Relapsed Children

Outcome

% of children who relapse within 6 months after recovery from severe wasting treatment

The indicator measures the proportion of children aged 6–59 months who, after being discharged as recovered from treatment for severe wasting and/or nutritional oedema, develop a new episode of severe wasting and/or nutritional oedema within six months. It assesses whether recovery is sustained after treatment.

Identify a cohort of children aged 6–59 months who were discharged as recovered from treatment for severe wasting and/or nutritional oedema and follow them at regular intervals (monthly where feasible) for six months after discharge. Count a child as having relapsed if, during this period, the child develops a new episode that meets the programme’s current admission criteria for severe wasting and/or nutritional oedema. Divide the number of children who relapse by the total number of children discharged as recovered and multiply by 100. Report the number and proportion of children whose status could not be ascertained during the six-month follow-up period.

Use the national programme’s admission and discharge criteria consistently and document them. WHO 2023 recommends that children aged 6–59 months with severe wasting and/or nutritional oedema exit nutritional treatment only when WHZ/WLZ is ≥−2 and MUAC is ≥125 mm for at least two consecutive visits/measurements, and nutritional oedema has been absent for at least two consecutive visits/measurements. Where national protocols use different criteria, document this, as it can affect comparability of relapse results.

This data can be disaggregated by sex, age group, and treatment site/geographical area.

1) Measuring true relapse requires post-discharge follow-up; routine treatment records alone capture only children who return for care and therefore measure readmission rather than all relapse. If active follow-up is not feasible, report readmission within six months as a separate proxy and state that it is likely to underestimate relapse.

2) CORTASAM recommends defining relapse as a new episode occurring within six months after discharge as recovered (see guidance below). This differs from the 2015 Standardised Indicators and Categories for Better CMAM Reporting, which classified relapse as readmission within two months after recovery. Results based on these approaches are not directly comparable.

3) Relapse applies only after recovery. Children who defaulted or left treatment without meeting recovery criteria and subsequently meet treatment criteria should not be counted as relapse; these represent ongoing episodes or regression after incomplete recovery.

4) There is currently no widely accepted global performance threshold for relapse. Interpret the result together with follow-up completeness, the admission and recovery criteria used, seasonality and the local burden of wasting.

Also consider using the following indicators:

• Recovery (Cure) Rate (measures successful recovery at discharge, while relapse assesses whether recovery is sustained)

• Non-Recovery Rate (helps distinguish failure to recover from a new episode occurring after recovery)

• Prevalence of Acute Malnutrition (MUAC, oedema) (provides context on the underlying burden of wasting when interpreting relapse)