Article Text
Abstract
Introduction Severe acute malnutrition (SAM) and disability are major global health issues. Although they can cause and influence each other, data on their co-existence are sparse. We aimed to describe the prevalence and patterns of disability among a cohort of children with SAM.
Methods A longitudinal cohort study in Malawi followed SAM survivors up to 7 years postdischarge. Clinical and anthropometric profiles were compared with sibling and community controls. Disability at original admission was identified clinically; at 7-year follow-up a standardised screening tool called ‘the Washington Group Questionnaire’ was used.
Results 60/938 (6.4%) of admissions to SAM treatment had clinically obvious disability at admission. Post-treatment mortality was high, with only 11/60 (18%) surviving till 7-year follow-up. SAM children with a disability at admission had 6.99 (95% CI 3.49 to 14.02; p<0.001) greater risk of dying compared with children without disability. They were also older, less likely to be HIV positive or have oedema and more severely malnourished. Long-term survivors were more stunted, had less catch-up growth, smaller head circumference, weaker hand grip strength and poorer school achievement than non-disabled survivors.
The Washington Group Questionnaire confirmed disability in all who had been identified clinically, and identified many who had not been previously flagged.
Conclusion Disability is common among children affected by SAM. Those with disability-associated SAM have greatly increased risk of dying even if they survive the initial episode of malnutrition. Survivors have poorer growth, physical strength and school achievement. To enable all children to survive and thrive post-SAM, it is vital to focus more on those with disabilities. SAM treatment programmes should consider using not just clinical assessment but structured assessments to better identify at-risk individuals as well as understand the population of children for which they are developing services.
- nutrition
- child health
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Footnotes
Handling editor Soumitra S Bhuyan
Twitter @Lelijveld_et_al, @mjgladstone, @GlobalHealthNut
Contributors Conceived and designed the study: MK, NL, NG. Performed the data collection: EC, TN, LM, MM and MK. Analysed the data and wrote the first draft of the manuscript: NL and SP. Contributed to the writing of the manuscript and agreed with the manuscript’s results and conclusions: NL, MK, JW, EC, TN, MM, MG, NG, SP and AS. All authors have read, and confirm that they meet, ICMJE criteria for authorship.
Funding The original research was funded by The Wellcome Trust through an 'Enhancement Award' (grant number 101113/Z/13/A). Further analysis was supported by Australian Department of Finance and Trade (DFAT), Grant No 524990, ‘Supporting the Institutional Capacity for the Washington Group on Disability Statistics', University College London (Groce PI).
Competing interests None declared.
Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.
Patient consent for publication Not required.
Ethics approval This study was conducted according to the guidelines laid down in the Declaration of Helsinki and all procedures involving human subjects were approved by the Malawi College of Medicine Research and Ethics Committee (COMREC) (reference P·02/13/1342); and University College London Research Ethics Committee (reference 4683/001); London School of Hygiene & Tropical Medicine Ethics Committee (reference 22464). Written informed consent was obtained from all subjects’ legal guardians and verbal assent was obtained from minors.
Provenance and peer review Not commissioned; externally peer reviewed.
Data availability statement Data are available on request.