PDF(Pubmed)
Abstract：
Severe acute malnutrition (SAM) is the most serious form of acute malnutrition and is associated with high mortality risk among children under 5. While the Community-based Management of Acute Malnutrition (CMAM) approach, recommended for treating cases of uncomplicated SAM, has increased treatment coverage and recovery outcomes, high relapse rates have been reported. Several risk factors for SAM relapse, such as insufficient food intake and high infectious disease burden in the community, have been identified. However, the role of household water, sanitation and hygiene (WASH) conditions remains unclear. This systematic review: (1) assesses the effectiveness of WASH interventions on preventing SAM relapse and (2) identifies WASH-related conditions associated with relapse to SAM among children aged 6-59 months discharged as recovered following SAM CMAM treatment. We performed electronic searches of six databases to identify relevant studies published between 1 January 2000 and 6 November 2023 and assessed their quality. After deduplication, 10,294 documents were screened by title and abstract, with 13 retrieved for full-text screening. We included three studies ranging from low- to medium-quality. One intervention study found that providing a WASH kit during SAM outpatient treatment did not reduce the risk of relapse to SAM. Two observational studies found inconsistent associations between household WASH conditions-unimproved sanitation and unsafe drinking water-and SAM relapse. Despite the paucity of evidence, the hypothesised causal pathways between WASH conditions and the risk of relapse remain plausible. Further evidence is needed to identify interventions for an integrated postdischarge approach to prevent relapse.
摘要：
严重急性营养不良（SAM）是急性营养不良的最严重形式，与5岁以下儿童的高死亡风险有关。虽然基于社区的急性营养不良管理(CMAM)方法，推荐用于治疗不复杂的SAM病例，增加了治疗覆盖率和恢复结果，据报道，复发率很高。SAM复发的几个危险因素，如食物摄入不足和社区传染病负担高，已被确认。然而,家庭用水的作用，环境卫生和个人卫生（WASH）条件仍不清楚。本系统评价：（1）评估WASH干预措施在预防SAM复发方面的有效性；（2）在SAMCMAM治疗后康复的6-59个月儿童中，确定与SAM复发相关的WASH相关状况。我们对六个数据库进行了电子搜索，以确定2000年1月1日至2023年11月6日之间发表的相关研究，并评估其质量。重复数据删除后，10294份文件按标题和摘要进行了筛选，检索到13个进行全文筛选。我们纳入了三项从低质量到中等质量的研究。一项干预研究发现，在SAM门诊治疗期间提供WASH试剂盒并不能降低SAM复发的风险。两项观察性研究发现，家庭WASH条件-未改善的卫生条件和不安全的饮用水-与SAM复发之间存在不一致的关联。尽管证据不足,假设的WASH条件和复发风险之间的因果途径仍然是合理的.需要进一步的证据来确定综合出院后预防复发的干预措施。
