Name What's the spontaneous recovery rate for SAM?

If there are 20 million SAM children globally and 1 million die of SAM each year, this makes it seem that many SAM children recover without treatment (given that we know global coverage of treatment to be extremely low). What do we know about the spontaneous recovery rate for SAM children?

I'll have a go at this ... First ... it all depends on how you define SAM. Spontaneous recovery rates for SAM defined by low MUAC will be different than for low W/H. They will depend upon the case-defining thresholds used. If using W/H, they will also depend upon location, ethnicity, and food-economy zone (amongst other factors). There is plenty of data on mortality amongst untreated children from the classic cohort studies of about 30 years ago. We can think of mortality as the opposite of recovery. It's not exactly that because it is possible to not recover and not die but it is probably safe to make the simplifying assumption that a SAM child either recovers or dies. I just did a very quick review of some of the original reports and found a mortality rate for children with a MUAC of 110 mm to be between 100 and 250 deaths per thousand per year. Turn this about and you get 75% - 90% spontaneous recovery. As MUAC gets lower the mortality increases. At 100 mm the range was 300 to 600 deaths per thousand per year. Turn this about and you get 40% - 70% recovery. Looking at these figures ... the 20:1 you quote seems to be wrong. The SAM definition used for this is probably using W/H which is not so strongly associated with mortality as MUAC. This is just a quick answer. The point I am trying to make is that you can use the mortality estimates from the classic cohorts to answer this question. The problem that you may find is that it was common to define "severe PEM" as < 80% W/H ... this is close to what we now call GAM. To get answers that fit with current case-deifntions would probably require data to be re-analysed. Some of the data may be available for re-analysis. I hope this helps.

Mark Myatt

Technical Expert

Answered:

14 years ago

From Victoria Sibson: Thanks Mark. That is helpful. I am surprised that spontaneous recovery for children with low MUAC is so high. I will try to find time to read some of the old literature Best wishes Vicky

Tamsin Walters

Forum Moderator

Answered:

14 years ago

As always, happy to help.

Mark Myatt

Technical Expert

Answered:

14 years ago

Hi Mark,
Would you mind sharing the articles for the cohort you mentioned?
Many thanks in advance!
Severine

Severine Frison

Answered:

9 years ago

Severine,

I have the references to the cohort studies as paper reprints in a library box. They are all references in my FNB review and the (IMO) excellent Pelletier (1994) review which concentrates on mortality and anthropometry. I have put this in a ZIP archive. I guess you have good library access and will be able to get PDFs of the key documents (if you can then please send me copies).

It would be good if we could get hold of some of this data and reanalyse with current case-defintions and over more useful classes.

Mark Myatt

Technical Expert

Answered:

9 years ago

Thanks a lot Mark!
I will keep you posted on the articles I'll manage to get from the library.
Agreed, that would be very interesting.
Best wishes,
Sev

Severine Frison

Answered:

9 years ago

Happy to help.

I would be happy to be part of a team looking that this data (if we can get it).

Mark Myatt

Technical Expert

Answered:

9 years ago

I have sent articles to Mark and Tamsin. Please feel free to contact them or me to get a copy.

Severine Frison

Answered:

9 years ago

Let us thank Severine. I have put the bundle of articles [url=http://www.brixtonhealth.com/AnthropometryRiskDeath.zip]in this ZIP archive[/url]. Severine also found this [url=http://archive.unu.edu/unupress/food/8F134e/8F134E02.htm]online FNB article[/url] which is also useful.

Mark Myatt

Technical Expert

Answered:

9 years ago

Thanks Mark

Kemal J. Tunne

Answered:

9 years ago

Under the auspices of the Nutrition in Emergencies Helpdesk/Global Nutrition Cluster/Infant Feeding in Emergency Core Group, a small group of experts is exploring whether specific guidance/tools are needed on IYCF in a cholera context.

We know that some materials are available, but we would like to assess whether all your questions and concerns are sufficiently addressed by what is available (globally, regionally or at the country level).

We value your expertise and would like to understand the main questions or challenges you and your team face when dealing with breastfeeding and/or complementary feeding during cholera outbreaks.

Whether you work within or outside Cholera Treatment Centers, your insights are crucial in shaping our future guidance/tools.

Examples of questions:

Should a cholera-infected mother on IV fluids breastfeed her child?
Can breastfeeding mothers in a cholera outbreak receive an Oral Cholera Vaccine and still breastfeed?
How to prepare food for infants 6 months and above during a cholera outbreak?

The questions you will share with us will help us understand what additional materials or tools we can develop/rebrand to support you.

Please feel free to respond via email to Alex Iellamo (aiellamo@fhi360.org) and Mija Ververs (mververs@cdc.gov) or post your queries here on EN-NET.

Mark Myatt

Technical Expert

Answered:

9 years ago