scholarly journals Safety, Tolerability, Efficacy and Logistics of Administration of Three Types of Therapeutic Feeds to Children with Severe Acute Malnutrition (SAM)

2018 ◽  
Vol 3 (1) ◽  
pp. 10-15
Author(s):  
Saunik Sujata ◽  
Phadke Mrudula ◽  
Nair Raji ◽  
Khosla Jatin ◽  
Patel Tarun ◽  
...  
Keyword(s):  
Randomized Trial ◽  
Severe Acute Malnutrition ◽  
Acute Malnutrition ◽  
Open Label ◽  
Recovery Rates ◽  
Number Of Children ◽  
Rich Food ◽  
The Difference

Objective: To analyse safety, tolerability, efficacy and logistic issues related to administration of 3 types of therapeutic feeds to children with severe acute malnutrition (SAM) from tribal district of Nandurbar, Maharashtra. Design: A three arm open label, block randomized trial using 3 therapeutic feeds i.e. commercially available ready to use therapeutic feed (C-RUTF), locally prepared ready to use therapeutic feed ( L-RUTF) & amylase rich food(ARF) was given to 1092 tribal children of SAM in Nandurbar District, Maharashtra, India during 2014-2015. Setting: Tribal district of Nandurbar, Maharashtra. Participants: 1092 children of SAM, 766 on C-RUTF, 184 on L-RUTF & 143 on ARF followed on treatment for 8 weeks. Outcomes: The recovery rates in the three groups, any untoward effects during treatment and logistic aspects of procurement, delivery, storage & administration of therapeutic feeds. Results: Total number of children with SAM were 1092. Gr 1 – Out of 765 children of SAM, 404 (52.8%) recovered on C-RUTF. Gr 2 – 80 (43.5%) recovered out of 184 on L-RUTF. Gr 3 – 64 (44.8%) recovered on ARF at the end of 8 weeks of treatment, the difference being statistically significant between C-RUTF & others. Out of 38 children on C-RUTF, it was observed that 1 had diarrhoea, 1 had vomiting, 1 had fever, 4 children reported more activity in terms of playfulness, more speaking & smiling. 31 children had nothing specific to report. Out of 34 children on L-RUTF, 6 children reported diarrhoea, 1 had vomiting & 4 children reported fever. 3 children reported more activity. 23 children had nothing specific to report. Out of 19 children on ARF, 1 had diarrhoea, 1 had vomiting, 1 had fever, 3 reported more activity. 13 had nothing specific to report. Untoward effects were noted in 3 out of 38 (7.89%) in C-RUTF group, 11 out of 34 (32.35%) in L-RUTF group and 3 out of 19 (15.7%) in ARF group. Conclusion: C-RUTF was found to be more efficacious, with least untoward effects, easy to administer and was more palatable when compared to L-RUTF & ARF.

scholarly journals Examining Response to Treatment of Severe Acute Malnutrition in Children 6–59 Months Old in Afghanistan, Chad, Mali, and Niger (P12-002-19)

2019 ◽  
Vol 3 (Supplement_1) ◽  
Author(s):  
Erin Boyd
Keyword(s):  
Weight Gain ◽  
Health Center ◽  
Severe Acute Malnutrition ◽  
Acute Malnutrition ◽  
Daily Weight Gain ◽  
Z Score ◽  
Factors Affecting ◽  
Number Of Children ◽  
Status Number ◽  
Significant Factors

Abstract Objectives Identify the most significant factors affecting the trajectory of recovery from severe acute malnutrition (SAM), as measured by average daily weight gain in each child 6–59 months of age who were diagnosed and treated for SAM and treated, adjusting for covariates including: breastfeeding status, number of children in household, illness, and distance to health center. Hypothesis 1a: Children 6–59 months enrolled in SAM treatment have slower times to recovery and slower weight gain if they are admitted for treatment at a lower anthropometric cut-off admission (weight for height z-score < −4) than children admitted for treatment at a higher anthropometric cut-off (weight for height z-score ≥ −4). Hypothesis 1b: Older children (24–59 months) recover more quickly than younger children (6–23 months) controlling for ration size. Methods A retrospective panel data analysis on children 6–59 months enrolled in standard outpatient treatment for severe acute malnutrition (SAM) between 2014 and 2016 was conducted. The study period was between September-December 2018. Children were exhaustively sampled. Children with edema, children with implausible z-scores for W/H (<−5 and >5) and H/A (<−6 and >6), children who were referred for inpatient therapeutic feeding to a stabilization center, and children from the same household, except in the case of twins, were eliminated from the analysis. There was one database per country. A total of 1384 children between 6–59 months were included in the analysis. Results The most significant factors affecting the proportional weight gain include age at enrollment (P = 0.001, 95%CI = −0.00—0.00) and Weight for height z-score (WHZ) (P = 0.00, 95%CI = 0.04—0.05) in each child 6–59 months of age who were diagnosed with SAM and treated, adjusting for covariates including: breastfeeding status, number of children in household, illness, and distance to health center. Sex of child did not significantly affect proportional weight gain (P = 0.404, 95%CI = −0.012–0.005). Conclusions The existing protocol to treat severe acute malnutrition should be modified to treat younger children and children who are admitted with a lower weight for height z-score due to different vulnerabilities. Funding Sources The research was conducted as part of a dissertation at The Friedman School of Nutrition Science and Policy at Tufts University. Data were obtained from World Vision.

