Clinical validation of appetite assessment tools for predicting short-term treatment outcomes in children with Severe Acute Malnutrition: APPT-SAM STUDY

Severe acute malnutrition (SAM) is a pervasive problem throughout resource-limited settings. Appetite assessment plays a critical role in both international and national SAM management guidelines, as it helps to differentiate between complicated and uncomplicated cases, which directly guides decisions regarding the level of care, whether inpatient or outpatient, and determines the treatment outcome. However, the evidence supporting these recommendations is limited. Therefore, this study aims to evaluate the ability of the appetite assessment tools in predicting short-term treatment outcomes in children diagnosed with SAM. The primary objective of the project is to clinically validate the accuracy of three appetite assessment tools in predicting short-term treatment outcomes in children with SAM. The secondary objective is to assess the main drivers of appetite recovery following treatment. An institution-based observational study is being conducted in Gondar, Ethiopia, from November 2024 to April 2027. A total of 350 children aged 6-59 months diagnosed with SAM will be enrolled in the study. The primary outcomes will be failure to respond to treatment, and the secondary outcomes include mortality, complications, and average weight gain. At enrollment, trained data collectors will gather sociodemographic, clinical, and nutritional data. The child’s appetite will be assessed using the standard “appetite test” along with two newly developed tools. One tool involves observing the child’s eating behavior, while the other is a parent-rated questionnaire designed specifically for children with SAM. The enrolled children will be monitored daily until discharge or death during inpatient treatment and weekly for four weeks during outpatient treatment. Clinical, anthropometric, and appetite assessments will be conducted at all visits. Our study findings may help justify the continued use of appetite assessment and propose a novel, simple, rapid, and objective tool for assessing appetite in low-resource settings that would be capable of identifying medical complications and predicting treatment outcomes. Improved risk stratification could reduce unnecessary hospital admissions, which are often associated with higher mortality rates, nosocomial infections, antimicrobial resistance, and strain on resources for both the family and health systems.