SQ-LNS to reduce relapse post-discharge from acute malnutrition treatment

Malnourished children are often treated and re-treated – previous work suggests up to 30% of children discharged “cured” end up malnourished again within just six months (Kangas et al., 2023; Stobaugh et al. 2019). With approximately 7.3 million children with severe wasting treated last year globally, up to 2.2 million would be expected to relapse within 6 months from discharge (WHO, 2023). The consequences of relapse are significant: They range from risk to the child (higher mortality), risk to the caregiver (more time in treatment), and drain on the health care system, as retreatment episodes require longer, more expensive treatment.

Small-Quantity Lipid-based Nutrient Supplements (SQ-LNS) are essentially micronutrient supplements with a small caloric boost: packaged in small 20g individual sachets, they contain approximately 100kcal and the recommended daily intakes of all key vitamins and minerals for young children. Even though SQ-LNS and RUTF both resemble peanut butter, they are very different products – delivered in different sachets, in different sizes, with a different intended use. SQ-LNS is more like a top-up for children, whereas RUTF for SAM treatment is a meal replacement.

Despite evidence suggesting the long- term effects of SQ-LNS, the product has not yet been tested for relapse. Given the product’s nutritional content, and the opportunity for follow-up touch points with the health system, we are optimistic that the product could keep vulnerable children on the brink of relapse from requiring a new, full round of treatment. The IRC is committed to studying the effectiveness of SQ-LNS as a strategy to reduce relapse and enhance post-discharge growth in children treated for acute malnutrition. We aim to rigorously study a supplementation study that the health system could actually take up, contributing to an evidence base for effective and operationally feasible interventions.