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.

scholarly journals Program and Caseload Implications of Adopting the Global MUAC Criteria for Community Management of Acute Malnutrition in Children Under 5 Years Old in Ethiopia

2020 ◽  
Vol 4 (Supplement_2) ◽  
pp. 157-157
Author(s):  
Yosef Asefaw ◽  
Seifu Hagose ◽  
Girmay Ayana ◽  
Solomon Hailu ◽  
Tadess Kebebe ◽  
...  
Keyword(s):  
Severe Acute Malnutrition ◽  
Acute Malnutrition ◽  
Cross Sectional ◽  
Number Of Children ◽  
Funding Sources ◽  
Malnourished Children ◽  
The Mean ◽  
Gates Foundation ◽  
Moderate Acute Malnutrition ◽  
Cluster Randomized

Abstract Objectives Ethiopia has been hesitant to shift to the global MUAC-based definitions for acute malnutrition given the two to four times potential increase in caseload suggested by several cross-sectional surveys. Thus, the objective of this study was to provide specific evidence on the caseload implications for Ethiopia of aligning with the WHO recommended criteria. Methods A cluster-randomized control study was conducted in four districts of Amhara and Oromia regions of Ethiopia in a total of 36 health posts (HPs). Districts and HPs were selected based on previous high case report. In each district, an equal numbers of HPs were randomly assigned to use either the global MUAC criteria of <11.5 cm for severe acute malnutrition (SAM) and the moderate acute malnutrition (MAM) criteria of ≥11.5cm to <12.5 cm (intervention) or the current Ethiopian criteria of <11 cm for SAM and ≥11 cm to <12 cm for MAM (control). All 6–59 mo children were screened regularly for 16 wks. Malnourished children were admitted to the study according to the criteria assigned to their HP. Results A total of 349 SAM and 986 MAM new cases were admitted during the 16 wk recruitment. Of the new SAM cases, 225 were in intervention and 124 were in control HPs. The ratio of SAM in intervention compared to control HPs was 1.78 (1.14–2.42, 95%CI), which indicates an increase in admissions of 78% (P = 0.019). The mean (±SD) monthly SAM admissions per HPs were 1.71 (0.53) in control and 2.97 (3.31) in intervention (P = 0.191). For MAM, 592 cases were in intervention and 394 were in control for a ratio of 1.50 (1.11–1.89). The global MUAC criteria increased caseload by 50% (P = 0.015) compared to control. The mean monthly new MAM admissions per HPs were 5.47 (4.02) in control and 8.22 (3.28) in intervention (P = 0.045). The mean number of children served during biweekly combined sessions for SAM and MAM was 19.67 (9.28) in intervention and 13.08 (8.28) in control (P = 0.026). For sessions restricted to SAM, a mean of 4.26 (4.11) was served in intervention and 1.92 (1.88) in control (P = 0.028). Conclusions The increases in cases and workload resulting from shifting from Ethiopia's current national SAM and MAM admission and discharge criteria to the WHO criteria are likely to be on a smaller scale than is usually claimed based on various cross-sectional surveys. Most HPs were not overwhelmed due to the shift. Funding Sources Bill and Melinda Gates Foundation.

scholarly journals Association between admission criteria and body composition among young children with moderate acute malnutrition, a cross-sectional study from Burkina Faso

2020 ◽  
Vol 10 (1) ◽  
Author(s):  
Christian Fabiansen ◽  
Bernardette Cichon ◽  
Charles W. Yaméogo ◽  
Ann-Sophie Iuel-Brockdorf ◽  
Kevin P. Q. Phelan ◽  
...  
Keyword(s):  
Body Composition ◽  
Cross Sectional Study ◽  
Acute Malnutrition ◽  
Admission Criteria ◽  
Sectional Study ◽  
Cross Sectional ◽  
Low Weight ◽  
Deuterium Dilution ◽  
Moderate Acute Malnutrition ◽  
Mid Upper Arm Circumference

