Table_1_Factors associated with non-response and nutrional status of non-responders at 6-month post-discharge: a cohort study nested in a MUAC-based nutrition programme for acutely malnourished children in Mirriah, Niger.DOCX

BackgroundIn the treatment of acute malnutrition (AM), non-response is considered a treatment failure for not meeting recovery criteria within a therapeutic window of 12–16 weeks, but this category of children is misunderstood. As current research emphasizes ways to simplify and optimize treatment protocols, non-response emerges as a new issue to enhance program efficiency.
MethodsA prospective cohort study was conducted from 2019 to 2020 at two health centres in Mirriah, Niger among children aged 6–59 months with uncomplicated AM treated under the Optimising treatment for Acute MAlnutrition (OptiMA) protocol. Children who did not meet recovery criteria by 12 weeks (mid-upper arm circumference (MUAC) ≥125 mm without oedema for two consecutive weeks) were classified as non-responders. Non-responders received a home visit six-months post-discharge. Logistic regression was used to analyze factors associated with non-responders compared with children who recovered.
ResultsOf the 1,112 children enrolled, 909 recovered and 139 were non-responders, of which 127 (80.6%) had significant MUAC gain (mean: +9.6 mm, sd = 5.1) at discharge. Girls (adjusted hazard ratio (aHR) = 2.07, 95% CI 1.33–3.25), children <12 months of age (aHr = 4.23, 95% CI 2.02–9.67), those with a MUAC <115 mm (aHR = 11.1, 95% CI 7.23–17.4) or severe stunting (aHR = 2.5, 1.38–4.83) at admission and a negative or flat MUAC trajectory between admission and week 4 (aHR = 4.66, 95% CI 2.54–9.13) were more likely to be non-responders. The nutritional status of non-responders had generally improved 6 months after discharge, but only 40% had achieved MUAC ≥125 mm.
ConclusionNon-responders are not a homogeneous group; while most children ultimately show significant nutritional improvement, rapid hospital referral is crucial for those not gaining MUAC early in treatment. As efforts to expand MUAC-based programming progress, adapting exit criterion and/or providing additional food supplementation with smaller daily ration for children with risk factors discussed here may help improve programme efficiency without adding to the cost of treatment.

### 研究背景
在急性营养不良（acute malnutrition, AM）的治疗中，无应答被定义为在12~16周的治疗窗内未达到康复标准的治疗失败情况，但此类儿童的分类标准仍存在认知偏差。当前研究聚焦于简化与优化治疗方案的路径，无应答问题遂成为提升项目执行效率的新兴研究议题。

### 研究方法
本研究于2019至2020年在尼日尔米拉赫（Mirriah）的两家卫生中心开展，为前瞻性队列研究，研究对象为6~59月龄的单纯性急性营养不良患儿，均采用急性营养不良优化治疗（Optimising treatment for Acute MAlnutrition, OptiMA）方案。将未在12周内达到康复标准的儿童归类为无应答者，康复标准为连续两周无水肿且中上臂围（mid-upper arm circumference, MUAC）≥125mm。无应答者于出院6个月后接受家访。采用Logistic回归分析无应答者与康复患儿的相关影响因素。

### 研究结果
本研究共纳入1112名儿童，其中909名实现康复，139名被归类为无应答者。在无应答者中，127名（80.6%）出院时MUAC出现显著增长（平均增长+9.6mm，标准差（standard deviation, sd）=5.1）。分析显示，女孩（调整后风险比（adjusted hazard ratio, aHR）=2.07，95%置信区间（confidence interval, CI）1.33~3.25）、月龄<12个月的儿童（aHR=4.23，95%CI 2.02~9.67）、入院时MUAC<115mm（aHR=11.1，95%CI 7.23~17.4）或存在严重发育迟缓（aHR=2.5，95%CI 1.38~4.83），且入院至第4周期间MUAC变化轨迹为负增长或平稳的儿童（aHR=4.66，95%CI 2.54~9.13），成为无应答者的风险显著更高。无应答者出院6个月后营养状况总体有所改善，但仅40%的儿童MUAC达到≥125mm。

### 研究结论
无应答者并非同质化群体；尽管多数患儿最终营养状况得到显著改善，但对于治疗早期MUAC未出现增长的患儿，及时转诊至医疗机构至关重要。随着基于MUAC的诊疗项目推广工作推进，针对本文提及的高危风险儿童，调整出院标准或/并提供每日分量更小的额外膳食补充剂，可在不增加治疗成本的前提下提升项目执行效率。