Relapses from acute malnutrition and related factors in a community-based management programme in Burkina Faso
Relapses from acute malnutrition and related factors in a community-based management programme in Burkina Faso
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DOI：
10.1111/mcn.12197
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发表时间：
2016-10-01
影响因子：
3.4
通讯作者：
Donnen, Philippe
中科院分区：
文献类型：
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作者：
Somasse, Yassinme Elysee;Dramaix, Michele;Donnen, Philippe
以社区为基础的急性营养不良管理（CMAM）是治疗急性营养不良的有效方法。然而，出院后往往缺乏随访。我们的目的是评估复发率和相关因素在布基纳法索的CMAM方案。要求从社区营养中心出院的儿童至少每3个月返回一次接受后续治疗。2012年1月，从210个村庄中随机抽取了45个村庄，收集了2010年7月至2011年6月出院的康复儿童（体重身高z评分-2）的数据。从父母那里收集了社会人口学数据、经济变量、家庭食物供应信息和儿童在过去24小时内的食物消费量。多变量考克斯比例风险回归用于确定复发相关因素。在637名儿童中，14名（2.2%）死亡，218名（34.2%）失访。返回随访的儿童的复发率[95%置信区间]为15.4 [11.8-19.0]/100儿童年。多因素考克斯回归分析显示，出院时上臂中围（MUAC）小于125 mm、最后24 h内未食用油脂和未接种疫苗是复发的相关因素。为了限制复发，CMAM计划应避免在MUAC至少125 mm之前过早出院。营养教育应强调脂肪/油是儿童的廉价能源。促进免疫接种对促进儿童成长至关重要。应组织对出院儿童的定期监测，以便及早发现有复发风险的儿童。复发率应该是CMAM有效性的指标。
Community-based management of acute malnutrition (CMAM) is effective in treating acute malnutrition. However, post-discharge follow-up often lacks. We aimed at assessing the relapse rate and the associated factors in a CMAM programme in Burkina Faso. Discharged children from the community nutrition centre were requested to return at least every 3 months for follow-up. The data of recovered children (weight-for-height z-score -2) who were discharged between July 2010 and June 2011 were collected in 45 villages, randomly selected out of 210 in January 2012. Sociodemographic data, economic variables, information on household food availability and the child's food consumption in the last 24h were collected from the parents. A multivariate Cox proportional hazards regression was used to identify the factors associated to relapse. Of the 637 children, 14 (2.2%) died and 218 (34.2%) were lost to follow-up. The relapse rate [95% confidence interval] among the children who returned for follow-up was 15.4 [11.8-19.0] per 100 children-years. The associated factors to relapses in multivariate Cox regression model were mid-upper arm circumference (MUAC) at discharge below 125mm, no oil/fat consumption during the last 24h and incomplete vaccination. To limit relapses, CMAM programmes should avoid premature discharge before a MUAC of at least 125mm. Nutrition education should emphasize fat/oil as inexpensive energy source for children. Promoting immunization is essential to promote child growth. Periodic monitoring of discharged children should be organized to detect earlier those who are at risk of relapse. The relapse rate should be a CMAM effectiveness indicator.