted for MAM treatment. This represents 82% of total estimated caseload in this group (50666). During the same period, only 14% (14473) of total estimated caseload (101333) in children 24-59 months aged group have been admitted and treated. Although 74% (41604) of total admission (56077 children 6-59 months) was 6-23 months aged ,the programme performance indicators show that children 24-59 respond better to the treatment compared to 6-23 months: Average recovery rate 88% vs 87%; death rate 0.55% vs 1.07% none response 0.21% vs 0.50%. Only, the defaulter rate was higher in 24-59, 10.21% vs 7.5%. Nevertheless, compared two Sphere performance norms and threshold, the programme is fully satisfactory in all categories. The seasonal analysis shows that the highest admission in MAM programme was registered between April and September in all categories. 79% of the total caseload has been admitted during this period which corresponds to lean season considering the bad agricultural campaign registered in previous years. Furthermore, 74% of 936 reentries (relapse) have been observed in this period. It's important to notice that 86% of registered relapse was children 6-23 months aged. The death rate in the pic of lean season (July-September) among 6-23 month reach 4% which higher than the acceptable threshold fixed by sphere under 3%, confirming the criticality of nutritional situation of children in this category. According these results, the moderate acute malnutrition is crucial among 6-23 month and that the duration of treatment need to be sustained by continuing preventive programme among 6-23 months to ensure that relapse is controlled during the lean season and reduce mortality burden. This will guarantee the best growth for children in an important part of their lives: the 1000 days and reduce subsequent burden of stunting. (author)