Treatment of severely underweight children

Currently, only severe wasting is intentionally addressed via therapeutic feeding. Children are admitted to therapeutic feeding programs for severe acute malnutrition (SAM) if their weight-for-height Z-score (WHZ) is below −3, they have a mid-upper arm circumference (MUAC) below 115 mm or in the presence of edema.

However, it is unclear whether the use of WHZ <−3 and MUAC <115 mm is optimal for capturing all children at the highest risk of mortality and for targeting all that would benefit from nutritional supplementation. An analysis of community-based cohort data from Senegal found that up to 62% of children at risk of death associated with growth deficits were missed when using WHZ <−3 and MUAC <115 mm.

This study will address whether children with WAZ <-3 but MUAC ≥125 mm benefit from therapeutic feeding with ready-to-use therapeutic foods (RUTF) and whether a simplified protocol is non-inferior to the weight-based standard protocol.