{
  "abstract": "Background In 2023, the WHO recommended prioritising treatment for moderately wasted children with higher risk characteristics, including mid-upper arm circumference (MUAC) 115–119 mm, weight-for-age z-score (WAZ) <–3, age <24 months or clinical and social vulnerabilities. However, applying multiple criteria is operationally challenging. The OptiMA (Optimising Acute Malnutrition Treatment) protocol treats children with MUAC <125 mm or oedema using reduced doses of ready-to-use therapeutic food. This study examined the distribution and programmatic relevance of WHO prioritisation criteria among moderately wasted children in West and central Africa.Methods A prospective observational cohort was conducted in 2022–2024 among children aged 6–59 months treated under OptiMA in Ngouri (Chad), Bamako (Mali) and Mirriah (Niger). Children with MUAC 115–124 mm in the higher-priority group (defined by MUAC 115–119 mm, WAZ <–3 or age <24 months) were compared with children in the lower-priority group (none of these criteria) across recovery, non-response, hospitalisation and death. A multinomial logistic regression model assessed associations between individual criteria and treatment failure.Results A total of 87 961 moderate wasting treatment episodes were analysed. Overall, 97.4% of children met at least one WHO higher-priority criterion, of whom 42.5% had a MUAC 115–119 mm. Among children with MUAC 120–124 mm, 46.1% were <24 months, 18.7% WAZ<–3 and 30.6% met both criteria. Recovery was high (85%–90%) and mortality was low (<0.4%) in both higher-priority and lower-priority groups. WAZ <–3 emerged as the strongest independent predictor of adverse outcomes.Conclusions Nearly all moderately wasted children managed under OptiMA met at least one WHO higher-priority criterion, calling into question the need for further risk stratification in areas using MUAC-based simplified combined protocols. Such protocols may need to be adapted, though, to include other higher-priority children, like those with WAZ <–3 and MUAC ≥125 mm.",
  "authors": [
    {
      "affiliations": [
        "Bordeaux Population Health Research Centre, University of Bordeaux, Bordeaux, France"
      ],
      "name": "Maguy Daures"
    },
    {
      "affiliations": [
        "ALIMA, Dakar, Senegal"
      ],
      "name": "Ibrahim Sana"
    },
    {
      "affiliations": [
        "ALIMA, Dakar, Senegal"
      ],
      "name": "Wah Coulibaly"
    },
    {
      "affiliations": [
        "ALIMA, Dakar, Senegal"
      ],
      "name": "Mahaman Nouhou"
    },
    {
      "affiliations": [
        "ALIMA, Dakar, Senegal"
      ],
      "name": "Susan Shepherd"
    },
    {
      "affiliations": [
        "Bordeaux Population Health Research Centre, University of Bordeaux, Bordeaux, France"
      ],
      "name": "Renaud Becquet"
    },
    {
      "affiliations": [
        "ALIMA, Paris, France"
      ],
      "name": "Kevin Phelan"
    }
  ],
  "title": "Assessing WHO prioritisation criteria for children 6–59 months treated for moderate wasting in a MUAC-based protocol: a multicountry analysis in West and Central Africa",
  "uid": "36a5fad9-0fb9-5b55-acf5-e463a6c8103b"
}