Agent-Based Modelling to Inform Health Intervention Strategies: The Case of Severe Acute Malnutrition in Children in High-Burden Low-Income Countries

2016 ◽  
pp. 461-486
Author(s):  
Hedwig Deconinck ◽  
Carine Van Malderen ◽  
Niko Speybroeck ◽  
Jean Macq ◽  
Jean-Christophe Chiem
Keyword(s):  
Low Income ◽  
Severe Acute Malnutrition ◽  
Health Intervention ◽  
Intervention Strategies ◽  
Acute Malnutrition ◽  
Low Income Countries ◽  
Agent Based ◽  
High Burden ◽  
Agent Based Modelling

scholarly journals Integrated and simplified approaches to community management of acute malnutrition in rural Kenya: a cluster randomized trial protocol

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Elizabeth Wambui Kimani-Murage ◽  
Hermann Pythagore ◽  
Elizabeth Mwaniki ◽  
Tewoldeberha Daniel ◽  
Betty Samburu ◽  
...  
Keyword(s):  
Health Facility ◽  
Low Income ◽  
Severe Acute Malnutrition ◽  
Intervention Group ◽  
Acute Malnutrition ◽  
Low Income Countries ◽  
Control Group ◽  
Community Case Management ◽  
Integrated Community Case Management ◽  
Cluster Randomized

Abstract Background In many low income countries, the majority of acutely malnourished children are either brought to the health facility late or never at all due to reasons related to distance and associated costs. Integrated community case management (iCCM) is an integrated approach addressing disease and malnutrition through use of community health volunteers (CHVs) in children under-5 years. Evidence on the potential impact and practical experiences on integrating community-based management of acute malnutrition as part of an iCCM package is not well documented. In this study, we aim to investigate the effectiveness and cost effectiveness of integrating management of acute malnutrition into iCCM. Methods This is a two arm parallel groups, non-inferiority cluster randomized community trial (CRT) employing mixed methods approach (both qualitative and quantitative approaches). Baseline and end line data will be collected from eligible (malnourished) mother/caregiver-child dyads. Ten community units (CUs) with a cluster size of 24 study subjects will be randomized to either an intervention (5 CUs) and a control arm (5 CUs). CHV in the control arm, will only screening and refer MAM/SAM cases to the nearby health facility for treatment by healthcare professionals. In the intervention arm, however; CHVs will be trained both to screen/diagnose and also treat moderate acute malnutrition (MAM) and severe acute malnutrition (SAM) without complication. A paired-matching design where each control group will be matched with intervention group with similar characteristics will be matched to ensure balance between the two groups with respect to baseline characteristics. Qualitative data will be collected using key informant and in-depth interviews (KIIs) and focused group discussions (FGDs) to capture the views and experiences of stakeholders. Discussion Our proposed intervention is based on an innovative approach of integrating and simplifying SAM and MAM management through CHWs bring the services closer to the community. The trial has received ethical approval from the Ethics Committee of AMREF Health Africa - Ethical and Scientific Review Committee (AMREF- ESRC), Nairobi, Kenya. The results will be disseminated through workshops, policy briefs, peer-reviewed publications, and presented to local and international conferences. Trial registration PACTR201811870943127; Pre-results. 26 November 2018.

scholarly journals Omitting edema measurement: how much acute malnutrition are we missing?