scholarly journals Integrated program achieves good survival but moderate recovery rates among children with severe acute malnutrition in India

2013 ◽  
Vol 98 (5) ◽  
pp. 1335-1342 ◽  
Author(s):  
Víctor M Aguayo ◽  
Vandana Agarwal ◽  
Manohar Agnani ◽  
Dwarka Das Agrawal ◽  
Sheela Bhambhal ◽  
...  
Keyword(s):  
Severe Acute Malnutrition ◽  
Acute Malnutrition ◽  
Good Survival ◽  
Recovery Rates ◽  
Integrated Program

scholarly journals STUDY OF NUTRITIONALAND IMMUNIZATION STATUS IN CHILDREN 6 MONTHS TO 3 YEARS ATTENDING IMMUNIZATION CLINIC, UHTC, IGIMS, PATNA.

2020 ◽  
pp. 1-3
Author(s):  
Abha Kumari ◽  
Sanjay Kumar Choudhary* ◽  
Sanjay Kumar
Keyword(s):  
Breast Feeding ◽  
Low Socioeconomic Status ◽  
Severe Acute Malnutrition ◽  
Acute Malnutrition ◽  
Great Effort ◽  
Exclusive Breast Feeding ◽  
Number Of Children ◽  
Immunization Status ◽  
Good Nutrition ◽  
Moderate Acute Malnutrition

Background: In the rst three years of life, good nutrition plays an important role in forming a good foundation that has impact on child's future physical and mental development. In this study we are focussing on the nutritional and immunization status in children 6months to 3 years attending immunization clinic,UHTC,IGIMS,PATNA with special emphasis to identify moderate acute malnutrition (MAM) and severe acute malnutrition (SAM) cases. Methods : It is an observational study carried out immunization clinic at UHTC,I.G.I.M.S. Patna included 400 cases age between 6 months to 3 years This study was conducted from January 2019 to June 2019 in immunization clinic UHTC, IGIMS Patna. Results:Incidence of SAM and MAM is 7.5% and 30.75 % respectively. Female predominance was seen in SAM and MAM i.e. 53.4% and 54.6% respectively. Signicant association of under-nutrition was found with LBW (p<0.05), not giving exclusive breast feeding up to 6 months of life (p<0.05) and, Low socioeconomic status (p<0.001). Higher numbers of females were unvaccinated. Conclusions: Despite our great effort for improving maternal and child health, signicant number of children are malnourished and unimmunized. So, for their better health we need to start from birth, institutional delivery, exclusive breast feeding, immunization, and timely introduction of complementary feeds, marriages at appropriate age, proper antenatal visits and birth spacing.

scholarly journals Comparing azithromycin to amoxicillin in the management of uncomplicated severe acute malnutrition in Burkina Faso: a pilot randomized trial

2021 ◽  
Author(s):  
Kieran S O'Brien ◽  
Ali Sié ◽  
Clarisse Dah ◽  
Millogo Ourohire ◽  
Moussa Ouédraogo ◽  
...  
Keyword(s):  
Single Dose ◽  
Weight Gain ◽  
Adverse Events ◽  
Burkina Faso ◽  
Randomized Trial ◽  
Severe Acute Malnutrition ◽  
Acute Malnutrition ◽  
World Health ◽  
Promising Alternative

