Anthropometry at discharge and risk of relapse in children treated for severe acute malnutrition: a prospective cohort study in rural Nepal

Abstract Background There is a dearth of evidence on what should be the optimal criteria for discharging children from severe acute malnutrition (SAM) treatment. Programs discharging children while they are still presenting varying levels of weight-for-height (WHZ) or mid-upper-arm circumference (MUAC) deficits, such as those implemented under the current national protocol in Nepal, are opportunities to fill this evidence gap. Methods We followed a cohort of children discharged as cured from SAM treatment in Parasi district, Nepal. Relapse as SAM, defined as the occurrence of WHZ<-3 or MUAC < 115 mm or nutritional edema, was investigated through repeated home visits, during six months after discharge. We assessed the contribution of remaining anthropometric deficits at discharge to relapse risk through Cox regressions. Results Relapse as SAM during follow-up was observed in 33 % of the cohort (35/108). Being discharged before reaching the internationally recommended criteria was overall associated with a large increase in the risk of relapse (HR = 3.3; p = 0.006). Among all anthropometric indicators at discharge, WHZ<-2 led to a three-fold increase in relapse risk (HR = 3.2; p = 0.003), while MUAC < 125 mm significantly raised it only in the older children. WHZ<-2 at discharge came up as the only significant predictor of relapse in multivariate analysis (HR = 2.8, p = 0.01), even among children with a MUAC ≥ 125 mm. Of note, more than 80 % of the events of relapse as SAM would have been missed if WHZ had not been monitored and used in the definition of relapse. Conclusions Our results suggest that the priority for SAM management programs should be to ensure that children reach a high level of WHZ at discharge, at least above or equal to the WHO recommended cut-off. The validity of using a single MUAC cut-off such as 125 mm as a suitable discharge criterion for all age groups is questioned. Further follow-up studies providing a complete assessment of nutritional status at discharge and not based on a restricted MUAC-only definition of relapse as SAM would be urgently needed to set evidence-based discharge criteria. These studies are also required to assess programs currently discounting or omitting WHZ for identification and management of SAM.

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

American Journal of Epidemiology ◽

10.1093/aje/kwaa139 ◽

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.

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The Effectiveness of a Child Psychiatric Unit: A Follow-up Study

The Canadian Journal of Psychiatry ◽

10.1177/070674378803300903 ◽

1988 ◽

Vol 33 (9) ◽

pp. 793-799 ◽

Cited By ~ 6

Author(s):

Philip G. Ney ◽

R. Robert ◽

Bruce R. Hanton ◽

Emma S. Brindad

Keyword(s):

Family Satisfaction ◽

Treatment Programs ◽

Older Children ◽

Psychiatric Unit ◽

Abused Children ◽

Physically Abused ◽

Follow Up Study ◽

Placement Decisions ◽

Child Psychiatric

This follow-up study to determine the effectiveness of a child psychiatric unit found evidence to support a program emphasizing a predetermined period of hospitalization. Most measures of family satisfaction, behaviour and social function improved significantly. The unit appears to treat older children as well as those less than 9, children from fighting families as well as those with less fighting, and sexually abused children as well as physically abused children. The program includes: 2 weeks of preadmission evaluations, 5 weeks hospitalization and 5 weeks of follow-up, placement decisions made before admission, primary responsibility for front line staff and treatment programs composed of various combinations of techniques from a list of 65 possible techniques.

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Ethnic and age differences in prediction of mortality by mid-upper arm circumference in children below 3 years of age in Nepal

Public Health Nutrition ◽

10.1017/s1368980018000940 ◽

2018 ◽

Vol 21 (12) ◽

pp. 2230-2237 ◽

Cited By ~ 1

Author(s):

Avni Gupta ◽

James M Tielsch ◽

Subarna K Khatry ◽

Steven C LeClerq ◽

Luke C Mullany ◽

...

Keyword(s):

