Background: A minimum inpatient stay of 14 days is recommended for children with severe acute malnutrition (SAM) admitted to nutrition rehabilitation centres (NRCs) in India, yet facility-level data consistently report mean stays well below this benchmark, and the consequences for weight gain and treatment outcomes have rarely been quantified. Objective: This study aimed to quantify the relationship between length of NRC stay and (i) average daily weight gain, (ii) attainment of the ≥ 8 g/kg/day target, and (iii) discharge outcomes (recovery, defaulter, non-responder) in a multicentre cohort of SAM children in Gwalior district, Madhya Pradesh, India. Methods: A prospective cohort of 332 SAM children admitted to the five NRCs of Gwalior district during 2021 was stratified by length of stay into three groups (≤ 7, 8-13, and ≥ 14 days). Stratum-wise mean weight gain, target attainment, and discharge outcomes were compared using analysis of variance (ANOVA) and χ² test. Adjusted associations were estimated by multivariable linear regression (weight gain) and multinomial logistic regression (outcome), controlling for age, sex, admission weight, oedematous SAM and comorbidity burden. Results: Mean length of stay was 9.88 ± 3.19 days; only 37 children (11.1%) completed ≥ 14 days. Mean weight gain rose monotonically across strata: 5.32 g/kg/day (≤ 7 days) → 7.18 g/kg/day (8-13 days) → 11.47 g/kg/day (≥ 14 days) (F = 14.83, p < 0.001). The proportion achieving the ≥ 8 g/kg/day target rose from 16.7% (14/84) to 31.8% (67/211) to 67.6% (25/37) across strata (χ² = 38.91, p < 0.001). Discharge recovery rose from 58.3% (49/84) to 73.5% (155/211) to 86.5% (32/37) (χ² = 12.74, p = 0.002), and defaulter rate fell from 30.9% (26/84) to 18.0% (38/211) to 5.4% (2/37) (χ² = 14.92, p < 0.001). In adjusted analysis, each additional inpatient day was associated with a 0.71 g/kg/day increase in weight gain (β = 0.71; 95% CI 0.45-0.97) and a 12% reduction in odds of default (adjusted odds ratio (aOR) 0.88 per day; 95% CI 0.83-0.93). Conclusion: Nine out of every 10 NRC stays in Gwalior ended before the 14-day benchmark, and the associated outcome deficit was measurable. Re-aligning discharge with anthropometric criteria (≥ 15% weight gain or ≥ 5 g/kg/day for three consecutive days) rather than fixed-day rules, combined with wage-equivalent caregiver reimbursement and structured community follow-up, may translate into better outcomes within existing infrastructure, a hypothesis that warrants confirmation in interventional or implementation research.
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Verma et al. (2026) studied this question.
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