2015 ◽  
Vol 102 (5) ◽  
pp. 1176-1181 ◽  
Author(s):  
Severine Frison ◽  
Francesco Checchi ◽  
Marko Kerac
Keyword(s):  
Low Income ◽  
Large Scale ◽  
Severe Acute Malnutrition ◽  
Acute Malnutrition ◽  
Low Income Countries ◽  
Public Health Issue ◽  
Data Sets ◽  
Cross Sectional Survey ◽  
Prevalence Estimates ◽  
The Impact

ABSTRACT Background: Acute malnutrition is a major public health issue in low-income countries. It includes both wasting and edematous malnutrition, but the terms wasting and acute malnutrition are often used interchangeably. Little is known about the burden of edematous malnutrition, and few large-scale surveys measure it. Objective: Most acute malnutrition might be captured by the measurement of wasting alone, but this is unknown. This article aims to fill this gap. Design: This article presents a secondary data analysis of 852 nutrition cross-sectional survey data sets of children aged 6–59 mo. The data sets assembled included surveys from East, West, South, and Central Africa; the Caribbean; and Asia. The overlap between edematous malnutrition and wasting was assessed, and the impact of including/excluding edema on acute malnutrition prevalence estimates was evaluated. Results: The prevalence of edematous malnutrition varied from 0% to 32.9%, and children were more likely to have bilateral edema in Central and South Africa (OR: 4; 95% CI: 2.8, 5.6). A large proportion of children with edematous malnutrition were not wasted [62% and 66% based on midupper arm circumference (MUAC) and weight-for-height (WFH), respectively], and most were not severely wasted (83% and 86% based on MUAC and WFH, respectively). When wasting and global acute malnutrition prevalence estimates as well as severe wasting and severe acute malnutrition prevalence estimates overall were compared, the differences between estimates were small (median of 0.0% and mean of 0.3% based on WFH and MUAC for global estimates and slightly higher median of 0.1% and mean of 0.4% based on MUAC and WFH, respectively, for the severe forms), but the picture was different at the regional level. Conclusions: The terms acute malnutrition and wasting should not be used interchangeably. The omission of the measurement of edema can have important repercussions, especially at the nutrition program level.

scholarly journals Incidence Correction Factors for Moderate and Severe Acute Child Malnutrition From 2 Longitudinal Cohorts in Mali and Burkina Faso

2020 ◽  
Vol 189 (12) ◽  
pp. 1623-1627
Author(s):  
Francisco M Barba ◽  
Lieven Huybregts ◽  
Jef L Leroy
Keyword(s):  
Burkina Faso ◽  
Low Income ◽  
Severe Acute Malnutrition ◽  
Acute Malnutrition ◽  
Cross Sectional ◽  
Incidence Data ◽  
Moderate Acute Malnutrition ◽  
Cluster Randomized ◽  
Definition Of ◽  
Mid Upper Arm Circumference

Abstract Child acute malnutrition (AM) is an important cause of child mortality. Accurately estimating its burden requires cumulative incidence data from longitudinal studies, which are rarely available in low-income settings. In the absence of such data, the AM burden is approximated using prevalence estimates from cross-sectional surveys and the incidence correction factor $K$, obtained from the few available cohorts that measured AM. We estimated $K$ factors for severe acute malnutrition (SAM) and moderate acute malnutrition (MAM) from AM incidence and prevalence using representative cross-sectional baseline and longitudinal data from 2 cluster-randomized controlled trials (Innovative Approaches for the Prevention of Childhood Malnutrition—PROMIS) conducted between 2014 and 2017 in Burkina Faso and Mali. We compared K estimates using complete (weight-for-length z score, mid-upper arm circumference (MUAC), and edema) and partial (MUAC, edema) definitions of SAM and MAM. $K$ estimates for SAM were 9.4 and 5.7 in Burkina Faso and in Mali, respectively; K estimates for MAM were 4.7 in Burkina Faso and 5.1 in Mali. The MUAC and edema–based definition of AM did not lead to different $K$ estimates. Our results suggest that $K$ can be reliably estimated when only MUAC and edema-based data are available. Additional studies, however, are required to confirm this finding in different settings.

