Caregiver Screening for Relapse Among Children Recently Recovered From Severe Acute Malnutrition: A Randomized Controlled Feasibility Trial

Relapse to acute malnutrition after recovery from severe acute malnutrition (SAM) is common. However, most programmatic resources are devoted to the acute phase of recovery, and fewer interventions are available for children recently discharged from outpatient nutritional programs. We evaluated the feasibility of training caregivers to screen for relapse using mid-upper arm circumference (MUAC) tapes for reducing time to detection of relapse among children recently recovered from SAM in Burkina Faso. Caregiver-child dyads were enrolled and randomized in a 1:1 fashion to either caregiver MUAC screening or local standard of care (SOC), which consists of monthly clinic-based follow-up visits for 3 months following discharge. In the MUAC screening group, caregivers were trained on how to use a standard MUAC tape and asked to screen their child weekly with a provided MUAC tape for the 6-month duration of the study. The primary outcome was time to relapse detection, defined as MUAC < 12.5 cm and/or weight-for-height Z-score < -2. Secondary outcomes included hospitalization and/or death over the 6-month study period. Of 200 caregiver-child dyads enrolled in the trial, 99 were randomized to the MUAC screening group and 101 to the SOC group. By 6 months after enrollment, the hazard of relapse detection was lower in the MUAC screening group compared to the SOC group (hazard ratio, HR, 0.65, 95% confidence interval, CI, 0.38-1.12). Fewer hospitalizations and/or deaths occurred in the MUAC screening group compared to the SOC group (MUAC: 3%; SOC: 14%, risk ratio 0.23, 95% CI, 0.07-0.79). Training caregivers to screen for relapse after recovery from SAM was feasible and may lead to modestly reduced time to detection of relapse, suggesting a full-scale trial is warranted. Trial Registration: This study was prospectively registered on clinicaltrials.gov (NCT05932992, registered June 27, 2023).