Linear Growth During Treatment With a Simplified, Combined Protocol: Secondary Analyses of Severely Wasted Children 6-59 Months in the ComPAS Cluster Randomized Controlled Trial

Grace Heymsfield; Kevin Stephenson; Zachary Tausanovitch; André Briend; Marko Kerac; Heather Stobaugh; Jeanette Bailey; Suvi T Kangas

doi:10.1111/mcn.13771

Linear Growth During Treatment With a Simplified, Combined Protocol: Secondary Analyses of Severely Wasted Children 6-59 Months in the ComPAS Cluster Randomized Controlled Trial

Matern Child Nutr. 2024 Dec 2:e13771. doi: 10.1111/mcn.13771. Online ahead of print.

Authors

Grace Heymsfield¹, Kevin Stephenson², Zachary Tausanovitch¹, André Briend^{3

4}, Marko Kerac^{5

6}, Heather Stobaugh^{7

8}, Jeanette Bailey¹, Suvi T Kangas¹

Affiliations

¹ International Rescue Committee, New York City, New York, USA.
² Department of Medicine, Washington University School of Medicine in St. Louis, St. Louis, Missouri, USA.
³ Department of Nutrition, Exercise and Sports, Faculty of Science, University of Copenhagen, Copenhagen, Denmark.
⁴ Center for Child Health Research, Faculty of Medicine and Health Technology, Arvo Building, Tampere University, Tampere, Finland.
⁵ Department of Population Health, London School of Hygiene and Tropical Medicine, London, UK.
⁶ Centre for Maternal, Adolescent, Reproductive, & Child Health, London School of Hygiene & Tropical Medicine, London, UK.
⁷ Action Against Hunger, New York City, New York, USA.
⁸ Tufts University, Boston, Massachusetts, USA.

PMID: 39623520
DOI: 10.1111/mcn.13771

Abstract

A simplified, combined protocol treats children with moderate acute malnutrition (MAM), defined by mid-upper arm circumference (MUAC) of < 125 and ≥ 115 mm and no oedema, with 1 daily sachet of ready-to-use therapeutic food (RUTF) and those with severe acute malnutrition (SAM), defined by MUAC < 115 mm and/or oedema, with two daily sachets of RUTF. This protocol was previously shown to result in non-inferior recovery compared to standard treatment that used higher, weight-based RUTF dosing among children with SAM and ready-to-use supplementary food (RUSF) for MAM in a cluster-based randomised controlled trial in Kenya and South Sudan. We conducted a secondary analysis of this trial to compare linear growth among children admitted with MUAC < 115 mm. Linear and ponderal growth were calculated from admission to discharge and visualised using aggregate growth curves. HAZ change adjusted for admission characteristics was negative across the course of treatment but similar across arms [-0.21 ± 0.18 SE in the standard arm, -0.24 ± 0.18 SE in simplified; difference (95% confidence interval) 0.03 (-0.12, 0.18)]. The unadjusted mean ± SE linear growth velocity from admission to discharge was 1.8 ± 0.7 mm/week in the standard arm compared to 1.7 ± 0.7 mm/week in the simplified arm [difference = 0.09 (-0.36, 0.53)] and similar in adjusted analysis. MUAC and weight gain velocities were not significantly different by treatment arm. Reducing the RUTF dose prescribed to children during SAM treatment does not appear to affect linear growth or other growth velocities during treatment.

Keywords: Kenya; South Sudan; acute malnutrition; linear growth; secondary analyses.

Grants and funding

The ComPAS study was funded by the United States Agency for International Development Office of U.S. Foreign Disaster Assistance (https://www.usaid.gov/who-we-are/organization/bureaus/bureau-democracy-conflict-and-humanitarian-assistance/office-us), grant number AID-OFDA-G-14-00208 awarded to the International Rescue Committee, and the Children's Investment Fund Foundation (https://ciff.org/) grant reference title 'Reinventing community management of acute malnutrition' awarded to Action Against Hunger.