Childhood growth during recovery from acute illness in Africa and South Asia: a secondary analysis of the childhood acute illness and nutrition (CHAIN) prospective cohort

Background Growth faltering is well -recognized during acute childhood illness and growth acceleration during convalescence, with or without nutritional therapy, may occur. However, there are limited recent data on growth after hospitalization in low- and middle -income countries. Methods We evaluated growth following hospitalization among children aged 2 - 23 months in sub-Saharan Africa and South Asia. Between November 2016 and January 2019, children were recruited at hospital admission and classi fi ed as: not -wasted (NW), moderately -wasted (MW), severely -wasted (SW), or having nutritional oedema (NO). We describe earlier (discharge to 45 -days) and later (45- to 180 -days) changes in length -for -age [LAZ], weight -for -age [WAZ], mid -upper arm circumference [MUACZ], weight -for -length [WLZ] z -scores, and clinical, nutritional, and socioeconomic correlates. Findings We included 2472 children who survived to 180 -days post -discharge: NW, 960 (39%); MW, 572 (23%); SW, 682 (28%); and NO, 258 (10%). During 180 -days, LAZ decreased in NW ( - 0.27 [ - 0.36, - 0.19]) and MW ( - 0.23 [ - 0.34, - 0.11]). However, all groups increased WAZ (NW, 0.21 [95% CI: 0.11, 0.32]; MW, 0.57 [0.44, 0.71]; SW, 1.0 [0.88, 1.1] and NO, 1.3 [1.1, 1.5]) with greatest gains in the first 45 -days. Of children underweight (< - 2 WAZ) at discharge, 66% remained underweight at 180 -days. Lower WAZ post -discharge was associated with ageinappropriate nutrition, adverse caregiver characteristics, small size at birth, severe or moderate anaemia, and chronic conditions, while lower LAZ was additionally associated with household -level exposures but not with chronic medical conditions. Interpretation Underweight and poor linear growth mostly persisted after an acute illness. Beyond short-term nutritional supplementation, improving linear growth post -discharge may require broader individual and family support.