Early Body Mass Index z ‐Score Change and Resolution of Severe Malnutrition in Children With Sickle Cell Anemia in a Low‐Income Setting: A Prospective Single‐Arm Extension Study

BACKGROUND: Children with sickle cell anemia (SCA) in low-income settings are at risk of severe malnutrition, but optimal nutritional management has not been established. We evaluated an intensified ready-to-use therapeutic food (RUTF) regimen in children with persistent severe malnutrition after initial treatment and assessed whether early change in body mass index z-score (BMIZ) was prognostic of later resolution of severe malnutrition. PROCEDURE: Children aged 5-12 years with SCA and BMIZ less than -3.0 after 12 weeks of supplemental RUTF received higher intensity, weight-based RUTF plus hydroxyurea through Week 24. We examined whether the change in BMIZ from baseline to Week 4 was associated with the resolution of severe malnutrition (BMIZ ≥-3.0) by Week 12 or, among extension participants, by Week 24. RESULTS: Of 108 children, 66 (61%) entered the extension. During Weeks 12-24, 11 of 66 (17%) achieved resolution, increasing the cumulative proportion with BMIZ ≥-3.0 from 39% (42/108) at Week 12 to 49% (53/108) by Week 24. Greater improvement in BMIZ from baseline to Week 4 was associated with higher odds of resolution by Week 12 or, among extension participants, by Week 24 (OR 12.38; p < 0.001), whereas older age was associated with lower odds of resolution (OR 0.72; p = 0.006). Among extension participants, higher Week-12 BMIZ was associated with higher odds of Week-24 resolution (OR 14.44; p = 0.039). CONCLUSIONS: In children with SCA and severe malnutrition, early BMIZ improvement in this small, single-arm extension was associated with later resolution of severe malnutrition, and may help risk-stratify children who need earlier reassessment or alternative management, a prognostic signal that warrants prospective testing rather than an immediate change in practice.