{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,26]],"date-time":"2026-09-26T05:23:41Z","timestamp":1790400221575,"version":"4.1.0"},"reference-count":28,"publisher":"Public Library of Science (PLoS)","issue":"2","license":[{"start":{"date-parts":[[2021,2,3]],"date-time":"2021-02-03T00:00:00Z","timestamp":1612310400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000200","name":"United States Agency for International Development","doi-asserted-by":"publisher","award":["AID-OFDA-G-14-00208"],"award-info":[{"award-number":["AID-OFDA-G-14-00208"]}],"id":[{"id":"10.13039\/100000200","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000200","name":"United States Agency for International Development","doi-asserted-by":"publisher","award":["AID-OFDA-G-14-00208"],"award-info":[{"award-number":["AID-OFDA-G-14-00208"]}],"id":[{"id":"10.13039\/100000200","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100010409","name":"Children\u2019s Investment Fund Foundation","doi-asserted-by":"publisher","award":["'Reinventing community management of acute malnutrition'"],"award-info":[{"award-number":["'Reinventing community management of acute malnutrition'"]}],"id":[{"id":"10.13039\/100010409","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100010409","name":"Children\u2019s Investment Fund Foundation","doi-asserted-by":"publisher","award":["'Reinventing community management of acute malnutrition'"],"award-info":[{"award-number":["'Reinventing community management of acute malnutrition'"]}],"id":[{"id":"10.13039\/100010409","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Action Against Hunger Foundation","award":["'Are there long-term effects for children treated for MAM using RUTF'"],"award-info":[{"award-number":["'Are there long-term effects for children treated for MAM using RUTF'"]}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Introduction<\/jats:title>\n<jats:p>Severe and moderate acute malnutrition (SAM and MAM) affect more than 50 million children worldwide yet 80% of these children do not access care. The Combined Protocol for Acute Malnutrition Study (ComPAS) trial assessed the effectiveness of a simplified, combined SAM\/MAM protocol for children aged 6\u201359 months and found non-inferior recovery compared to standard care. To further inform policy, this study assessed post-discharge outcomes of children treated with this novel protocol in Kenya.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Methods<\/jats:title>\n<jats:p>Six \u2018combined\u2019 protocol clinics treated SAM and MAM children using an optimised mid-upper arm circumference (MUAC)-based dose of ready-to-use therapeutic food (RUTF). Six \u2018standard care\u2019 clinics treated SAM with weight-based RUTF rations; MAM with ready-to-use supplementary food (RUSF). Four months post-discharge, we assessed anthropometry, recent history of illness, and body composition by bioelectrical impedance analysis. Data was analysed using multivariable linear regression, adjusted for age, sex and allowing for clustering by clinic.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Results<\/jats:title>\n<jats:p>We sampled 850 children (median age 18 months, IQR 15\u201323); 44% of the original trial sample in Kenya. Children treated with the combined protocol had similar anthropometry, fat-free mass, fat mass, skinfold thickness z-scores, and frequency of common illnesses 4 months post-discharge compared the standard protocol. Mean subscapular skinfold z-scores were close to the global norm (standard care: 0.24; combined 0.27). There was no significant difference in odds of relapse between protocols (SAM, 3% vs 3%, OR = 1.0 p = 0.75; MAM, 10% vs 12%, OR = 0.90 p = 0.34).<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>Conclusions<\/jats:title>\n<jats:p>Despite the lower dosage of RUTF for most SAM children in the combined protocol, their anthropometry and relapse rates at 4 months post-discharge were similar to standard care. MAM children treated with RUTF had similar body composition to those treated with RUSF and neither group exhibited excess adiposity. These results add further evidence that a combined protocol is as effective as standard care with no evidence of adverse effects post-discharge. A simplified, combined approach could treat more children, stretch existing resources further, and contribute to achieving Sustainable Development Goal Two.