The effectiveness of interventions to treat severe acute malnutrition in young children
Further research is required on most aspects of the management of severe acute malnutrition (SAM) in children < 5 years, including intravenous resuscitation regimens for shock, management of subgroups (e.g. infants < 6 months old, infants and children with SAM who are human immunodeficiency virus sero-positive) and on the use of antibiotics.
SAM can occur following sudden food shortage and has been associated with loss of body fat and skeletal muscle wasting. To date, different forms of intervention and treatments for SAM still result in high levels of mortality and morbidity. This review aimed to assess the effectiveness of interventions treating SAM in children aged < 5. Seventy-four articles were included for review, assessed and checked for quality by two authors. Results showed hypo-osmolar oral rehydration solution (H-ORS) benefited children with acute diarrhea, compared with the standard World Health Organization-oral rehydration solution (WHO- ORS), no significant difference was observed between the results of using WHO- ORS and rehydration solution for malnutrition (ReSoMal). Rice-based ORS was more beneficial than glucose-based ORS. WHO-ORS plus zinc had favorable outcomes on treatment of diarrhea. When treating infection in children with persistent diarrhea, no significant effect on recovery was found for amoxicillin, nor ceftriaxone when compared to no antibiotic provision. Inpatient treatment for SAM was considered as effective as treatment in home, or other settings. Many trials evaluated the effects of zinc on treating SAM but no firm conclusion was reached. Limited evidence was obtained regarding supplementary potassium or nicotinic acid and nucleotides. No evidence was found relating to treatment of children with SAM who were human immunodeficiency virus sero-positive, nor for SAM in infants < 6 months old. No evidence was found in relation to long-term survival, readmission rates, clinical effectiveness of management strategies for treating children with comorbidities, nor for program sustainability. Key questions were prioritized for this review according to a Delphi study and did not cover all areas of SAM management.
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