Afterword I The status of public health in low-income countries

2018 ◽  
Author(s):  
Benjamin Roche ◽  
Hélène Broutin ◽  
Frederic Simard
Keyword(s):  
Public Health ◽  
Low Income ◽  
Global Scale ◽  
High Income ◽  
Health Programs ◽  
Low Income Countries ◽  
Public Health Programs ◽  
High Burden ◽  
The Status ◽  
Very High

In this first part of the book, we have highlighted that infectious diseases still impose a very high burden on populations living in low-income countries, with millions of deaths every year attributable to pathogens that have (almost) disappeared in high-income countries (such as malaria or tuberculosis). Numerous public health programs at a global scale are trying to diminish this burden through multiple interventions, involving vaccines, antibiotics, drugs and vector control, among others. Many of these global programs have been extremely successful, but their impacts have been much more striking in high-income countries than in low-income countries, where, despite noticeable successes, achievements are fragile, sustainability is uncertain and there are still many possible improvements....

scholarly journals Nutritional services for children in Beira, Mozambique: a study reporting on participatory use of data to generate quality improvement recommendations

2019 ◽  
Vol 8 (4) ◽  
pp. e000758 ◽  
Author(s):  
Marzia Lazzerini ◽  
Kajal Chhaganlal ◽  
Augusto Cesar Macome ◽  
Giovanni Putoto
Keyword(s):  
Low Income ◽  
Recovery Rate ◽  
Severe Acute Malnutrition ◽  
Phase 1 ◽  
Participatory Approach ◽  
Health Hazards ◽  
Acute Malnutrition ◽  
Phase 2 ◽  
Middle Income ◽  
Malnourished Children

BackgroundExisting literature suggest frequent gaps in the quality of care (QoC) provided to children with malnutrition in low-income and middle-income countries. Beira is the second largest city in Mozambique. This study included two phases: phase 1 was a systematic assessment of the QoC provided to malnourished children in Beira; phase 2 aimed at using findings of the assessment to develop recommendations, with a participatory approach, to improve QoC.MethodsIn phase 1, all facilities offering nutritional care to children in Beira were included, and exit health outcomes were reviewed against international SPHERE standards. A sample of four (66%) facilities was randomly selected for a comprehensive assessment of all areas contributing to QoC using an adapted WHO tool. In phase 2, key stakeholders were identified, and using a participatory approach, a list of actions for improving the QoC for malnourished children was agreed.ResultsIn phase 1, outcomes of 1428 children with either severe acute malnutrition or moderate acute malnutrition (MAM) were reviewed. In-hospital recovery rate (70.1%) was almost in line with the SPHERE standard (75%), while at outpatient level, it was significantly lower (48.2%, risk ratio (RR) 0.68, p<0.0001). Recovery rate was significantly lower in HIV seropositive compared with seronegative (39.2% vs 52.8%, RR 1.34, p=0.005). High heterogeneity in MAM recovery rate was detected among facilities (range 32.5%–61.0%). Overall, out of all domains contributing to QoC in the sample, 28/46 (60.8%) indicated suboptimal care with significant health hazards and 13/46 (28.2%) indicated totally inadequate care with severe health hazards. In phase 2, a list of 38 actions to improve QoC for malnourished children was agreed among 33 local and national stakeholders.ConclusionsLarge heterogeneity in QoC for malnourished children in Beria was detected. The study documents a concrete example of using data proactively, for agreeing actions to improve QoC.

Urinary Organic Acids Increase After Clinical Stabilization of Hospitalized Children With Severe Acute Malnutrition

2019 ◽  
Vol 40 (4) ◽  
pp. 532-543
Author(s):  
Allison I. Daniel ◽  
Matilda E. Arvidsson Kvissberg ◽  
Edward Senga ◽  
Christian J. Versloot ◽  
Philliness Prisca Harawa ◽  
...  
Keyword(s):  
Organic Acids ◽  
Low Income ◽  
Severe Acute Malnutrition ◽  
Urinary Metabolites ◽  
Acute Malnutrition ◽  
Partial Recovery ◽  
Nutritional Rehabilitation ◽  
Risk Of Death ◽  
Urinary Organic Acids ◽  
Clinical Stabilization

