Dear Martha, Could you indicate studies reference for the 50% of EBF at point of discharge? Do you refer to cure rate according to discharge criteria in IPF for SAM in infants < 6mth or any independent audit / assessment of re- lactation status at point of discharge?

In Vygen et al the study reported 85% recovery rate. Their discharge criteria was weight gain of 10g/kg/day under EBF for 5 days and good general condition with no pathology. However they report that follow-up in the community was incomplete and hence were unable to inform on the EBF retention rate after discharge. Reference: Vygen SB, Roberfroid D, Captier V, Kolsteren P. Treatment of severe acute malnutrition in infants aged <6 months in Niger. J Pediatr. Mar 2013;162(3):515-521 e513. Another study by Cobert et al in Congo recruited 25 infants and reports 16 (64%) discharged while exclusively breastfeeding and gaining weight. Reference: Corbett M. Severe Malnutrition in the infants less than 6 months: Use of Supplemental Suckling Technique. Field Exchange 2000; http://fex.ennonline.net/9/tfp. Accessed 9. Sign et al reported that SST was successful in 34 (56%)of 62 mothers applied. Reference: Singh DK, Rai R, Mishra PC, Maurya M, Srivastava A. Nutritional Rehabilitation of Children < 6 mo with Severe Acute Malnutrition. Indian J Pediatr. Nov 23 2013. One that did not do so well is Oberlin et al reported a success rate of 29% relactated infants by discharge Reference: Oberlin O, Wilkinson C. Evaluation of Relactation by Supplemental Suckling Technique. Field Exchange 2008; http://fex.ennonline.net/32/evaluation. Accessed 32. I am looking for information on how well EBF was retained after discharge from the health facility especially among infants recovering from SAM who were successful relactated and discharged on EBF.

Thanks for these references. I had them already. The Vygen & all study in Niger reports recovery rate of case series in an NGO managed TFC in 2010-11. I also did a review on the quality of SAM management in infants < 6mth in Niger main Hospitals in 2013 and found almost the same recovery rates but SST is rarely used nowadays ( < 1% of infants ). Once we get the information you are looking for on post discharge EBF retention of “SST fed children”, we may come back to discuss what are the implications in different settings of “Non SST feeding” on 1) how to ascertain EBF at discharge point and 2) continuation of EBF after discharge at home.