{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,17]],"date-time":"2026-01-17T03:56:24Z","timestamp":1768622184954,"version":"3.49.0"},"reference-count":19,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2022,11,26]],"date-time":"2022-11-26T00:00:00Z","timestamp":1669420800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2022,11,26]],"date-time":"2022-11-26T00:00:00Z","timestamp":1669420800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/100018185","name":"Office of U.S. Foreign Disaster Assistance","doi-asserted-by":"publisher","award":["720FDA19GR00278"],"award-info":[{"award-number":["720FDA19GR00278"]}],"id":[{"id":"10.13039\/100018185","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["BMC Nutr"],"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n                <jats:title>Background<\/jats:title>\n                <jats:p>Community-based management of acute malnutrition (CMAM) is an effective intervention at recovering children from severe acute malnutrition (SAM) and preventing mortality. However, there is growing evidence that for many children recovery is not sustained post-discharge. This study will assess the economic implications of relapse by calculating the average cost of treating a case of SAM that relapses after initial CMAM treatment compared to the cost of a case that remains recovered for 6\u00a0months post-discharge.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Methods<\/jats:title>\n                <jats:p>This protocol outlines the methods for a cost-efficiency analysis to assess cost per episode of treatment for acute malnutrition for children enrolled in CMAM programs for initial SAM treatment in Mali, Somalia and South Sudan. Cost data will be collected and analyzed on a monthly basis for each CMAM service component (outpatient treatment program for SAM, supplementary feeding program for moderate acute malnutrition, and inpatient stabilization care for SAM with medical complications). Financial data will be extracted from expenditure records from institutional accounting systems where possible. Where these are not present, cost data will be collected via interview and review of financial documents. Staff time allocation interviews will be conducted. This data will be applied to quantify personnel costs, to apportion costs that are shared between programs and to exclude staff time spent on research activities.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Discussion<\/jats:title>\n                <jats:p>This study will provide the first estimates to address the limited evidence on the economic implications of SAM relapse in CMAM programs. Data from this economic analysis will help raise awareness and provide actionable data for the global nutrition community to address the financial burden of relapse. Estimating the cost of relapse in three countries representing different geographic and operational contexts will help in generalizing these results.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Trial registration<\/jats:title>\n                <jats:p>Registration # IORG0007116, Date of registration: 06\/09\/2020. This study is not registered as a clinical trial as it is observational research and does not include an intervention. The study has received the required ethical approvals as outlined in the declarations.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1186\/s40795-022-00631-7","type":"journal-article","created":{"date-parts":[[2022,11,27]],"date-time":"2022-11-27T01:19:13Z","timestamp":1669511953000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["A multi-country, prospective cohort study to evaluate the economic implications of relapse among children recovered from severe acute malnutrition: a study protocol"],"prefix":"10.1186","volume":"8","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5163-5933","authenticated-orcid":false,"given":"Chloe","family":"Puett","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sarah","family":"King","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Heather","family":"Stobaugh","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2022,11,26]]},"reference":[{"issue":"9551","key":"631_CR1","doi-asserted-by":"publisher","first-page":"1992","DOI":"10.1016\/S0140-6736(06)69443-9","volume":"368","author":"S Collins","year":"2006","unstructured":"Collins S, Dent N, Binns P, Bahwere P, Sadler K, Hallam A. Management of severe acute malnutrition in children. Lancet. 2006;368(9551):1992\u20132000.","journal-title":"Lancet"},{"key":"631_CR2","doi-asserted-by":"publisher","first-page":"a2180","DOI":"10.1136\/bmj.a2180","volume":"337","author":"MJ Manary","year":"2008","unstructured":"Manary MJ, Sandige HL. Management of acute moderate and severe childhood malnutrition. BMJ. 2008;337:a2180.","journal-title":"BMJ"},{"key":"631_CR3","volume-title":"Community-based management of severe acute malnutrition: a joint statement by the World Health Organization, the World Food Programme, the United Nations System Standing Committee on Nutrition and the United Nations Children\u2019s Fund","author":"WHO, WFP, UNSCN, UNICEF","year":"2007","unstructured":"WHO, WFP, UNSCN, UNICEF. Community-based management of severe acute malnutrition: a joint statement by the World Health Organization, the World Food Programme, the United Nations System Standing Committee on Nutrition and the United Nations Children\u2019s Fund. New York: United Nations Children\u2019s Fund; 2007."},{"issue":"8","key":"631_CR4","doi-asserted-by":"publisher","first-page":"e0202053","DOI":"10.1371\/journal.pone.0202053","volume":"13","author":"NP O\u2019Sullivan","year":"2018","unstructured":"O\u2019Sullivan NP, Lelijveld N, Rutishauser-Perera A, Kerac M, James P. Follow-up between 6 and 24 months after discharge from treatment for severe acute malnutrition in children aged 6\u201359 months: a systematic review. 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(June 2020, Reference: MOH\/ERB 6\/2020).The costing sub-study did not collect individual data from participants, but instead used institutional-level accounting data and interviews with program staff (MoH and ACF) regarding their time allocation and material costs related to the CMAM activities. Therefore consent for the costing study was not obtained. For the overarching SAM Relapse study, written consent was obtained as follows. On the day of enrollment, participants are informed about the duration and requirements of participation in the study along with the potential harms and benefits of participation through an interactive oral presentation and through written consent forms. Caregivers are repeatedly told that participation is voluntary, and they can stop study participation at any time without consequences for the care they might receive. Only participants who express continued interest in the study after being fully informed are enrolled. As study participants are under 16\u00a0years old, consent forms are signed and dated by the responsible caregiver for the participating child. In the case of illiterate participants, a participant draws a cross in replacement of a signature. If study participants withdraw from the study after enrollment, any data already collected and analyzed will be used, unless the participant requests otherwise; however, no further analysis will be done, nor samples kept. All electronic data will be stored on a study-specific password-protected encrypted server and located within a protected network to enable safe access. All patient files and data collection forms will be maintained securely in a locked file throughout the study to ensure participant confidentiality. The study is conducted in accordance with ICH-GCP E6 guidelines.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not applicable","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare that they have no competing interests.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"139"}}