Background: Despite a reduction of child mortality in low-income countries, acutely ill undernourished children still have an elevated risk of death. Those at highest risk are children with severe acute malnutrition (SAM) who often show metabolic dysregulation that remains poorly understood. Objective: We performed a pilot study to examine changes in urinary organic acids during nutritional rehabilitation of children with SAM, and to identify metabolites associated with the presence of edema or with mortality. Methods: This study included 76 children aged between 6 and 60 months, hospitalized for SAM at the Moyo Nutritional Rehabilitation and Research Unit in Blantyre, Malawi. Urine was collected at admission and 3 days after clinical stabilization and metabolomics were performed using gas chromatography–mass spectrometry. Metabolite concentrations were evaluated with both uni- and multivariate approaches. Results: Most metabolites increased 3 days after clinical stabilization, and total urinary concentration changed from 1.2 mM (interquartile range [IQR], 0.78-1.7) at admission to 3.8 mM (IQR, 2.1-6.6) after stabilization ( P < .0001). In particular, 6 metabolites showed increases: 3-hydroxybutyric, 4-hydroxyhippuric, p-hydroxyphenylacetic, oxoglutaric, succinic, and lactic acids. Urinary creatinine was low at both time points, but levels did increase from 0.63 mM (IQR, 0.2-1.2) to 2.6 mM (IQR,1.6-4.4; P < .0001). No differences in urinary profiles were found between children who died versus those who survived, nor between children with severe wasting or edematous SAM. Conclusions: Total urinary metabolites and creatinine increase after stabilization and may reflect partial recovery of overall metabolism linked to refeeding. The use of urinary metabolites for risk assessment should be furthered explored. Trial registration: TranSAM study (ISRCTN13916953).

scholarly journals Field Evaluation of Xpert HPV Point-of-Care Test for Detection of Human Papillomavirus Infection by Use of Self-Collected Vaginal and Clinician-Collected Cervical Specimens

2016 ◽  
Vol 54 (7) ◽  
pp. 1734-1737 ◽  
Author(s):  
P. Toliman ◽  
S. G. Badman ◽  
J. Gabuzzi ◽  
S. Silim ◽  
L. Forereme ◽  
...  
Keyword(s):  
Human Papillomavirus ◽  
Low Income ◽  
Point Of Care ◽  
Cervical Screening ◽  
Field Evaluation ◽  
World Health ◽  
Low Income Countries ◽  
High Burden ◽  
Screening Programs ◽  
Hpv Test

The World Health Organization has recommended that testing for high-risk human papillomavirus (HPV) (hrHPV) infection be incorporated into cervical screening programs in all settings worldwide. In many high-burden, low-income countries, it will not be feasible to achieve high cervical screening coverage using hrHPV assays that require clinician-collected samples. We conducted the first evaluation of self-collected vaginal specimens compared with clinician-collected cervical specimens for the detection of hrHPV infection using the Xpert HPV test. Women aged 30 to 54 years attending two well-woman clinics in Papua New Guinea were invited to participate and provided self-collected vaginal and clinician-collected cervical cytobrush specimens. Both specimen types were tested at the point of care by using the Xpert HPV test. Women were given their cervical test result the same day. Those with a positive hrHPV test and positive examination upon visual inspection of the cervix with acetic acid were offered same-day cervical cryotherapy. A total of 1,005 women were enrolled, with 124 (12.3%; 95% confidence interval [CI], 10.3%, 14.4%) being positive for any hrHPV infection. There was a 99.4% overall percent agreement (OPA) between vaginal and cervical tests for HPV-16 (95% CI, 98.9%, 99.9%), a 98.5% OPA for HPV-18/45 (95% CI, 97.7%, 99.3%), a 94.4% OPA for other hrHPV infections (95% CI, 92.9%, 95.9%), and a 93.4% OPA for all hrHPV types combined (95% CI, 91.8%, 95.0%). Self-collected vaginal specimens had excellent agreement with clinician-collected cervical specimens for the detection of hrHPV infection using the Xpert HPV test. This approach provides for the first time an opportunity to incorporate point-of-care hrHPV testing into clinical cervical screening algorithms in high-burden, low-income settings.

scholarly journals Understanding the role of the gut in undernutrition: what can technology tell us?

