Children with Moderate Acute Malnutrition with No Access to Supplementary Feeding Programmes Experience High Rates of Deterioration and No Improvement: Results from a Prospective Cohort Study in Rural Ethiopia

Background: Children with moderate acute malnutrition (MAM) have an increased risk of mortality, infections and impaired physical and cognitive development compared to well-nourished children. In parts of Ethiopia not considered chronically food insecure there are no supplementary feeding programmes (SFPs) for treating MAM. The short-term outcomes of children who have MAM in such areas are not currently described, and there remains an urgent need for evidence-based policy recommendations. Methods: We defined MAM as mid-upper arm circumference (MUAC) of ≥11.0cm and <12.5cm with no bilateral pitting oedema to include Ethiopian government and World Health Organisation cut-offs. We prospectively surveyed 884 children aged 6–59 months living with MAM in a rural area of Ethiopia not eligible for a supplementary feeding programme. Weekly home visits were made for seven months (28 weeks), covering the end of peak malnutrition through to the post-harvest period (the most food secure window), collecting anthropometric, socio-demographic and food security data. Results: By the end of the study follow up, 32.5% (287/884) remained with MAM, 9.3% (82/884) experienced at least one episode of SAM (MUAC <11cm and/or bilateral pitting oedema), and 0.9% (8/884) died. Only 54.2% of the children recovered with no episode of SAM by the end of the study. Of those who developed SAM half still had MAM at the end of the follow up period. The median (interquartile range) time to recovery was 9 (4–15) weeks. Children with the lowest MUAC at enrolment had a significantly higher risk of remaining with MAM and a lower chance of recovering. Conclusions: Children with MAM during the post-harvest season in an area not eligible for SFP experience an extremely high incidence of SAM and a low recovery rate. Not having a targeted nutrition-specific intervention to address MAM in this context places children with MAM at excessive risk of adverse outcomes. Further preventive and curative approaches should urgently be considered

Children and Youth Perceptions of Family Food Insecurity and Bullying

Children at high risk for going to school or bed hungry are also at risk to develop psychosocial problems at school. These psychosocial problems are associated with bullying. To date, no empirical studies examine the association between going to school or bed hungry (i.e., food insecurity) and bullying. Perceptions of food insecurity are aligned with perceived social standing, and this study is guided by the conceptual framework that youth subjective appraisal of their social standing is associated with psychosocial problems. This study uses a representative US sample of 12,642 students from the “Health Behaviour in School-aged Children” survey. Omnibus Kruskal–Wallis and pairwise test statistically analyze the data. Findings indicate food-insecure students bully others and are victims of bullying more frequently than food-secure students. These results suggest food not only impacts health, but perceptions of lack of food are related to psychosocial problems in the form of school bullying. Schools can implement treatment models that address individual-level psychosocial perceptions to advance positive youth developmental trajectories and prevent food insecurity and bullying