Factors Associated With Failure to Respond to Treatment for Moderate Acute Malnutrition in Sierra Leone

OBJECTIVES: To assess factors associated with failure to respond to treatment for moderate acute malnutrition (MAM) while enrolled in a supplementary feeding program (SFP) in Pujehun District, Sierra Leone. METHODS: This was a secondary analysis of a cluster-randomized trial. The main study examined the cost-effectiveness of four specialized nutritious foods (SNFs) for treating MAM in children 6–59 months. Each SNF (Corn Soy Blend Plus, Corn Soy Whey Blend, Super Cereal Plus with Amylase, and Ready to Use Supplementary Food) was provided to caregivers in 14-day isocaloric rations for 12 weeks or until reaching an outcome. Outcomes were: Recovery (mid-upper arm circumference [MUAC]≥12.5cm), Failure (11.5 > MUAC < 12.5 after 12 weeks of treatment), severe acute malnutrition [SAM] (MUAC ≤ 11.5), Default (3 consecutive missed visits), or Death. Beneficiary caregivers provided standard demographic information at enrollment. Height, weight, and MUAC were taken every 14 days during a clinical visit as was information on illness (incidence of diarrhea, fever, cough, and vomit). Multinomial logistic regression assessed demographic and illnesses’ influence on the relative risk of Failure or developing SAM compared to Recovery. RESULTS: Of enrolled children (N = 2682), 1675 (63%) recovered, 498 (19%) worsened to SAM, and 259 (10%) failed to respond. In the 2 weeks prior to enrollment, more children who recovered experienced fever (30%), cough (23%), diarrhea (9%), or vomit (7%) than children who did not recover. By exit, a larger % of children who developed SAM reported fever (30%), cough (27%), diarrhea (16%), or vomit (10%) in the 2 preceding weeks than children who failed or recovered. In both adjusted and unadjusted models, children who entered the program with higher MUACs or reported any illness in the 2 weeks preceding enrollment were at significantly lower risk of worsening to SAM or failing to recover. Children who were transferred from a SAM treatment program were at significantly greater risk of worsening to SAM and failing to respond as were children with any illness in the 2 weeks preceding exit. CONCLUSIONS: Underlying infections or illness may explain why some children with MAM fail to recover. Illness at enrollment may signal a transitory condition remedied with treatment. FUNDING SOURCES: Bureau for Humanitarian Assistance, U.S. Agency for International Development.