Preventing Relapse From Wasting: The Role of Sociodemographic, Child Feeding, and Health Care Determinants and of Wasting Prevention Interventions in Burkina Faso and Mali
Bibliographic record
Abstract
Background Relapse among children treated for wasting is a major concern. We estimated the frequency and determinants of relapse to wasting in two populations exposed to PROMIS, an integrated wasting prevention and screening program. Methods Using longitudinal data from PROMIS trials in Burkina Faso and Mali, we calculated the incidence rate and period prevalence of relapse to wasting within 6 months in children who had ≥1 wasting episode ending when they were ≥6 months old for which they were treated and recovered (N Burkina Faso =247; N Mali =220). We used backward elimination to select a multivariable model of sociodemographic, nutrition- and health-related determinants of relapse. We also evaluated if prevention interventions (behavior change communication (BCC) and/or small quantity lipid-based nutrient supplements (SQ-LNS) were associated with relapse, adjusting for confounders and trial arm. Results Relapse incidence was 2.6 per child-year in Burkina Faso (N=291 episodes) and 1.6 per child-year in Mali (N=300 episodes). In both countries, being fed the recommended food frequency or iron-rich foods after recovering from wasting was associated with lower risk of relapse. In Mali, longer wasting episodes, lack of minimally diverse diet consumption, and several caregiver/household characteristics were associated with lower risk of relapse. In both countries, receipt of BCC after recovery from wasting was associated with lower risk of relapse (Incidence rate ratio [IRR] Burkina Faso = 0.51 [95% confidence interval [CI] = 0.30, 0.86]; IRR Mali = 0.26 [95% CI = 0.11, 0.65]), as was receipt of SQ-LNS (IRR Burkina Faso = 0.33 [95% CI = 0.16, 0.70]; (IRR Mali = 0.43 [95% CI = 0.19, 0.94]), after adjustments. Conclusion Children being discharged from wasting treatment are a well-defined vulnerable population who stand to benefit from targeted post-discharge preventive interventions. BCC that includes advice on optimal infant and young child feeding practices and SQ-LNS may help prevent wasting relapse in at-risk children.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.004 | 0.007 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".