Severe Acute Malnutrition ◽

Sociodemographic Factors ◽

Nutrition Intervention ◽

Acute Malnutrition ◽

Older Children ◽

Upper Arm ◽

Prediction Of Mortality ◽

Arm Circumference ◽

Increased Risk ◽

Mid Upper Arm Circumference

AbstractObjectiveTo assess ethnicity- and age-modified associations between mid-upper arm circumference (MUAC) and mortality in Nepalese children and whether sociodemographic factors explain these associations.DesignSecondary data analysis of children followed until 3 years of age. Estimated mortality hazard ratios (HR) for MUAC<11·5cm (recommended cut-off for identifying severe acute malnutrition among children ≥6 months old) compared with ≥11·5cm in younger (<6 months) and older children (≥6 months) of Pahadi and Madhesi ethnicity, adjusting for sex, socio-economic status (SES) and mother’s education using Cox proportional hazard models.SettingSarlahi, Nepal (21 October 2001–2 February 2006).SubjectsChildren (n 48 492) enrolled in the Nepal Nutrition Intervention Project, Sarlahi-4.ResultsAmong children aged ≥6 months, MUAC<11·5 cm was associated with increased risk of mortality in both Pahadis (HR=4·01; 95 % CI 1·42, 11·76) and Madhesis (HR=5·60; 95 % CI 3·87, 8·11) compared with those with MUAC≥11·5 cm, after adjusting for sex, SES and maternal literacy. Among children <6 months old, MUAC<11·5 cm was not associated with mortality in Pahadis with (HR=1·12; 95 % CI 0·72, 1·73) or without adjusting (HR=1·17; 95 % CI 0·75, 1·18) as compared with Madeshis (adjusted HR=1·76; 95 % CI 1·35, 2·28).ConclusionsAmong older children, MUAC<11·5 cm is associated with subsequent mortality in both ethnicities regardless of other characteristics. However, among children aged <6 months, it predicted mortality only among Madhesis, while sociodemographic factors were more strongly associated with mortality than MUAC<11·5cm among Pahadis.

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1105. Vibriocidal Titer Variation and Likelihood of Protection in Children Compared With Adults in a Cholera Endemic Area

Open Forum Infectious Diseases ◽

10.1093/ofid/ofy210.939 ◽

2018 ◽

Vol 5 (suppl_1) ◽

pp. S331-S331

Author(s):

Alaina Ritter ◽

Fahima Chowdhury ◽

Rachel Becker ◽

Taufiq Bhuiyan ◽

Ashraful Khan ◽

...

Keyword(s):

Young Children ◽

Vaccine Development ◽

Massachusetts General Hospital ◽

Age Groups ◽

Older Children ◽

Baseline Serum ◽

Household Contacts ◽

Antibody Titers ◽

Training Grant

Abstract Background Vibrio cholerae, the causative agent of cholera, is responsible for significant morbidity and mortality worldwide. Children less than 5 years old have the highest disease burden of cholera in endemic areas. While children develop serum vibriocidal antibody responses to cholera vaccines, they derive less protection from vaccination compared with adults. The aim of our study was to determine whether the vibriocidal immune responses to V. cholerae infection are equally accurate as markers of protection in all age groups. Methods Cholera patients and their household contacts, who are known to be at high risk of V. cholerae infection, were enrolled between 2001 and 2017 in Dhaka, Bangladesh. Baseline vibriocidal titers were measured at the time of enrollment of household contacts, and participants were followed prospectively for development of V. cholerae infection. Results We studied 50 contacts < 5 years old (“young children”), 228 contacts 5–16 years old (“older children”), and 548 contacts > 16 years old (“adults”). The baseline serum vibriocidal titer was higher in contacts who remained uninfected from all age groups than in contacts who developed cholera during the follow-up period (young children: P = 0.0092; older children: P = 0.0003, adults: P = 0.0012). Conclusion We found that higher vibriocidal antibody titers were associated with protection against V. cholerae infection across all three age categories. These findings may help increase our understanding of the protective immune response against V. cholerae infection and have importance for future vaccine development strategies. Acknowledgments: This research was supported by Massachusetts General Hospital training grant T32AI007061. Disclosures All authors: No reported disclosures.

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Follow-up of a historic cohort of children treated for severe acute malnutrition between 1988 and 2007 in Eastern Democratic Republic of Congo

PLoS ONE ◽

10.1371/journal.pone.0229675 ◽

2020 ◽

Vol 15 (3) ◽

pp. e0229675 ◽

Cited By ~ 1

Author(s):

Pacifique Mwene-Batu ◽

Ghislain Bisimwa ◽

Gaylord Ngaboyeka ◽

Michelle Dramaix ◽

Jean Macq ◽

...

Keyword(s):

Democratic Republic ◽

Democratic Republic Of Congo ◽

Severe Acute Malnutrition ◽

Acute Malnutrition ◽

Republic Of Congo ◽

Historic Cohort

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Identification Of Low Risk Group In Infants With Acute Lymphoblastic Leukemia By Flow Cytometric Minimal Residual Disease Measurement At Day 15 Of Interfant-99 and Interfant-06 Protocols Treatment

Blood ◽

10.1182/blood.v122.21.1333.1333 ◽

2013 ◽

Vol 122 (21) ◽

pp. 1333-1333

Author(s):

Alexander Popov ◽

Barbara Buldini ◽

Paola de Lorenzo ◽

Emanuella Giarin ◽

Annamaria Di Meglio ◽

...