Introduction. Given the potential for asymptomatic infection in children with uncomplicated severe acute malnutrition (SAM), the World Health Organization recommends a broad-spectrum antibiotic like amoxicillin. Azithromycin is a promising alternative to amoxicillin as it can be administered as a single dose and has efficacy against several pathogens involved in the burden of infectious disease and mortality in this population. In this pilot study, we aimed to establish the feasibility of a larger randomized controlled trial and to provide preliminary evidence comparing the effect of azithromycin to amoxicillin on weight gain in children with uncomplicated SAM. Methods. This pilot randomized trial enrolled children 6-59 months old with uncomplicated SAM at 6 healthcare centers in Burkina Faso. Participants were randomized to a single dose of azithromycin or a 7-day course of amoxicillin. All participants received ready-to-use therapeutic food and were followed weekly until nutritional recovery and again at 8 weeks. The primary feasibility outcomes included enrollment potential, refusals, and loss to follow-up. The primary clinical outcome was weight gain (g/kg/day) over the 8-week period. Outcome assessors were masked. Results. Between June and October 2020, 312 children were screened, 301 were enrolled with 0 refusals, and 282 (93.6%) completed the 8-week visit. Average weight gain was 2.5 g/kg/day (SD 2.0) in the azithromycin group and 2.6 (SD) 1.7) in the amoxicillin group (Mean Difference -0.1, 95% CI -0.5 to 0.3, P = 0.63). Fewer adverse events were reported in the azithromycin group (Risk Ratio 0.50, 95% CI 0.31 to 0.82, P = 0.006). Conclusions. No differences were found in weight gain between groups. Given the ability to administer a single dose and the potential for fewer adverse events, azithromycin may be an alternative to amoxicillin for uncomplicated SAM. With strong enrollment and follow-up, a larger trial in this setting is feasible.

Avenger 500, a phase III open-label randomized trial of the combination of CPI-613 with modified FOLFIRINOX (mFFX) versus FOLFIRINOX (FFX) in patients with metastatic adenocarcinoma of the pancreas.

2019 ◽  
Vol 37 (4_suppl) ◽  
pp. TPS479-TPS479
Author(s):  
Philip Agop Philip ◽  
Marc E. Buyse ◽  
Angela Tatiana Alistar ◽  
Caio Max Sao Pedro Rocha Lima ◽  
Sanjeev Luther ◽  
...  
Keyword(s):  
Overall Survival ◽  
Randomized Trial ◽  
Primary Endpoint ◽  
Response Rate ◽  
Standard Dose ◽  
Complete Response ◽  
Hazard Ratio ◽  
Open Label ◽  
The Difference ◽  
Type Boundary

TPS479 Background: Metastatic pancreatic ductal adenocarcinoma (PDAC) is one of the deadliest cancers. Current treatments using FOLFIRINOX and gemcitabine plus nab-paclitaxel, provide median survivals of 11.1 and 8.5 months, respectively. PDAC cells have altered metabolism. CPI-613 is a novel TCA cycle inhibitor that targets cancer cells. In a phase I study mFFX plus CPI-613 resulted in a 61% objective response rate with 3 of 18 patients achieving a complete response. Methods: Avenger 500 (NCT03504423) is an open-label randomized trial of CPI-613 plus mFFX versus FFX in untreated patients with metastatic PDAC. 500 patients will be randomized 1:1 between arms. The experimental arm comprises CPI-613 500 mg/m2 on day 1 and 3 of a 14-day cycle. The mFFX regimen is the standard dose and schedule of 5-Fluorouracil but reduced doses of oxaliplatin (65 mg/m²) and irinotecan (140 mg/m²). The control arm is standard dose FFX. There are two co-primary endpoints: Overall Response Rate (ORR, Complete Response + Partial Response). Best response within the first 12 cycles will be used for this determination, to be confirmed by independent, blinded, central review. Progression-Free Survival (PFS), is the second co-primary endpoint. Secondary endpoints are overall survival, duration of response and safety. Patient reported outcomes will be compared using the NCCN-FACT FHSI-18. An interim analysis will be done after 167 patients are evaluable for response. The difference in ORR will be tested using a Lan-DeMets Pocock type boundary for futility and efficacy. Futility will be declared if the difference in ORR between the arms is smaller than 5%, while efficacy will be declared if it is larger than 20%. The PFS hazard ratio will be tested using a Lan-DeMets O’Brien-Fleming type boundary. Efficacy will be declared if the hazard ratio is less than 0.48. The final analysis will be done with 500 patients randomized, when ~375 PFS events are available. Significance will be reached if the PFS hazard ratio is less than 0.80, or the difference in ORR is at least 11%. If the trial reaches significance for either primary endpoint, overall survival will be tested. Clinical trial information: NCT03504423.

scholarly journals Using cross-sectional surveys to estimate the number of severely malnourished children needing to be enrolled in specific treatment programmes

2017 ◽  
Vol 20 (8) ◽  
pp. 1362-1366 ◽  
Author(s):  
Nancy M Dale ◽  
Mark Myatt ◽  
Claudine Prudhon ◽  
André Briend
Keyword(s):  
Conversion Factor ◽  
Severe Acute Malnutrition ◽  
Specific Treatment ◽  
Acute Malnutrition ◽  
Population Estimates ◽  
Data Sets ◽  
Cross Sectional ◽  
Number Of Children ◽  
Treatment Services ◽  
Incident Cases

