Abstract
BACKGROUND AND AIMS
The detection and management of (nutritionally) at-risk mothers and infants under 6 months (MAMI) has been identified by WHO as a priority. In 2015 the MAMI tool was published. As the tool is new with updated versions being developed/piloted, there is still uncertainty on the ideal MUAC cut-off for enrolling these infants. In addition, it is unknown which risk factors during their enrolment period in MAMI, contribute to the development of wasting beyond the age of 6 months.
METHODS
With the aim of identifying the predictors associated with wasting by the age of 1 year, Medair conducted a prospective cohort study among infants enrolled in MAMI in Cox’s Bazar refugee camp, Bangladesh. MAMI enrolment criteria included weight-for-age z-score (WAZ) <-2 (discharge WAZ >2), breastfeeding and maternal problems (latter excluded from analysis). Acute malnutrition in children over 6 months was diagnosed as MUAC <12.5 cm.
RESULTS
497 infants were enrolled between January 2020 and April 2021. 246 infants presented with WAZ <−2 (‘WAZ’ group); 251 were enrolled for breastfeeding problems (‘OTHERS’ group). In multivariate analysis, ‘WAZ’ group was strongly associated with the risk of wasting by the age of 1 year, when compared to ‘OTHERS’ group (OR 2.59 (95% CI [1.39-4.80], p=0.007)). Sub-analysis of ‘WAZ’ group identified predictors protecting from wasting occurrence: protective younger age (<2 months) at MAMI enrollment (OR 0.98 (95% CI [0.97–0.99], p=0.011)); protective male sex (OR 0.41 (0.19–0.89, p<0.024); protective higher MUAC (≥12.3 cm) at discharge (OR 0.30 (0.17–0.50, p<0.001). [Download abstract PDF for a table with fuller results.]
CONCLUSIONS
‘WAZ’ infants have a higher risk of wasting by the age of 1 year compared to ‘OTHERS’. To mitigate this risk, ‘WAZ’ infants should be screened/enrolled in MAMI as early as possible. When they reach the age of 6 months, ‘WAZ’ infants should be considered for receiving Small-Quantity Lipid Nutrient Supplementation.
