Action Against Hunger, in collaboration with the WHO/UNICEF TAG Wasting Research Sub-working Group, is seeking data to contribute to a secondary analysis on weight gain during the treatment of severe acute malnutrition (SAM) in children aged 6-59 months in outpatient treatment settings. This research aims to enhance the evidence base for defining optimal weight gain parameters and inform global guidance on SAM treatment. We are requesting high-quality, individualized child-level data from rigorous research studies that track children’s progress during SAM treatment, including key indicators such as weight gain and treatment outcomes. If you or your organization can share relevant data, please see the full call for data below for more details on required datasets and collaboration.
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Call for Data
We are writing to request you and/or your organization share data with Action Against Hunger to contribute to an analysis of weight gain during the treatment of severe acute malnutrition (SAM) in children 6-59 months in outpatient treatment settings. This analysis aims to strengthen the evidence-base to inform global guidance on the treatment of acute malnutrition.
Introduction
A significant challenge in policy and programmatic decision-making lies in the lack of consensus on critical outcomes and understanding around meaningful values in these outcomes—an issue particularly highlighted as problematic by the Guideline Development Group (GDG) during the development process for the 2023 WHO guideline on wasting and nutritional oedema. As a result, WHO is currently undergoing a systematic process to develop a list of core outcomes for effectiveness trials1 and weight gain has emerged as a critical outcome to be assessed and reported in all trials involving children with SAM treated in outpatient/community settings.
Despite consensus that weight gain is a critical outcome, the current evidence base is not sufficient for defining parameters and thresholds around weight gain, let alone any guidance on interpretation or application of such. Currently, the working assumption is that faster weight gain is always best and any relatively slower weight gain is generally considered a poor outcome. However, a recent systematic review suggests that slower weight gain does not appear to have important associations with mortality/recovery. In this review weight gain averages 3.9 g/kg/day in outpatient programs and 9.1g/kg/day in inpatient programs2. Also, weight gain that is too fast may not be ideal considering potential links between severe acute malnutrition and cardiometabolic non-communicable diseases in later life3.
A better understanding of what optimal weight gain constitutes and how long recovery should take are crucial information for making evidence-based judgements comparing the effectiveness of different treatment protocols. The work we propose here aims to build on WHO’s current work on defining critical outcomes by identifying an acceptable range for weight gain in order to support interpretation of this outcome.
Objective:
Action Against Hunger and the WHO/UNICEF TAG Wasting Research Sub-working Group aim to conduct a secondary data analysis to explore patterns of weight gain during treatment and the relationships between weight-gain and other discharge and post-discharge outcomes.
Data Use and Proposed Research Questions:
Using pooled datasets, with the unit of analysis being the individual child, we aim to answer the following research questions to the best of our ability, pending available datasets:
- How do different indicators of weight-gain (i.e. rate of weight gain through full treatment; rate of weight gain during first two weeks, total weight gain, etc.) during SAM treatment associate with programmatic outcomes (i.e. recovery, non-response, death, etc.)?
- How does weight gain differ according to various maximum lengths of stay in initial SAM treatment?
- Is there an optimal range of weight gain associated with nutritional recovery from initial SAM treatment?
- If so, what weight gain cut-offs are significantly associated with a clinically relevant risk of non-recovery from initial SAM treatment?
- Do these ranges differ according to age, sex, and anthropometric status upon admission?
- Is weight gain during initial treatment associated with post-discharge outcomes (i.e. linear growth, relapse, post-discharge mortality, etc.)?
- Is there an optimal range of weight gain associated with sustained recovery post initial SAM treatment?
- If so, what are the optimal weight gain cut-offs significantly associated with a clinically-relevant risk of non-sustained recovery following initial SAM treatment?
- Is weight gain associated with other, non-operational outcomes, such as body mass index, cognitive development, or micronutrient deficiencies?
- If so, is there an optimal range associated with such positive outcomes?
Where possible, we would like to conduct sub-analyses by age, sex, severity of wasting/acute malnutrition, geographic location, etc. when addressing the above research questions.
Data Request:
We are requesting data from research studies data that include prospective data collection following individual children throughout the treatment of severe acute malnutrition in outpatient treatment settings. Conversely, we are not interested in coverage assessments, surveillance surveys, or point prevalence data. We are also not interested in programmatic data that consists only of admission and discharge data points. Data must have been collected as part of a rigorous research study that involved data collection supervision and high-quality data management.
Datasets must include:
- Individualized, child-level data for children aged 6-59 months at admission
- Variables including (at a minimum) child age (or DOB), sex, height/length, weight, and MUAC in an OTP or TSFP upon admission and at each follow-up visit during treatment until discharge from the program; date of admission and at each follow-up visit during treatment until discharge that corresponds with the follow-up anthropometric measurements;
- Treatment outcome (cured, defaulted, non-response, died, etc.)
Additional required information:
- Original study protocol under which the data was collected, including criteria used to for admission and to define programatic outcomes: cure, default, non-response, death.
- Ethical approval documentation for original study
Highly desired information:
- any contextual information regarding the type of programming or situation in which the treatment was provided
- any post-discharge follow-up data
- any data related to co-morbidities, micronutrient status, or other health-related indicators collected throughout treatment
- any data related to cognitive outcomes
Data Sharing Agreements:
If an organization or researcher is willing to share their datasets with Action Against Hunger, we will agree on a Data Sharing Agreement for all/any related parties to discuss and sign prior to the sharing of any data.
Collaboration:
Action Against Hunger and the WHO/UNICEF TAG Wasting Research Sub-Working Group are closely collaborating to ensure this analysis complements other ongoing research efforts on this topic.
Tentative Timeline:
Our goal is to collect and compile datasets no later than September 1, 2025 and conduct the analysis during the rest of the 2025 through to March of 2026. Therefore, we expect final manuscript development and publication process to occur sometime in mid-2026. Please note, this is a tentative timeline.
Outcomes and Significance:
Once the analysis is complete, we intend to submit the results for a peer-reviewed publication(s). We do hope that these results can help to inform future decision-making regarding the effectiveness of different SAM treatment protocols.
Contact:
Please contact Bailey Adams (badams@actionagainsthunger.org) and/or Heather Stobaugh (hstobaugh@actionagainsthunger.org) with any further questions or if you have data to share.