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Critical evaluation of the appetite test for children with severe acute malnutrition
Author(s) -
Zangenberg Mike,
Abdissa Alemseged,
Johansen Øystein H.,
Tesfaw Getnet,
Friis Henrik,
Briend André,
Eshetu Beza,
Kurtzhals Jørgen A. L.,
Girma Tsinuel
Publication year - 2020
Publication title -
tropical medicine and international health
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.056
H-Index - 114
eISSN - 1365-3156
pISSN - 1360-2276
DOI - 10.1111/tmi.13360
Subject(s) - medicine , malnutrition , appetite , poor appetite , observational study , logistic regression , pediatrics , test (biology) , acute care , emergency medicine , health care , paleontology , economics , biology , economic growth
Objectives The appetite test is used to risk stratify for children with severe acute malnutrition (SAM) in inpatient or outpatient care. The test is recommended in guidelines despite lack of evidence. We evaluated its ability to identify children at risk of a poor treatment outcome. Methods We conducted an observational study of children diagnosed with SAM at three health facilities in Ethiopia. The appetite test was done independently, and the result did not affect decisions about hospitalisation and clinical care. Data were analysed using mixed linear and logistic regression models. Results Appetite was tested in 298 (89%) of 334 children enrolled; 56 (19%) passed. Children failing the appetite test had a 6.6% higher weight gain per day (95% CI: 2.6, 10.8) adjusted for type of treatment, oedema, duration of follow‐up and age than children passing the test. We found medical complications in 179 (54%) children. Medical complications were associated with blood markers of metabolic disturbance. Children with medical complications tended to have lower weight gain than those without complications (3.5%, 95% CI: −0.25, 7.0). Neither the appetite test nor medical complications were correlated with bacteraemia or treatment failure. Conclusions Our findings question the use of the appetite test to identify children who need inpatient care. An assessment of medical complications alone could be a useful risk indicator but needs to be evaluated in other settings.