Abstract Children with moderate acute malnutrition (MAM) are treated based on low weight-for-length z-score (WLZ), low mid-upper arm circumference (MUAC) or both. This study aimed to assess associations of admission criteria and body composition (BC), to improve treatment of MAM. We undertook a cross-sectional study among 6–23 months old Burkinabe children with MAM. Fat-free (FFM) and fat mass (FM) were determined by deuterium dilution and expressed as FFM (FFMI) and FM index (FMI). Of 1,489 children, 439 (29.5%) were recruited by low MUAC only (MUAC-O), 734 (49.3%) by low WLZ and low MUAC (WLZ-MUAC) and 316 (21.2%) by low WLZ only (WLZ-O). Thus, 1,173 (78.8%) were recruited by low MUAC, with or without low WLZ (ALL-MUAC). After adjustments, WLZ-O had 89 g (95% confidence interval (CI) 5; 172) lower FFM compared to MUAC-O. Similarly, WLZ-O had 0.89 kg/m2 (95% CI 0.77; 1.01) lower FFMI compared to MUAC-O, whereas there was no difference for FMI. However, boys included by WLZ-O compared to MUAC-O had 0.21 kg/m2 (95% CI 0.05; 0.38) higher FMI. In contrast, girls included by WLZ-O had 0.17 (95% CI 0.01; 0.33) kg/m2 lower FMI compared to MUAC-O (interaction, p = 0.002). We found that different criteria for admission into MAM treatment programmes select children with differences in BC, especially FFMI. Trial registration: ISRCTN42569496.

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 Treating moderate acute malnutrition in first-line health services: an effectiveness cluster-randomized trial in Burkina Faso

2014 ◽  
Vol 100 (1) ◽  
pp. 241-249 ◽  
Author(s):  
Laetitia Nikièma ◽  
Lieven Huybregts ◽  
Patrick Kolsteren ◽  
Hermann Lanou ◽  
Simon Tiendrebeogo ◽  
...  
Keyword(s):  
Health Services ◽  
Burkina Faso ◽  
Randomized Trial ◽  
Cluster Randomized Trial ◽  
Acute Malnutrition ◽  
First Line ◽  
Moderate Acute Malnutrition ◽  
Cluster Randomized

scholarly journals Quality of care of treatment for uncomplicated severe acute malnutrition provided by lady health workers in Pakistan

2017 ◽  
Vol 21 (2) ◽  
pp. 385-390 ◽  
Author(s):  
Eleanor Rogers ◽  
Muhammad Ali ◽  
Shahid Fazal ◽  
Deepak Kumar ◽  
Saul Guerrero ◽  
...  
Keyword(s):  
Quality Of Care ◽  
Health Workers ◽  
Severe Acute Malnutrition ◽  
Acute Malnutrition ◽  
Cross Sectional ◽  
Supervision And Training ◽  
Mid Upper Arm Circumference ◽  
The Impact ◽  
Care Study

AbstractObjectiveTo assess the quality of care provided by lady health workers (LHW) managing cases of uncomplicated severe acute malnutrition (SAM) in the community.DesignCross-sectional quality-of-care study.SettingThe feasibility of the implementation of screening and treatment for uncomplicated SAM in the community by LHW was tested in Sindh Province, Pakistan. An observational, clinical prospective multicentre cohort study compared the LHW-delivered care with the existing outpatient health facility model.SubjectsLHW implementing treatment for uncomplicated SAM in the community.ResultsOedema was diagnosed conducted correctly for 87·5 % of children; weight and mid upper-arm circumference were measured correctly for 60·0 % and 57·4 % of children, respectively. The appetite test was conducted correctly for 42·0 % of cases. Of all cases of SAM without complications assessed during the study, 68·0 % received the correct medical and nutrition treatment. The proportion of cases that received the correct medical and nutrition treatment and key counselling messages was 4·0 %.ConclusionsThis quality-of-care study supports existing evidence that LHW are able to identify uncomplicated SAM, and a majority can provide appropriate nutrition and medical treatment in the community. However, the findings also show that their ability to provide the complete package with an acceptable level of care is not assured. Additional evidence on the impact of supervision and training on the quality of SAM treatment and counselling provided by LHW to children with SAM is required. The study has also shown that, as in other sectors, it is essential that operational challenges are addressed in a timely manner and that implementers receive appropriate levels of support, if SAM is to be treated successfully in the community.

scholarly journals Early development in children with moderate acute malnutrition: A cross‐sectional study in Burkina Faso

