Today in The Lancet Global Health: First-of-Its-Kind Study on Why Some Children Relapse After Being Treated for Malnutrition

NEW YORK, December 19, 2024 /3BL/ - A first-of-its-kind study on relapse among children treated for severe acute malnutrition (SAM) was published today in The Lancet Global Health one of the world’s most respected and long-standing peer-reviewed medical journals.

The groundbreaking study - originally released by Action Against Hunger in December 2023 by Action Against Hunger prior to being peer-reviewed - shows that a significant percentage of children successfully treated for severe acute malnutrition are vulnerable to relapse, providing valuable new insights that could save lives by improving the long-term impact of threadbare aid budgets. Globally, 47 million children are acutely malnourished, but before this study, little was known about their prognosis after treatment is completed.

Funded by USAID’s Bureau for Humanitarian Assistance, the study was co-authored by individuals from Action Against Hunger, the CDC, the London School of Tropical Medicine, and Washington University of St. Louis. Researchers tracked the outcomes of children treated for severe acute malnutrition (SAM), a life-threatening form of hunger, across three different countries: Mali, Somalia and South Sudan. The children’s progress was monitored for six months after treatment and compared to their otherwise healthy peers.

“Recent decades have seen major strides in our ability to effectively treat children suffering from SAM. Yet, major questions remained about what happens after children leave our treatment centers,” said Heather Stobaugh, PhD., Associate Director of Research at Action Against Hunger and the principal investigator of this study. “Now, we have more information to develop solutions that will help us develop post-care interventions and support to prevent the need for retreating children repeatedly, which ultimately leads to the use of limited resources most efficiently.”

Key Study Findings Include:

Need for Longer-Term Services – Children who recover from SAM are up to five times as likely than their non-previously malnourished peers to need future treatment for SAM. Prior to this study, it was assumed that children who recovered from malnutrition were as healthy as their peers, yet these new findings suggest the risk for poor outcomes is much higher once a child has experienced SAM. This potentially opens the door for follow-up services that could reduce the health impacts and costs associated with relapse.

Children Who Respond Better Are More Likely to Sustain Recovery – Children who respond better to treatment for malnutrition are more likely to sustain their recovery, even if they live in households dealing with food insecurity. Study authors hypothesize that those same extenuating biological or social factors that hindered their response to treatment likely continue to be problematic after treatment.

Boys More Vulnerable Than Girls – Researchers found that boys, as opposed to girls, are more likely to relapse to malnutrition. This coincides with other new findings showing boys are generally more susceptible to acute malnutrition than girls.

Community and Context Matters – Broader community and context matter more to sustaining recovery from malnutrition than factors associated with the specific individuals. This insight helps organizations like Action Against Hunger to better understand in which contexts children will be more vulnerable after initial recovery. Also, it could lead to solutions that focus on providing households greater access to community-wide services, such as healthcare, cash transfers, or other support services.

Urban versus Rural Context – Relapse rates are higher in rural areas (30-64%), where populations likely have limited access to healthcare, cash, or other assistance programs. Conversely, in urban Mogadishu, Somalia, researchers observed relatively lower relapse rates (23%), even among internally displaced populations. Study authors hypothesize that access to services such as health care, cash, remittances and food distributions play a significant role in determining the longer-term well-being of children after they recover from the life-threatening form of malnutrition: severe acute malnutrition.

Action Against Hunger is also actively researching innovative treatments for SAM. One promising area of focus is the gut microbiome. The bacteria in the gut break down food to supply essential nutrients that fuel the body. An imbalance in the healthy bacteria can have negative impacts on the digestive, immune, and nervous systems. The gut is also significantly negatively impacted by malnourishment. This discovery offers exciting possibilities: by comparing the microbiome of malnourished children with those of healthy children, researchers aim to identify ways to transform the microbiomes of SAM-affected children to be more resilient to potentially sustain recovery from malnutrition.

“There is still a lot we do not know, and as a next step, we hope to secure funding for future research that tests new approaches to provide children after initial recovery to ensure they sustain recovery and go on to thrive in childhood,” Stobaugh said. “We need evidence-based ways to make aid budgets stretch farther and act as efficiently as possible.”

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About Action Against Hunger 
Action Against Hunger leads the global movement to end hunger. We innovate solutions, advocate for change, and reach 21 million people every year with proven hunger prevention and treatment programs. As a nonprofit that works across 59 countries, our 8,900 dedicated staff members partner with communities to address the root causes of hunger, including climate change, conflict, inequity, and emergencies. We strive to create a world free from hunger, for everyone, for good.