Introduction
Limited data exist to inform community management of children with moderate acute malnutrition (MAM), who are normally, excluded from severe acute malnutrition (SAM) treatment programmes.  This study was conducted to generate evidence of longitudinal outcomes in children aged 6-59 months with MAM (MUAC 115-124mm), without interventional supplementary feeding.

Methods
Children with MAM were enrolled over a 12-month period in 46 centres in Jharkhand state, and followed up for 6 months while attending government integrated child development services.  Anthropometric, clinical and socio-demographic characteristics were recorded at enrolment. The primary outcome was deterioration to SAM (MUAC <115 or bilateral pitting oedema) or death within 6 months. Risk factors for the outcome were investigated.

Results
Of 971 children enrolled 105 (10.8%) were lost-to-follow-up. Of 861 children, 595 (61.3%) were female, with a mean (SD) age of 16.0 months (9.7). At enrolment 333 (34.3%) had MUAC 115-119mm and 430 (44.3%) had weight-for-height z-score (WHZ) <-3. Within 6 months, 133 (15.5%) deteriorated to SAM or died (95% CI: 13.1-18.0%; 5 deaths), two-thirds of whom within 3 months; (n=97, 11.3% deteriorated to SAM and 1 death).

In an adjusted logistic regression model, with an interaction between MUAC at enrolment (115-119, 120-124mm) and age (6-11, 12-23, ≥24months), significantly increased odds of deterioration to SAM or death were seen amongst those with MUAC 115-119mm in all age groups (p≤0.02) and in those under one year with MUAC<125mm. After adjustment, there was no evidence of associations with socio-demographic factors, breast feeding or WHZ<-3.

Conclusions
High proportion of MAM children deteriorates to SAM within 6 months.Children under 1 year and children with MUAC 115-119mm should be closely monitored considering high MAM burdens in India. Increasing the MUAC admission criterion and/or targeted interventions for MAM children at higher risk could be considered.