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MUAC ≥120mm AS A SIMPLE, SAFE AND EFFECTIVE DISCHARGE CRITERIA FOR SAM IN BIHAR, INDIA

MUAC ≥120mm AS A SIMPLE, SAFE AND EFFECTIVE DISCHARGE CRITERIA FOR SAM IN BIHAR, INDIA. MSF SPAIN. Structure of the session. Background Methods Programme outcomes Long-term outcomes Conclusions. Background. India has 40% of the worldwide burden of childhood SAM.

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MUAC ≥120mm AS A SIMPLE, SAFE AND EFFECTIVE DISCHARGE CRITERIA FOR SAM IN BIHAR, INDIA

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  1. MUAC ≥120mm AS A SIMPLE, SAFE ANDEFFECTIVE DISCHARGE CRITERIA FOR SAMIN BIHAR, INDIA MSF SPAIN

  2. Structure of the session • Background • Methods • Programme outcomes • Long-term outcomes • Conclusions

  3. Background • India has 40% of the worldwide burden of childhood SAM. • WHO currently recommends admission using MUAC<115mm and/or WHZ<-3SD, and discharge when 15% body-weight has increased. Although this 15% increasehas been discredited, debate is ongoing regarding using different MUAC and/or W/H cut-offs for discharge. • MUAC has been shown to be an effective method for screening and admitting SAM children, and much simpler than W/H. • MSF in Bihar is one of the only and longest running CMAM programmes worldwide routinely using exclusively MUAC+/-oedema for admission (<115mm) and discharge (≥120mm) • This presentation describes the programmatic results and long-term outcomes of using exclusively MUAC≥120mm for discharge for children 6-59 months of age.

  4. Methods • Data from all children cured (defined as MUAC≥120mm) from July 2010-September 2011 (n=2288) were retrospectively analyzed. • Children with oedema (0.3%, n=8), length of stay<14 days (3.8%,n=95) and >140 days (2.9%,n=71) were excluded. • During a targeted follow-up study, children discharged as cured from the programme were traced up to 18 months post-discharge (n=1036) . • These results were then matched.

  5. Admission characteristics MUAC <115mm (6-59m)

  6. Outcomes by admission criteria (6-59m)

  7. Outcomes stratified by height (6-59m) • 76.2% of childrenreacheda W/H≥-2SD, 21,8% ≥-3 to <-2 and 2.0%<-3SD • Mean age at discharge: • < -3 at discharge: 20 months • ≥-3 to <-2: 18 months • > -3: 15 months

  8. Follow up survey (relapses) Objective: To determine the nutritional status & mortality rates of children discharged cured from the programme over different lengths of time(3,6,9,12,18 months) . Design: Retrospective cohort. 3 periods: • Mid Oct 2011: After 3 months of food insecurity • Mid Dec 2011: After 2 months of food security • Mid Feb 2012: After 4 months of food security Sample size: 1036 children followed up Results (overall follow up): • Relapses: 4.0% • Mortality: 0.8% • 15.5%: reached MUAC ≥125mm at time of discharge • Mortality and relapse rate: no significant difference between children discharged with MUAC > 120 to those having a MUAC 120-125 at discharge

  9. Long Term Outcomes of Children CuredOverall Relapses (MUAC < 115mm) Percentage of children with SAM Time following discharge

  10. Long Term Outcomes of Children CuredRelapses (MUAC < 115) by time of the survey Percentage of children with SAM Time following discharge Majority of children discharged as cured remain cured in the long term, however higher risk of relapse in first 3 months associated with food security season.

  11. Risk factors for relapse and mortality in cured children For relapse: • W/H < -3SD • Not using Anganwadi services • Low standard of living score • Longer LOS in programme • Season None associated with mortality

  12. Conclusions • When analysing nutrition status at discharge, MUAC≥120mm discharge demonstrated acceptable programme characteristics. • Relapse rates appeared significantly higher in children discharged with WHZ<-3SD but absolute numbers were very small (2.0%, 21/1036), not reflected in mortality (0%) and represented an older admission population. • When discharge is done during food insecurity period important follow up. • Current MUAC > 120 mm dischargecriteriaresults in a longLOS forchildrenwithlowMUAC and forchildren< 65 cm (> 6 months): selfrecoveryperception-defaulting. Needtoreadjustcriteriaforchildren < 65 cm.

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