What question did this study set out to answer?

This study aims to assess the effectiveness of a simplified treatment protocol for severe acute malnutrition in reducing relapse rates among children.

March 16, 2026Open Access

Reducing relapses after acute malnutrition treatment: evidence from a simplified approach in emergency settings of Mali

Key Points

This study aims to assess the effectiveness of a simplified treatment protocol for severe acute malnutrition in reducing relapse rates among children.
Non-randomized controlled trial conducted in Gao, Mali from Dec 2022 to Dec 2023.
Involved 506 children aged 6–59 months treated for severe acute malnutrition.
Intervention group received treatment via a simplified protocol using MUAC-only criteria and fixed RUTF doses.
Relapse was monitored for up to eight months post-discharge using anthropometric criteria.
Cox regression models identified risk factors for relapse.
Relapse incidence was significantly lower in the simplified protocol group (5.6%) compared to the standard group (39.8%).
The simplified protocol group had a longer length of stay and used lower RUTF quantities.
Fewer comorbidities were reported at discharge in the simplified protocol group.
Older age at discharge and greater MUAC gain were identified as protective factors against relapse.

Abstract

Background Acute malnutrition remains a critical public health issue, particularly in emergency settings. While simplified treatment protocols show promise in improving access and cost-effectiveness, evidence on their impact on relapse rates remains limited. This study aimed to compare relapse incidence among children treated for severe acute malnutrition (SAM) using a simplified protocol versus the standard Community Management of Acute Malnutrition (CMAM) protocol in the emergency context of Gao, Mali. Methods This is a non-randomized controlled trial conducted between December 2022 and December 2023, involving 506 children aged 6–59 months discharged as cured from SAM. The intervention group ( n = 270) received treatment via a simplified protocol using Mid-upper arm circumference, (MUAC)-only criteria and fixed ready-to-use therapeutic (RUTF) dose, while the standard protocol group ( n = 236) followed the standard CMAM protocol. Children were followed for up to eight months post-discharge. Relapse was defined as meeting anthropometric criteria for acute malnutrition during follow-up. Cox regression models were used to identify risk factors. Results Relapse incidence was significantly lower in the simplified protocol group (5.6%) compared to the standard one (39.8%). The simplified protocol also had longer length of stay, used lower quantity of RUTF, and fewer comorbidities at discharge. We found similar results when analyzing the sub-sample with those children admitted with MUAC-only in the control group. Multivariate analysis identified treatment with the simplified protocol, older age at discharge, and greater MUAC gain as protective factors. Comorbidities during follow-up were the strongest predictor of relapse. Conclusion Simplified protocols may reduce relapse rates after SAM treatment, even with reduced RUTF doses. Strengthening discharge procedures and post-discharge monitoring, particularly in emergency settings, is essential to sustain recovery and prevent relapse.

Bookmark

View Full Paper