AbstractObjectiveWhen planning severe acute malnutrition (SAM) treatment services, estimates of the number of children requiring treatment are needed. Prevalence surveys, used with population estimates, can directly estimate the number of prevalent cases but not the number of subsequent incident cases. Health managers often use a prevalence-to-incidence conversion factor (J) derived from two African cohort studies to estimate incidence and add the expected number of incident cases to prevalent cases to estimate expected SAM caseload for a given period. The present study aimed to estimate J empirically in different contexts.DesignObservational study, with J estimated by correlating expected numbers of children to be treated, based on prevalence surveys, population estimates and assumed coverage, with the observed numbers of SAM patients treated.SettingSurvey and programme data from six African and Asian countries.SubjectsTwenty-four data sets including prevalence surveys and programme admissions data for 5 months following the survey.ResultsA statistically significant relationship between the number of SAM cases admitted to SAM treatment services and the estimated burden of SAM from prevalence surveys was found. Estimate for the slope (intercept forced to be zero) was 2·17 (95 % CI 1·33, 3·79). Estimates for the prevalence-to-incidence conversion factor J varied from 2·81 to 11·21, assuming programme coverage of 100 % and 38 %, respectively.ConclusionsEstimation of expected caseload from prevalence may require revision of the currently used prevalence-to-incidence conversion factor J of 1·6. Appropriate values for J may vary between different locations.

scholarly journals Evaluation of Medical Officers’ Certificate Programme (MOCP) Course Competency Based Learning

2015 ◽  
Vol 4 (4) ◽  
pp. 320
Author(s):  
Mrudula A Phadke
Keyword(s):  
Severe Acute Malnutrition ◽  
Training Programme ◽  
Acute Malnutrition ◽  
Postgraduate Students ◽  
Number Of Children ◽  
Before And After ◽  
Competency Based ◽  
Moderate Acute Malnutrition ◽  
Training Programmes ◽  
Medical Colleges

Medical Officers’ Certificate Programme (MOCP) is a 6 months training programme in Pediatrics/Medicine at Medical colleges wherein doctors work like postgraduate students, learn various OPD, IPD, (Out Patients and In Patient Department) procedures, attain hands on skills, perform day and night duties, attend postgraduate training programmes and specialty clinics. This is a course unique to Maharashtra. It has been designed to overcome shortage of Pediatrians &amp; Physicians in the state. Public Health Dept deputed 28 Medical Officers of Primary Health Centers to various Medical Colleges. At the end of 6 months training course they were evaluated during 2012-2013.It was done by questionnaire used before and after training. It was observed that OPD increased by 24% and IPD by 54%. There was a decrease in the number of cases referred to tertiary centers by 24%, post MOCP training. Infant immunization increased by 35% after training. Number of children with severe acute malnutrition/moderate acute malnutrition treated increased by 22%, neonatal emergencies, resuscitation, sepsis, jaundice patients treated, increased by 36%. No of adults with diarrhoea and snake bite treated increased by 40% &amp; 63% respectively. No. of ECGs taken and myocardial infarctions managed also has shown rising trend. Thus, there was tremendous benefit to the patients after MOCP training. Skill of doctors was found to have enhanced. It is therefore recommended that such novel trainings should be imparted in other states of India too.

scholarly journals Role of mother’s knowledge and feeding practices in improvement of children from severe acute malnutrition

2019 ◽  
Vol 6 (6) ◽  
pp. 2565
Author(s):  
Prashant K. Jaiswal ◽  
Shubhra A. Gupta ◽  
Nirmal Verma
Keyword(s):  
Dietary Diversity ◽  
Severe Acute Malnutrition ◽  
Knowledge Score ◽  
Feeding Practices ◽  
Malnourished Child ◽  
Acute Malnutrition ◽  
Feeding Practice ◽  
Number Of Children ◽  
Minor Ailments