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0245477","type":"journal-article","created":{"date-parts":[[2021,2,3]],"date-time":"2021-02-03T18:32:37Z","timestamp":1612377157000},"page":"e0245477","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":27,"title":["Relapse and post-discharge body composition of children treated for acute malnutrition using a simplified, combined protocol: A nested cohort from the ComPAS RCT"],"prefix":"10.1371","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8452-0198","authenticated-orcid":true,"given":"Natasha","family":"Lelijveld","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eunice","family":"Musyoki","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Susan Were","family":"Adongo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amy","family":"Mayberry","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jonathan C.","family":"Wells","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Charles","family":"Opondo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3745-7317","authenticated-orcid":true,"given":"Marko","family":"Kerac","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4343-4939","authenticated-orcid":true,"given":"Jeanette","family":"Bailey","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2021,2,3]]},"reference":[{"issue":"9608","key":"pone.0245477.ref001","doi-asserted-by":"crossref","first-page":"243","DOI":"10.1016\/S0140-6736(07)61690-0","article-title":"Maternal and child undernutrition: global and regional exposures and health consequences","volume":"371","author":"RE Black","year":"2008","journal-title":"The lancet"},{"key":"pone.0245477.ref002","volume-title":"2018 Global Nutrition Report: Shining a light to spur action on nutrition","author":"D Initiatives","year":"2018"},{"key":"pone.0245477.ref003","unstructured":"Lives NW. The State of Acute Malnutrition [https:\/\/acutemalnutrition.org\/en\/countries]."},{"issue":"1","key":"pone.0245477.ref004","doi-asserted-by":"crossref","first-page":"241","DOI":"10.3945\/ajcn.113.072538","article-title":"Treating moderate acute malnutrition in first-line health services: an effectiveness cluster-randomized trial in Burkina Faso","volume":"100","author":"L Niki\u00e8ma","year":"2014","journal-title":"The American journal of clinical nutrition"},{"key":"pone.0245477.ref005","unstructured":"van der Kam S. Does a short term nutritional supplementation prevent malnutrition in ill children? PhD Thesis. 2017."},{"issue":"1","key":"pone.0245477.ref006","doi-asserted-by":"crossref","first-page":"251","DOI":"10.1186\/s13063-018-2643-2","article-title":"Combined Protocol for Acute Malnutrition Study (ComPAS) in rural South Sudan and urban Kenya: study protocol for a randomized controlled trial","volume":"19","author":"J Bailey","year":"2018","journal-title":"Trials"},{"issue":"1","key":"pone.0245477.ref007","doi-asserted-by":"crossref","first-page":"252","DOI":"10.1186\/s13063-018-2594-7","article-title":"The\" ComPAS Trial\" combined treatment model for acute malnutrition: study protocol for the economic evaluation","volume":"19","author":"N Lelijveld","year":"2018","journal-title":"Trials"},{"issue":"7","key":"pone.0245477.ref008","doi-asserted-by":"crossref","first-page":"e1003192","DOI":"10.1371\/journal.pmed.1003192","article-title":"A simplified, combined protocol versus standard treatment for acute malnutrition in children 6\u201359 months (ComPAS trial): A cluster-randomized controlled non-inferiority trial in Kenya and South Sudan","volume":"17","author":"J Bailey","year":"2020","journal-title":"PLoS Med"},{"key":"pone.0245477.ref009","doi-asserted-by":"crossref","unstructured":"Shrimpton R, Rokx C. The double burden of malnutrition: a review of global evidence. World Bank; 2012.","DOI":"10.1596\/27417"},{"key":"pone.0245477.ref010","doi-asserted-by":"crossref","unstructured":"Singhal A. The global epidemic of noncommunicable disease: the role of early-life factors. 2014.","DOI":"10.1159\/000354951"},{"issue":"8","key":"pone.0245477.ref011","doi-asserted-by":"crossref","first-page":"e0202053","DOI":"10.1371\/journal.pone.0202053","article-title":"Follow-up between 6 and 24 months after discharge from treatment for severe acute malnutrition in children aged 6\u201359 months: A systematic review","volume":"13","author":"NP O\u2019Sullivan","year":"2018","journal-title":"PloS one"},{"issue":"2","key":"pone.0245477.ref012","doi-asserted-by":"crossref","first-page":"e12702","DOI":"10.1111\/mcn.12702","article-title":"Relapse after severe acute malnutrition: A systematic literature review and secondary data analysis","volume":"15","author":"HC Stobaugh","year":"2019","journal-title":"Maternal & child nutrition"},{"issue":"Supplement 1","key":"pone.0245477.ref013","doi-asserted-by":"crossref","first-page":"15S","DOI":"10.1177\/15648265040251S104","article-title":"The WHO Multicentre Growth Reference Study: planning, study design, and methodology","volume":"25","author":"M de Onis","year":"2004","journal-title":"Food & Nutrition Bulletin"},{"key":"pone.0245477.ref014","unstructured":"de Onis M. WHO Child Growth Standards: length\/height-for-age, weight-for-age, weight-for-length, weight-for-height and body mass index-for-age. 2006."