The marked improvement in global under 5 mortality has not been matched by improvements in children’s nutritional status. In 2013, an estimated 161m under fives were stunted (HAZ <-2; 25% of the world’s children), 51m were wasted (WHZ <-2; 8%) and 17m were severely wasted (WHZ <-3; 3%). Undernutrition was considered to underlie almost 50% of the 6.3m child deaths that occurred in 2013 and severe acute malnutrition (SAM) to account directly for 1m under 5 deaths.
The outcomes for children admitted to hospitals with SAM remain very poor. It has long been recognised that children with SAM have intestinal inflammation that is not addressed adequately by current management. The gut lesion has many similarities with that seen in inflammatory bowel disease and food intolerance in industrialised countries. Working with colleagues based in the Queen Elizabeth Central Hospital and College of Medicine, Blantyre, Malawi and the University of Toronto, Canada, we will be evaluating the use of hypoallergenic and anti-inflammatory formula feeds, used as first line management in the UK, in Malawian children with complicated SAM. This trial is funded through a MRC/DfID/Wellcome Global Health Trials Development Grant. We are collaborating in a study led by from the University of Nottingham, UK, in the effects of microfinance on child growth with colleagues based at Patna Medical College, Bihar, India.