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Development of Acute Malnutrition Despite Nutritional Supplementation in Malawi

Kaimila, Yankho*; Pitman, Ryan T.; Divala, Oscar*; Hendrixson, D. Taylor; Stephenson, Kevin B.; Agapova, Sophia; Trehan, Indi; Maleta, Ken*; Manary, Mark J.*,†

Journal of Pediatric Gastroenterology and Nutrition: May 2019 - Volume 68 - Issue 5 - p 734–737
doi: 10.1097/MPG.0000000000002241
Short Communications: Nutrition

ABSTRACT Malnutrition in children is most often attributed to inadequate nutrient intake. Utilizing data from 2 prospective, randomized controlled trials of complimentary feeding with supplemental legumes (n = 693, ages 6–24 months) in 2 Malawian villages, Masenjere, and Limera, we document a high rate 70/693 (10.1%) of acute malnutrition (AM). Risks for AM in this setting, as determined by Cox regression analysis, include study village (hazard ratio [HR] 3.0), prior malnutrition (HR 4.12), stunting (HR 2.87), and a marker of food insecurity (HR 1.89). Comparison of Masenjere to Limera demonstrate adequate and similar nutritional intake yet an increased rate of AM in Masenjere, 56 of 400 (14.0%) versus 14 of 293 (4.8%), and stunting, 140 of 400 (35%) versus 80 of 293 (27%), environmental enteric dysfunction 246 of 400 (71%) versus 181/293 (67%), and infectious symptoms (cough and diarrhea). Masenjere did have cleaner water and less food insecurity 200 of 399 (50.5%) versus 204 of 293 (69.6%). These findings suggest adequate complementary nutrient intake does not protect young children against AM.

*School of Public Health and Family Medicine, College of Medicine, University of Malawi, Blantyre, Malawi

Department of Pediatrics, Washington University, St. Louis, MO.

Address correspondence to Mark J. Manary, MD, Department of Pediatrics, Washington University, St. Louis, MO 63110 (e-mail:

Received 27 August, 2018

Accepted 9 November, 2018 registration numbers: NCT02472262, NCT02472301.

Y.K. and R.T.P. contributed equally to this work.

United States Agency for International Development (USAID), as part of Feed the Future, the US Government's global hunger and food security initiative, under the terms of Cooperative Agreement No. EDH-A-00-07-00005-00, and the Children's Discovery Institute of Washington University and St. Louis Children's Hospital. The opinions expressed herein are those of the authors and do not necessarily reflect the views of USAID or the US Government.

The authors report no conflicts of interest.

© 2019 by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology,