Seasonality and risk factors of relapse to acute malnutrition: a multi-country prospective cohort study in Mali, South Sudan, and Somalia, 2021-2022.

Despite the effectiveness of community-based management of acute malnutrition (CMAM) in treating severe acute malnutrition (SAM), recent data show that up to 60% of treated children relapse into acute malnutrition (AM) within six months. A key gap in understanding relapse is the limited evidence on seasonal timing and drivers. We analyzed rolling study enrollment data from April 2021 to November 2022, tracking 1,689 recently recovered SAM children for six months, compared to 1,060 same-sex, age-matched counterparts without AM in the past year. The results show that AM and relapse are highly seasonal, with the highest prevalence during transitions between dry and rainy seasons, and rainy and harvest periods. The seasonal AM peaks occurred earlier, at greater amplitude, and for longer durations for recently recovered SAM children than their matched counterparts, highlighting their increased vulnerability and need for targeted follow-up prior to known seasonal peaks to maximize cost-efficiency amid limited funding.