Gut ◽  
2021 ◽  
pp. gutjnl-2020-323609
Author(s):  
Alex J Thompson ◽  
Claire D Bourke ◽  
Ruairi C Robertson ◽  
Nirupama Shivakumar ◽  
Christine A Edwards ◽  
...  
Keyword(s):  
Low Income ◽  
Severe Acute Malnutrition ◽  
Point Of Care ◽  
Critical Role ◽  
Acute Malnutrition ◽  
Gut Morphology ◽  
Middle Income ◽  
Gut Barrier Function ◽  
Gut Function ◽  
And Function

Gut function remains largely underinvestigated in undernutrition, despite its critical role in essential nutrient digestion, absorption and assimilation. In areas of high enteropathogen burden, alterations in gut barrier function and subsequent inflammatory effects are observable but remain poorly characterised. Environmental enteropathy (EE)—a condition that affects both gut morphology and function and is characterised by blunted villi, inflammation and increased permeability—is thought to play a role in impaired linear growth (stunting) and severe acute malnutrition. However, the lack of tools to quantitatively characterise gut functional capacity has hampered both our understanding of gut pathogenesis in undernutrition and evaluation of gut-targeted therapies to accelerate nutritional recovery. Here we survey the technology landscape for potential solutions to improve assessment of gut function, focussing on devices that could be deployed at point-of-care in low-income and middle-income countries (LMICs). We assess the potential for technological innovation to assess gut morphology, function, barrier integrity and immune response in undernutrition, and highlight the approaches that are currently most suitable for deployment and development. This article focuses on EE and undernutrition in LMICs, but many of these technologies may also become useful in monitoring of other gut pathologies.

scholarly journals Determinants of Acute Malnutrition among Children Aged 6–59 Months in Public Health Facilities of Pastoralist Community, Afar Region, Northeast Ethiopia: A Case Control Study

2017 ◽  
Vol 2017 ◽  
pp. 1-7 ◽  
Author(s):  
Anwar Seid ◽  
Berhanu Seyoum ◽  
Firehiwot Mesfin
Keyword(s):  
Low Income ◽  
Case Control Study ◽  
Case Control ◽  
Acute Malnutrition ◽  
Low Income Countries ◽  
Rural Residence ◽  
Monthly Income ◽  
Child Feeding ◽  
Afar Region ◽  
Control Study

Background. In low income countries, acute malnutrition continues to be the most important risk factor for illnesses and deaths. The aim of this study was to assess the determinants of acute malnutrition among children aged 6–59 months.Methods. A facility based unmatched case control study was employed on 420 (140 cases and 280 controls) children aged 6–59 months with their caregivers between January 20 and February 20, 2014. Data was analyzed using SPSS version 20.0. APvalue < 0.05 was considered statistically significant.Results. Children aged 12–23 months [AOR = 10.51, 95% CI = 4.93, 22.34], rural residence [AOR = 2.42, 95% CI = 1.22, 4.79], illiterate father [AOR = 2.47, 95% CI = 1.32, 4.61], Monthly income of less than 1000 birr [AOR = 3.98, 95% CI 2.05, 7.69], and food served together with family [AOR = 2.18, 95% CI = 1.10, 4.30] were associated with acute malnutrition.Conclusion. Rural residence, illiterate father, monthly income of less than 1000 birr, and food served together with family are statistically associated with acute malnutrition. Improving practices of parents on appropriate child feeding and creating awareness related to key risk factors of acute malnutrition should be further strengthened.

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