BMJ global health · 2026
Assessing WHO prioritisation criteria for children 6-59 months treated for moderate wasting in a MUAC-based protocol: a multicountry analysis in West and Central Africa.
СтатьяНаблюдательное исследованиеНазвание и аннотация: Перевод пока не подготовлен
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Daures Maguy, Sana Ibrahim, Coulibaly Wah, Nouhou Mahaman, Shepherd Susan, Becquet Renaud, Phelan Kevin
Аннотация
BACKGROUND: In 2023, the WHO recommended prioritising treatment for moderately wasted children with higher risk characteristics, including mid-upper arm circumference (MUAC) 115-119 mm, weight-for-age z-score (WAZ) <-3, age <24 months or clinical and social vulnerabilities. However, applying multiple criteria is operationally challenging. The OptiMA (Optimising Acute Malnutrition Treatment) protocol treats children with MUAC <125 mm or oedema using reduced doses of ready-to-use therapeutic food. This study examined the distribution and programmatic relevance of WHO prioritisation criteria among moderately wasted children in West and central Africa.
METHODS: A prospective observational cohort was conducted in 2022-2024 among children aged 6-59 months treated under OptiMA in Ngouri (Chad), Bamako (Mali) and Mirriah (Niger). Children with MUAC 115-124 mm in the higher-priority group (defined by MUAC 115-119 mm, WAZ <-3 or age <24 months) were compared with children in the lower-priority group (none of these criteria) across recovery, non-response, hospitalisation and death. A multinomial logistic regression model assessed associations between individual criteria and treatment failure.
RESULTS: A total of 87 961 moderate wasting treatment episodes were analysed. Overall, 97.4% of children met at least one WHO higher-priority criterion, of whom 42.5% had a MUAC 115-119 mm. Among children with MUAC 120-124 mm, 46.1% were <24 months, 18.7% WAZ<-3 and 30.6% met both criteria. Recovery was high (85%-90%) and mortality was low (<0.4%) in both higher-priority and lower-priority groups. WAZ <-3 emerged as the strongest independent predictor of adverse outcomes.
CONCLUSIONS: Nearly all moderately wasted children managed under OptiMA met at least one WHO higher-priority criterion, calling into question the need for further risk stratification in areas using MUAC-based simplified combined protocols. Such protocols may need to be adapted, though, to include other higher-priority children, like those with WAZ <-3 and MUAC ≥125 mm.
METHODS: A prospective observational cohort was conducted in 2022-2024 among children aged 6-59 months treated under OptiMA in Ngouri (Chad), Bamako (Mali) and Mirriah (Niger). Children with MUAC 115-124 mm in the higher-priority group (defined by MUAC 115-119 mm, WAZ <-3 or age <24 months) were compared with children in the lower-priority group (none of these criteria) across recovery, non-response, hospitalisation and death. A multinomial logistic regression model assessed associations between individual criteria and treatment failure.
RESULTS: A total of 87 961 moderate wasting treatment episodes were analysed. Overall, 97.4% of children met at least one WHO higher-priority criterion, of whom 42.5% had a MUAC 115-119 mm. Among children with MUAC 120-124 mm, 46.1% were <24 months, 18.7% WAZ<-3 and 30.6% met both criteria. Recovery was high (85%-90%) and mortality was low (<0.4%) in both higher-priority and lower-priority groups. WAZ <-3 emerged as the strongest independent predictor of adverse outcomes.
CONCLUSIONS: Nearly all moderately wasted children managed under OptiMA met at least one WHO higher-priority criterion, calling into question the need for further risk stratification in areas using MUAC-based simplified combined protocols. Such protocols may need to be adapted, though, to include other higher-priority children, like those with WAZ <-3 and MUAC ≥125 mm.