Keyword(s):

Residual Disease ◽

Risk Group ◽

Cox Model ◽

Lymphoblastic Leukemia ◽

Low Risk ◽

Older Children ◽

Flow Cytometric ◽

Minimal Residual ◽

Risk Of Relapse

Abstract Background Acute lymphoblastic leukemia (ALL) in infants is a relatively rare disease with peculiar biological features and worse outcome in comparison to ALL in older children. Infant ALL is characterized by a high frequency of MLL gene rearrangements, mainly CD10-negative B-cell precursor ALL (BCP-ALL) immunophenotype and high tumor burden at diagnosis. Even with new therapeutic approaches event-free survival (EFS) in this subgroup of patients does not exceed 50%. Although flow cytometric (FCM) minimal residual disease (MRD) detection at day 15 of remission induction is well established for patients' stratification in older children treated with the AIEOP-BFM-2009 protocol, the prognostic value of FCM MRD in infant ALL is not fully known yet. Aim of the present study was to evaluate the prognostic significance of FCM MRD measurement in infants with ALL treated with Interfant-99 and Interfant-06 protocols in AIEOP (Associazione Italiana Ematologia Oncologia Pediatrica) centers in Italy. Patients and methods Between May 1999 and December 2011, 120 consecutive infants aged 0 to 365 days with newly diagnosed ALL were treated in AIEOP centers with the Interfant99 and the on-going Interfant-06 protocols. Among these patients, 51 (42.5%) with available day 15 follow-up bone marrow samples were included in this study on FCM MRD. In 39 (76.5%) cases, different types of MLL gene rearrangements were identified by fluorescence in situ hybridization (FISH), while 12 (23.5%) patients had germline MLL. MRD detection was performed by 4-6-color FCM. Median follow-up time was 3.5 years (range: 1 month – 7.5 years). Outcome was estimated by evaluating the probability of EFS and the cumulative incidence of relapse (CIR). Analysis of prognostic relevance of FCM MRD in combination with other criteria used for stratifying patients enrolled in the Interfant-06 protocol was performed with the Cox model on the cause-specific hazard of relapse. Results and discussion We classified infants according to the AIEOP-BFM day 15 stratification into three risk groups: 14 patients (27.5%) were considered at standard risk (SR: MRD less than 0.1%), 9 patients (15.7%) at high risk (HR: MRD 10% or more), and the majority of infants (29, 56.9%) at intermediate risk (IR: MRD 0.1% to 10%). As the 14 SR patients had 3-year EFS and CIR significantly better than other patients, we considered two major groups of patients with different outcome: SR group (MRD<0.1%) with 3-year EFS 77.9% (standard error, SE, 11.3) and CIR 14.9% (SE 10.2), and non-SR group with 3-year EFS 32.0% (SE 8.5) and CIR 58.0% (SE 8.8, p=0.0104 and p=0.0085, respectively). Half of SR group (7 of 14 cases) had germline MLL. 4 out of 7 MLL-positive SR-patients were in continuous complete remission (CCR) In contrast, the majority of infants in the non-SR group carried various types of MLL rearrangements. Only 5 cases in the non-SR group were MLL germline and only two of them are still in CCR. We evaluated the prognostic impact of day 15 MRD in MLL-positive cases (n=39). In this cohort of patients, we also observed a difference, although not statistically significant, between SR and non-SR groups both in 3-year EFS (57.1%, SE 18.7 and 30.9%, SE 9.2, respectively; p=0.3630) and in 3-year CIR (28.6%, SE 18.9 and 60.9%, SE 9.5, respectively; p=0.1733). We evaluated the suitability of MLL negativity and of day 15 FCM MRD <0.1% as single criterion for the identification of low-risk patients. Each factor, when separately analyzed in a Cox model, was significantly correlated with a reduction in the risk of relapse, as shown in Table 1, left panel. Nevertheless, as day 15 FCM MRD levels are strictly related to MLL status, the Cox model which analyzes jointly the two factors, is unable to identify the one independently impacting on the risk of relapse (Table 1, right panel). Thus, although being a strong prognostic factor by itself, day 15 FCM MRD stratification did not confer an advantage in relapse prediction when considered in combination with MLL status, which is the only low-risk group criterion in the Interfant-06 stratification. Conclusion Day 15 FCM MRD proved to be a suitable variable predicting treatment failure and can be used as an alternative or in combination with Interfant-06 stratification criteria to identify SR patients. Disclosures: Popov: Alexion: Research Funding.

