Applying WHO Prioritization Criteria for Moderate Wasting: Programmatic Implications

Abstract

The World Health Organization's 2023 recommendations for managing moderate wasting provide criteria for prioritizing children to receive specially formulated foods (SFF) rather than counseling alone. However, the practical programmatic impact of such prioritization is unclear. This secondary analysis aimed to describe the caseload and treatment outcomes among moderately wasted 6- to 59-month-old Malian children, categorized into higher-priority (HP) and lower-priority (LP) groups. All children admitted with a MUAC ≥ 115 to < 125 mm without nutritional edema received SFF (500 kcal/day) until they achieved a MUAC ≥ 125 mm for 2 consecutive visits. HP criteria were < 2 years old, WAZ < −3 SD, or MUAC 115–119 mm; LP criteria were ≥ 2 years, WAZ ≥ −3 SD, or MUAC ≥ 120 mm. We reported the caseload per priority criterion and compared treatment outcomes, including recovery and anthropometric changes, between LP and HP children. Of the 35 685 children included in the analysis, 95% met at least one priority criterion. The proportion of children recovered was similar between LP and HP children, regardless of the criterion used. MUAC-for-age z-score and WAZ weekly changes showed similar trajectories. Furthermore, although classified as LP, children > 2 years exhibited lower WAZ throughout treatment compared to children < 2 years. Most moderately wasted children (MUAC < 125 mm) met at least one priority criterion, raising concerns about the feasibility and rationale of the prioritization approach. The similar recovery rates in higher- and lower-priority groups after both received SFF highlight the need for research to assess the impact of different interventions.