{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T22:57:05Z","timestamp":1792191425937,"version":"4.4.0"},"reference-count":35,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2018,7,4]],"date-time":"2018-07-04T00:00:00Z","timestamp":1530662400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Maternal &amp; Child Nutrition"],"published-print":{"date-parts":[[2019,1]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>Severe acute malnutrition (SAM) affects ~4 million infants under 6\u00a0months (u6m) worldwide, but evidence underpinning their care is \u201cvery low\u201d quality. To inform future research and policy, the objectives of our study were to identify risk factors for infant u6m SAM and describe the clinical and anthropometric outcomes of treatment with current management strategies. We conducted a prospective cohort study in infants u6m in Barisal district, Bangladesh. One group of 77 infants had SAM (weight\u2010for\u2010length Z\u2010score [WLZ] &lt;\u22123 and\/or bipedal oedema); 77 others were \u201cnon\u2010SAM\u201d (WLZ \u2265\u22122 to &lt;+2, no oedema, mid\u2010upper\u2010arm circumference \u2265125\u00a0mm). All were enrolled at 4\u20138\u00a0weeks of age and followed up at 6\u00a0months. Maternal education and satisfaction with breastfeeding were among factors associated with SAM. Duration of exclusive breastfeeding was shorter at enrolment (3\u00b79\u00a0\u00b1\u00a02.1 vs. 5.7\u00a0\u00b1\u00a02.2\u00a0weeks, <jats:italic>P<\/jats:italic>\u00a0&lt;\u00a00.0001) and at age 6\u00a0months (13.2\u00a0\u00b1\u00a08.9 vs. 17.4\u00a0\u00b1\u00a07.9\u00a0weeks; <jats:italic>P<\/jats:italic>\u00a0=\u00a00.003) among SAM infants. Despite referral, only 13 (17%) reported for inpatient care, and at 6\u00a0months, 18 (23%) infants with SAM still had SAM, and 3 (3.9%) died. In the non\u2010SAM group, one child developed SAM, and none died. We conclude that current treatment strategies have limited practical effectiveness: poor uptake of inpatient referral being the main reason. World Health Organization recommendations and other intervention strategies of outpatient\u2010focused care for malnourished but clinically stable infants u6m need to be tested. Breastfeeding support is likely central to future treatment strategies but may be insufficient alone. Better case definitions of nutritionally at\u2010risk infants are also needed.<\/jats:p>","DOI":"10.1111\/mcn.12642","type":"journal-article","created":{"date-parts":[[2018,7,4]],"date-time":"2018-07-04T08:09:45Z","timestamp":1530691785000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":26,"title":["Severe malnutrition in infants aged &lt;6\u00a0months\u2014Outcomes and risk factors in Bangladesh: A prospective cohort study"],"prefix":"10.1111","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8780-8760","authenticated-orcid":false,"given":"M.","family":"Munirul Islam","sequence":"first","affiliation":[{"name":"Nutrition and Clinical Services Division International Centre for Diarrhoeal Disease Research, Bangladesh (icddr, b)  Dhaka Bangladesh"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yasir","family":"Arafat","sequence":"additional","affiliation":[{"name":"Department of Health and Nutrition Save the Children Bangladesh  Dhaka Bangladesh"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nichola","family":"Connell","sequence":"additional","affiliation":[{"name":"Department of Global Health Save the Children USA  Washington District of Columbia USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Golam","family":"Mothabbir","sequence":"additional","affiliation":[{"name":"Department of Health and Nutrition Save the Children Bangladesh  Dhaka Bangladesh"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marie","family":"McGrath","sequence":"additional","affiliation":[{"name":"Emergency Nutrition Network  Oxford UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"James A.","family":"Berkley","sequence":"additional","affiliation":[{"name":"KEMRI\/Wellcome Trust Research Programme  Kilifi Kenya"},{"name":"The Childhood Acute Illness &amp; Nutrition Network (CHAIN)  Nairobi Kenya"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tahmeed","family":"Ahmed","sequence":"additional","affiliation":[{"name":"Nutrition and Clinical Services Division International Centre for Diarrhoeal Disease Research, Bangladesh (icddr, b)  Dhaka Bangladesh"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3745-7317","authenticated-orcid":false,"given":"Marko","family":"Kerac","sequence":"additional","affiliation":[{"name":"Department for Population Health &amp; MARCH Centre London School of Hygiene &amp; Tropical Medicine  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2018,7,4]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/S2214-109X(16)30096-1"},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.1038\/nrdp.2017.67"},{"key":"e_1_2_9_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(13)60937-X"},{"key":"e_1_2_9_5_1","doi-asserted-by":"publisher","DOI":"10.1177\/15648265150361S103"},{"key":"e_1_2_9_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.bpobgyn.2018.02.003"},{"key":"e_1_2_9_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpeds.2016.01.023"},{"key":"e_1_2_9_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(01)05630-6"},{"key":"e_1_2_9_9_1","doi-asserted-by":"publisher","DOI":"10.1177\/15648265060273S304"},{"key":"e_1_2_9_10_1","doi-asserted-by":"publisher","DOI":"10.7717\/peerj.380"},{"key":"e_1_2_9_11_1","unstructured":"Greenslade L.(2015).Architecture for impact: Nutrition and the Sustainable Development Goals. Available from:http:\/\/globalnutritionreport.org\/2015\/06\/17\/architecture\u2010for\u2010impact\u2010nutrition\u2010and\u2010the\u2010sustainable\u2010development\u2010goals\/(Accessed on September 23 2017)."},{"key":"e_1_2_9_12_1","doi-asserted-by":"publisher","DOI":"10.1111\/mcn.12345"},{"key":"e_1_2_9_13_1","unstructured":"Institute of Public Health Nutrition (IPHN) Director General of Health Services (DGHS) Ministry of Health and Family Welfare (MoHFW) Peoples Republic of Bangladesh (PRB). (2008).National guidelines for the management of severely malnourished children in Bangladesh. 2008. Available from:http:\/\/www.unicef.org\/bangladesh\/SAM_Guideline.pdf(Accessed on September 23 2017)."},{"key":"e_1_2_9_14_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11154-012-9216-6"},{"key":"e_1_2_9_15_1","volume-title":"Towards rollout of new WHO guidelines for improved management of severe acute malnutrition in infants aged <6\u00a0months: An AGREE appraisal of national guidelines","author":"Kerac M.","year":"2017"},{"key":"e_1_2_9_16_1","doi-asserted-by":"publisher","DOI":"10.1136\/adc.2010.191882"},{"key":"e_1_2_9_17_1","doi-asserted-by":"crossref","unstructured":"Kerac M. Frison S. Connell N. Page B. &McGrath M.(2016).Improving the management of acute malnutrition in infants aged under 6\u00a0months: Malnutrition risk factors identified from secondary analysis of twenty demographic and health surveys 3nd International Conference on Nutrition and Growth. 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