2020 ◽  
Vol 16 (2) ◽  
Author(s):  
Mette F. Olsen ◽  
Ann‐Sophie Iuel‐Brockdorff ◽  
Charles W. Yaméogo ◽  
Bernardette Cichon ◽  
Christian Fabiansen ◽  
...  
Keyword(s):  
Burkina Faso ◽  
Early Development ◽  
Cross Sectional Study ◽  
Acute Malnutrition ◽  
Sectional Study ◽  
Cross Sectional ◽  
Moderate Acute Malnutrition

scholarly journals Frequency of Leading Factors of Severe Acute Malnutrition in Children Below Five Years of Age Attending National Institute of Child Health, Karachi

2021 ◽  
pp. 438-443
Author(s):  
Iqra Rafique Khokhar ◽  
Mohsina Noor Ibrahim ◽  
Sanam Khan ◽  
Aiysha Farhat ◽  
Farah Jamil ◽  
...  
Keyword(s):  
Birth Weight ◽  
Child Health ◽  
Low Birth Weight ◽  
Low Income ◽  
Exclusive Breastfeeding ◽  
Severe Acute Malnutrition ◽  
Cross Sectional Study ◽  
Acute Malnutrition ◽  
Cross Sectional ◽  
First Feeding

Aim: To determine the frequency of leading factors of severe acute malnutrition in children below five years of age. Study Design: Cross-sectional study. Place and Duration of Study: Outpatient department, National Institute of Child Health (NICH) Karachi from December 7, 2017 to June 9, 2018. Methodology: All children of 6 months to 5 years of age of either gender presented with severe acute malnutrition were included. Information regarding age, gender, weight, height and all leading factors of severe acute malnutrition were noted. Results: Out of total 157 children, pre-maturity was observed in 21 (13.4%) children, low birth weight in 84 (53.5%) children, anemia in 105 (66.9%) children, lack of complete immunization in 81 (51.6%) children, maternal illiteracy 96 (61.1%), paternal illiteracy 31 (19.7%), low income 116 (73.9%), lack of exclusive breastfeeding in 87 (55.4%) children, administration of Pre-lacteals as the first feeding in 54 (34.4%) whereas initiation of complementary feeding after nine months was observed in 48 (30.6%) children. Conclusion: The presence of low income, anemia, maternal illiteracy, lack of exclusive breastfeeding and low birth weight were the leading factors of severe acute malnutrition in children below the age of five years.

scholarly journals Mid-upper arm circumference in detection of weight-for-height Z-score below −3 in children aged 6–59 months

2018 ◽  
Vol 21 (10) ◽  
pp. 1794-1799 ◽  
Author(s):  
Umesh Kapil ◽  
RM Pandey ◽  
Rahul Bansal ◽  
Bhavana Pant ◽  
Amit Mohan Varshney ◽  
...  
Keyword(s):  
Severe Acute Malnutrition ◽  
Characteristic Curve ◽  
Predictive Ability ◽  
Acute Malnutrition ◽  
Test Accuracy ◽  
Cross Sectional Survey ◽  
Upper Arm ◽  
Cross Sectional ◽  
Arm Circumference ◽  
Mid Upper Arm Circumference

AbstractObjectiveTo evaluate the predictive ability of mid-upper arm circumference (MUAC) for detecting severe wasting (weight-for-height Z-score (WHZ) <−3) among children aged 6–59 months.DesignCross-sectional survey.SettingRural Uttar Pradesh, India.SubjectsChildren (n 18 456) for whom both WHZ (n 18 463) and MUAC were available.ResultsThe diagnostic test accuracy of MUAC for severe wasting was excellent (area under receiver-operating characteristic curve = 0·933). Across the lower range of MUAC cut-offs (110–120 mm), specificity was excellent (99·1–99·9 %) but sensitivity was poor (13·4–37·2 %); with higher cut-offs (140–150 mm), sensitivity increased substantially (94·9–98·8 %) but at the expense of specificity (37·6–71·9 %). The optimal MUAC cut-off to detect severe wasting was 135 mm. Although the prevalence of severe wasting was constant at 2·2 %, the burden of severe acute malnutrition, defined as either severe wasting or low MUAC, increased from 2·46 to 17·26 % with cut-offs of <115 and <135 mm, respectively. An MUAC cut-off <115 mm preferentially selected children aged ≤12 months (OR=11·8; 95 % CI 8·4, 16·6) or ≤24 months (OR=23·4; 95 % CI 12·7, 43·4) and girls (OR=2·2; 95 % CI 1·6, 3·2).ConclusionsBased on important considerations for screening and case detection in the community, modification of the current WHO definition of severe acute malnutrition may not be warranted, especially in the Indian context.

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