},{"key":"pone.0245477.ref015","article-title":"Bioimpedance index for measurement of total body water in severely malnourished children: Assessing the effect of nutritional oedema","author":"T Girma","year":"2015","journal-title":"Clinical Nutrition"},{"key":"pone.0245477.ref016","doi-asserted-by":"crossref","first-page":"534","DOI":"10.1038\/ki.1994.305","article-title":"A new method for monitoring body flid variation by bioimpedance analysis: The RXc graph","volume":"46","author":"A Piccoli","year":"1994","journal-title":"Kidney international"},{"issue":"12","key":"pone.0245477.ref017","doi-asserted-by":"crossref","first-page":"1776","DOI":"10.1017\/S0007114509991255","article-title":"Body composition by 2 H dilution in Gambian infants: comparison with UK infants and evaluation of simple prediction methods","volume":"102","author":"JC Wells","year":"2009","journal-title":"British journal of nutrition"},{"issue":"3","key":"pone.0245477.ref018","doi-asserted-by":"crossref","first-page":"713","DOI":"10.1016\/j.clnu.2015.05.002","article-title":"Bioimpedance index for measurement of total body water in severely malnourished children: Assessing the effect of nutritional oedema","volume":"35","author":"T Girma","year":"2016","journal-title":"Clinical nutrition"},{"issue":"6","key":"pone.0245477.ref019","doi-asserted-by":"crossref","first-page":"854","DOI":"10.1016\/j.clnu.2012.05.008","article-title":"Bioelectrical phase angle and impedance vector analysis\u2013clinical relevance and applicability of impedance parameters","volume":"31","author":"K Norman","year":"2012","journal-title":"Clinical Nutrition"},{"key":"pone.0245477.ref020","doi-asserted-by":"crossref","first-page":"402","DOI":"10.1016\/j.worlddev.2017.01.006","article-title":"Who are the world\u2019s food insecure? New evidence from the Food and Agriculture Organization\u2019s food insecurity experience scale","volume":"93","author":"MD Smith","year":"2017","journal-title":"World Development"},{"key":"pone.0245477.ref021","article-title":"Chronic disease outcomes after severe acute malnutrition in Malawian children (ChroSAM): a cohort study","author":"N Lelijveld","year":"2016","journal-title":"The Lancet Global Health"},{"issue":"11","key":"pone.0245477.ref022","doi-asserted-by":"crossref","first-page":"2604","DOI":"10.3945\/jn.115.214957","article-title":"Severe and moderate acute malnutrition can be successfully managed with an integrated protocol in Sierra Leone","volume":"145","author":"A Maust","year":"2015","journal-title":"The Journal of nutrition"},{"issue":"1","key":"pone.0245477.ref023","doi-asserted-by":"crossref","first-page":"5981","DOI":"10.1038\/s41598-019-42436-y","article-title":"Biomarkers of post-discharge mortality among children with complicated severe acute malnutrition","volume":"9","author":"JM Njunge","year":"2019","journal-title":"Scientific reports"},{"issue":"6","key":"pone.0245477.ref024","doi-asserted-by":"crossref","first-page":"2128","DOI":"10.1210\/jc.2013-4018","article-title":"Severe acute malnutrition in childhood: hormonal and metabolic status at presentation, response to treatment, and predictors of mortality","volume":"99","author":"S Bartz","year":"2014","journal-title":"The Journal of Clinical Endocrinology & Metabolism"},{"key":"pone.0245477.ref025","first-page":"e13107","article-title":"Relapse and regression to severe wasting in children under 5 years: A theoretical framework","volume":"2020","author":"R Schaefer","journal-title":"Maternal & Child Nutrition"},{"issue":"8","key":"pone.0245477.ref026","doi-asserted-by":"crossref","first-page":"e1002887","DOI":"10.1371\/journal.pmed.1002887","article-title":"Impact of reduced dose of ready-to-use therapeutic foods in children with uncomplicated severe acute malnutrition: A randomised non-inferiority trial in Burkina Faso","volume":"16","author":"ST Kangas","year":"2019","journal-title":"PLoS medicine"},{"issue":"1","key":"pone.0245477.ref027","doi-asserted-by":"crossref","first-page":"24","DOI":"10.1186\/s13690-016-0136-x","article-title":"Safety and practicability of using mid-upper arm circumference as a discharge criterion in community based management of severe acute malnutrition in children aged 6 to 59 months programmes","volume":"74","author":"PJ Binns","year":"2016","journal-title":"Archives of Public Health"},{"issue":"4","key":"pone.0245477.ref028","doi-asserted-by":"crossref","first-page":"253","DOI":"10.1093\/tropej\/fmr083","article-title":"A follow-up experience of 6 months after treatment of children with severe acute malnutrition in Dhaka, Bangladesh","volume":"58","author":"H Ashraf","year":"2011","journal-title":"Journal of tropical pediatrics"}],"container-title":["PLOS ONE"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0245477","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,2,3]],"date-time":"2021-02-03T18:33:13Z","timestamp":1612377193000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0245477"}},"subtitle":[],"editor":[{"given":"Samson","family":"Gebremedhin","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2021,2,3]]},"references-count":28,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2021,2,3]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0245477","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,2,3]]}}}