Background: Under nutrition is significant health problem in India as well as in Chhattisgarh, recent NFHS 4 data shows that there is increase in number of children who are severely wasted from 5.6% in NFHS 3 to 8.4% in Chhattisgarh. Literature shows appropriate feeding practices and break in malnutrition infection cycle help malnourished child to recover, so present study was planned with the objective to find out the role of mother knowledge regarding feeding practices and management of minor ailments related to improvement of severe acute malnourished children discharged cured from nutritional rehabilitation centres in Chhattisgarh.Methods: A community based study was planned among children discharged as cured from NRC between March to December 2017. They were followed in community to find out socio-demographic factor, feeding practice after discharge, mother knowledge score, household dietary diversity using 24 hour recall method & anthropometric measurements.Results: Out of 156 children discharged as cured from March to December 2017, total 132 children were covered during the survey from January to June 2018. It was observed that improvement in nutritional status after discharge was significantly associated with increasing knowledge score for mother regarding nutrition and children who were separately feed after discharge from NRC.Conclusions: Mother knowledge regarding nutrition and management of minor ailments and feeding practice to child after discharge are important factors associated with the improvement of children from SAM.

scholarly journals Malnutrisi Akut Berat dan Determinannya pada Balita di Wilayah Rural dan Urban

2014 ◽  
Vol 9 (1) ◽  
pp. 50
Author(s):  
Titih Huriah ◽  
Laksono Trisnantoro ◽  
Fitri Haryanti ◽  
Madarina Julia
Keyword(s):  
Rural Communities ◽  
Urban Areas ◽  
Severe Acute Malnutrition ◽  
Economic Status ◽  
Lower Class ◽  
Acute Malnutrition ◽  
Anthropometric Measurement ◽  
Cross Sectional ◽  
Major Health Problem ◽  
Number Of Children

Malnutrisi akut berat merupakan malnutrisi yang paling serius yang memengaruhi balita dan merupakan masalah kesehatan utama di negara-negara berkembang. Malnutrisi telah meluas baik di perkotaan maupun perdesaan. Akar permasalahan malnutrisi di negara berkembang salah satunya adalah faktor sosial demografi. Tujuan penelitian untuk melihat perbedaan kejadian malnutrisi dan determinannya di area perkotaan dan pedesaan di Yogyakarta. Penelitian menggunakan desain potong lintang dengan responden adalah semua balita malnutrisi akut berat di Kabupaten Sleman (23 balita) dan Kota Yogyakarta (33 balita). Analisis data menggunakan statistik deskriptif dan inferensial. Penelitian dilaksanakan pada Bulan Desember 2012 - Februari 2013. Prevalensi balita malnutrisi akut lebih banyak di perkotaan daripada di pedesaan (59% vs. 41%). Persentase faktor risiko kejadian malnutrisi pada kelompok urban dan rural adalah jumlah balita dalam keluarga satu orang (60,7%), jenis kelamin laki-laki (58,9%), riwayat pemberian ASI tidak eksklusif (60,7%), usia ibu kurang dari 35 tahun (62,5%), pekerjaan non-PNS (98,2%), penghasilan orang tua lebih dari UMR (58,9%), tingkat pendidikan ayah dan ibu tinggi (71,4% dan 64,3% ) dan pengasuh balita di rumah adalah ibu (82,1%). Perbedaan yang signifikan (p<0,05) pada variabel pekerjaan dan penghasilan orang tua, tingkat pendidikan orang tua dan pengasuh balita, sedangkan hasil pengukuran antropometri tidak menunjukkan adanya perbedaan. Determinan kejadian malnutrisi pada kelompok urban dan rural adalah jumlah balita dalam keluarga.Severe acute malnutrition is the most serious form of malnutrition affecting children under-five and widely recognized as a major health problem in developing countries. It is wide spread in rural and urban areas. Social demographic factor is one of the main causes of severe acute malnutrition. This study was conducted to determine the prevalence of severe acute malnutrition and determinants of children in urban and rural area in Yogyakarta. A cross-sectional study was used in this study, where the respondents were all children with severe acute malnutrition in Sleman and Yogyakarta (23 and 33 children respectively). Descriptive and inferencial statistic were used to analyze the data. The study was carried out in December 2012-February 2013. The prevalence of severe acute malnutrition children was higher in urban than rural communities (59% vs. 41%). Risk factors percentage of malnourished were number of children in family was one person (60.7%), male gender (58.9%), the history of not exclusive breastfeeding (60.7%), mother age less than 35 years old (62.5%), lower class job (98.2%), monthly income was high (58.9%), higher education of father and mother (71.4% and 64.3% respectively), and children caregiver was mother (82.1%). There were a significant diference (p<0.05) in father profession, parents’ education, household economic status, and caregiver of children, whereas anthropometric measurement did not show any difference between two groups. Determinants of malnutrition in urban and rural groups is the number of children in the family.

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 &lt;11.5 cm for severe acute malnutrition (SAM) and the moderate acute malnutrition (MAM) criteria of ≥11.5cm to &lt;12.5 cm (intervention) or the current Ethiopian criteria of &lt;11 cm for SAM and ≥11 cm to &lt;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.

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