Treatment of severe and moderate acute malnutrition in low- and middle-income settings

Added October 1, 2020

Citation: Lenters L.M., Wazny K., Webb P., et al. Treatment of severe and moderate acute malnutrition in low- and middle-income settings: A systematic review, meta-analysis and Delphi process. BMC Public Health, 2013;13(Suppl 3):1-15

Community-based treatment is backed by a substantive programme of evidence. However, there are clear gaps in the availability of well-designed studies which evaluate the effectiveness of interventions to manage Severe Acute Malnutrition (SAM) and Moderate Acute Malnutrition (MAM) in a range of contexts. To close the gap between research and practice, further studies are needed that compare approaches to managing SAM and MAM, taking local context into consideration.

Globally, SAM and MAM affect around 52 million children under five. World Health Organization (WHO) protocol for inpatient management and community-based management with ready-to-use-therapeutic food (RUTF) have become much utilized interventions for the treatment of SAM and MAM. This review aimed to evaluate the effectiveness of the interventions for treating SAM in children under 5 years, by conducting a meta-analysis and a Delphi process. The Delphi process was undertaken to complement the systematic review. Results showed fatality rates, for inpatient treatment of SAM, using the WHO protocol, ranged from 3.4% to 35%. For community-based treatment of SAM, children who received RUTF were 51% more likely to achieve nutritional recovery than the standard care group. For the treatment of MAM, children in the RUSF group were significantly more likely to recover. Weight gain in the intervention group was higher overall. Heterogeneity in many outcomes and an inability to separate intervention effects and commodity effects led to analysis limitations. The Delphi process showed that adhering to standardized protocols for the treatment of SAM and MAM should improve mortality and recovery rates. However, no concrete conclusion on this was reached.


Disclaimer: This summary has been written by staff and volunteers of Evidence Aid in order to make the content of the original document accessible to decision makers who are searching for the available evidence the prevention and treatment of malnutrition but may not have the time, initially, to read the original report in full. This summary is not intended as a substitute for the medical advice of physicians, other health workers, professional associations, guideline developers, or national governments and international agencies. If readers of this summary think that the evidence that is presented within it is relevant to their decision-making they should refer to the content and details of the original article, and the advice and guidelines offered by other sources of expertise, before making decisions. Evidence Aid cannot be held responsible for any decisions made about prevention or treatment of malnutirition on the basis of this summary alone.