Relapse and regression to severe wasting in children under 5 years: A theoretical framework.
children
regression
relapse
theoretical framework
wasting
Journal
Maternal & child nutrition
ISSN: 1740-8709
Titre abrégé: Matern Child Nutr
Pays: England
ID NLM: 101201025
Informations de publication
Date de publication:
04 2021
04 2021
Historique:
revised:
04
10
2020
received:
15
07
2020
accepted:
15
10
2020
pubmed:
5
11
2020
medline:
29
7
2021
entrez:
4
11
2020
Statut:
ppublish
Résumé
Systematic reviews have highlighted that repeated severe wasting after receiving treatment is likely to be common, but standardised measurement is needed urgently. The Council of Research & Technical Advice for Acute Malnutrition (CORTASAM) released recommendations on standard measurement of relapse (wasting within 6 months after exiting treatment as per recommended discharge criteria), regression (wasting within 6 months after exiting treatment before reaching recommended discharge criteria) and reoccurrence (wasting after 6 months of exit from treatment as per recommended discharge criteria). We provide a theoretical framework of post-treatment relapse and regression to severe wasting to guide discussions, risk factor analyses, and development and evaluations of interventions. This framework highlights that there are factors that may impact risk of relapse and regression in addition to the impact of contextual factors associated with incidence and reoccurrence of severe wasting more generally. Factors hypothesised to be associated with relapse and regression relate specifically to the nutrition and health status of the child on admission to, during and exit from treatment and treatment interventions, platforms and approaches as well as type of exit from treatment (e.g., before reaching recommended criteria). These factors influence whether children reach full recovery, and poorer nutritional and immunological status at exit from treatment are more proximate determinants of risk of severe wasting after treatment, although post-treatment interventions may modify risks. The evidence base for many of these factors is weak. Our framework can guide research to improve our understanding of risks of relapse and regression and how to prevent them and inform programmes on what data to collect to evaluate relapse. Implementation research is needed to operationalise results in programmes and reduce post-treatment severe wasting at scale.
Identifiants
pubmed: 33145990
doi: 10.1111/mcn.13107
pmc: PMC7988852
doi:
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
e13107Informations de copyright
© 2020 The Authors. Maternal & Child Nutrition published by John Wiley & Sons Ltd.
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