Global WACh

March 2, 2023

New study focuses on immune function to improve treatment of severely malnourished children worldwide

Severe acute malnutrition (SAM) remains a global public health emergency, especially among young children in limited resource settings who are not consuming enough energy, fat, protein, and other nutrients to maintain healthy bodily functions. This places children at high risk of life-threatening infectious diseases, such as diarrhea and pneumonia. Severely malnourished children are often treated at inpatient and outpatient hospital clinics or feeding centers, using protocols promoted by the World Health Organization (WHO). Treatment currently focuses on initial recovery as defined by anthropometric standards without adequately addressing the health of children after discharge from treatment programs.

There is a growing body of evidence that shows many children treated and discharged from treatment programs relapse and return for the same treatment again. Emerging research findings suggest there are likely continued immunodeficiencies following recovery, leaving these children at high risk for further growth faltering, infectious diseases, and mortality. The underlying mechanisms of immune function in malnutrition are not well known, given the complicated conditions needed for handling blood samples for immunologic evaluation. Generating evidence to fill this knowledge gap is critical to treat malnourished children effectively.

Dr. Indi Trehan, faculty in the Departments of Global Health, Pediatrics, and Epidemiology, is leading a new study to generate evidence on such immunodeficiency for the first time with a new assay amenable to collection in austere field conditions to improve the treatment and follow-up of children with SAM worldwide. It is a prospective cohort study leveraging an existing study platform evaluating the risk factors for adverse post-treatment outcomes being conducted by Action Against Hunger in Aweil East, South Sudan. Three hundred children 6-59 months old who recover from SAM will be followed at four time points over 6-12 months and compared with a cohort of 240 age- and sex-matched community controls who had not suffered from SAM. Leveraging the technology used to collect dried blood spots during the time points (similar to those used in routine newborn screening), the study team will conduct lab tests to quantify markers for continued immunodeficiency following treatment.

Just as there is an important emphasis on considering the risk of relapse, long-term growth, and cognitive/developmental outcomes following treatment for malnutrition, truly appropriate care for acutely malnourished children requires that we consider their full physiologic recovery and not solely anthropometric recovery.  We look forward to sharing future updates on this study.