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Universal Definition of Loss to Follow-Up in HIV Treatment Programs: A Statistical Analysis of 111 Facilities in Africa, Asia, and Latin America

PLoS Medicine ◽

10.1371/journal.pmed.1001111 ◽

2011 ◽

Vol 8 (10) ◽

pp. e1001111 ◽

Cited By ~ 111

Author(s):

Benjamin H. Chi ◽

Constantin T. Yiannoutsos ◽

Andrew O. Westfall ◽

Jamie E. Newman ◽

Jialun Zhou ◽

...

Keyword(s):

Latin America ◽

Statistical Analysis ◽

Hiv Treatment ◽

Treatment Programs ◽

Loss To Follow Up ◽

Universal Definition ◽

Definition Of

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Prevalence, Pattern and Risk Factors of Severe Acute Malnutrition in Children below Six Months Old in Jos North Central Nigeria

Journal of BioMedical Research and Clinical Practice ◽

10.46912/jbrcp3i1.2020135 ◽

2020 ◽

Vol 3 (1) ◽

pp. 212-216

Author(s):

C John ◽

R Adah ◽

R Caleb ◽

S Okolo

Keyword(s):

Risk Factors ◽

Birth Weight ◽

Severe Acute Malnutrition ◽

Economic Status ◽

Acute Malnutrition ◽

Health Concern ◽

Older Children ◽

Anthropometric Parameters ◽

Significant Difference ◽

Nutritional Data

Severe Acute Malnutrition (SAM) in infants of less than 6 months of age (U6m) is a serious public health concern globally, especially with declined rates of exclusive breastfeeding. With challenges in the use of the standard anthropometric parameters and higher mortality in these infants than in older children, it is pertinent to document the burden, pattern and risk factors for SAM in U6m. This study aimed to determine the prevalence of SAM in U6m, the pattern and the determinants of malnutrition using weight-for-length (WFL) Z score and mid-upper arm circumference (MUAC), and also to determine the usability of MUAC and WFL in detection of SAM in U6m. Infants six weeks to <6months were recruited. Socio-demographic and nutritional data were collected using researcher administered questionnaire. WFL z scores <-3 and MUAC <11.5cm were used to define SAM. Of the 233 infants aged<6months, mean age was 90.0±38.3days. Females accounted for 52.8%. Nineteen, (8.5%), were born with low birth weight and 11.7% were preterm deliveries. Males had higher mean length for age and weight for age than females but MUAC showed no significant difference. The prevalence of SAM was 2.6% by MUAC and WFL parameters but MUAC identified more SAM subjects in those <3months while WFL identified more in older children. Concordance between MUAC and WFL was poor. Both MUAC and WFL showed more female children than males with MAM. Lower social economic status was significantly associated with SAM while birth weight, birth order, maternal nutritional status and time of first feed did not affect prevalence of SAM in any of the parameters. It is recommended that both WFL and MUAC be employed in the screening of acute malnutrition in this U6m.

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Study to determine gender variation in severe acute malnutrition at nutrition rehabilitation centre

International Journal of Contemporary Pediatrics ◽

10.18203/2349-3291.ijcp20190695 ◽

2019 ◽

Vol 6 (2) ◽

pp. 602

Author(s):

Suguna S. ◽

Vidyasagar V.

Keyword(s):

Weight Gain ◽

District Hospital ◽

Severe Acute Malnutrition ◽

Acute Malnutrition ◽

Rehabilitation Centre ◽

Gender Variation ◽

Nutrition Rehabilitation ◽

Time Of Admission ◽

Discharge Criteria

Background: The objective of this study is to know the gender variation in number of admissions, severity of malnutrition at the time of admission, gaining of weight and adherence to follow up in children admitted to nutrition rehabilitation center and during follow up.Methods: This is a retrospective study involving the review of existing programme records. Children who were admitted to nutrition rehabilitation centre, district hospital, Chamarajanagar, Karnataka, India, between January 2017 to December 2017 with severe acute malnutrition were involved in the study. The programme included 2 weeks of in-patient care, and four follow-up visits to the NRC subsequently as follows; 1st visit at 7 days, 2nd at 14 days, 3rd at 1 month and 4th at 2 months after discharge.Results: Among 57 children who admitted to NRC females were 30 (52.6%) and males 27 47.4%). 25 among 57 children (43.9%) could sustain weight gain of >5grams/kg/day as per one of the discharge criteria. 13 (52%) were females and 12 (48%) were males. 32(56%) among 57 admitted children to NRC, could achieve <-1SD during entire programmed. 15(46.8%) were females and 17 (53.1%) were males.Conclusions: There was no gender variation in either number of admission or severity of malnutrition at the time of admission or weight gain during NRC programme.

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