scholarly journals Potential impact of expanded MUAC-only programs on targeting of acutely malnourished children and ready-to-use-therapeutic-food allocation: lessons from cross-sectional surveys

2019 ◽  
Author(s):  
Benjamin Guesdon ◽  
Alexia Couture ◽  
Danka Pantchova ◽  
Oleg Bilukha
Keyword(s):  
A Priori ◽  
Acute Malnutrition ◽  
Case Definitions ◽  
Cross Sectional ◽  
Number Of Children ◽  
Malnourished Children ◽  
Potential Impact ◽  
Mid Upper Arm Circumference ◽  
The Impact ◽  
Therapeutic Food

Abstract Background Some of the recently piloted innovative approaches for the management of acute malnutrition in children use the “expanded MUAC-only” approach, with Mid Upper Arm Circumference (MUAC) <125mm as the sole anthropometric criterion for screening and admission, classification of cases into moderate or severe using the 115mm cut-off, and use Ready-to-Use-Therapeutic-Food (RUTF) for the management of both moderate (MAM) and severe (SAM) cases of acute malnutrition. Our study aimed at exploring the potential impact of this “expanded MUAC-only” program scenario on the eligibility for treatment and RUTF allocation, as compared with the existing WHO normative guidance.Methods We analyzed data from 550 population representative cross-sectional cluster surveys conducted since 2007. We retrieved all children classified as SAM and MAM according to currently used case definitions, and calculated the proportions of SAM children who would be excluded from treatment, misclassified as MAM, or whose specific risks (because of having both MUAC and weight-for height deficits) would be ignored. We also analyzed the expected changes in the number and profile of children meant to receive RUTF according to the new approach.Results We found that approximately one quarter of SAM children would not be detected and eligible for treatment under the “expanded MUAC-only” scenario, and another 20% would be classified as MAM. A further 17% of the total SAM children would be admitted and followed only according to their MUAC or oedema status, while they also present with a severe weight-for height deficit on admission. Considering MAM targeting, about half of the MAM children would be left undetected. This scenario also shows a 2.5 time increase in the number of children targeted with RUTF, with approximately 70% of MAM and 30% of SAM cases among this new RUTF target.Conclusions This empirical evidence suggests that adoption of “expanded MUAC-only” programs would likely lead to a priori exclusion from treatment or misclassifying as MAM a large proportion of SAM cases, while redirecting programmatic costs in favor of those less in need. It underscores the need to explore other options for improving the impact of programs addressing the needs of acutely malnourished children.

scholarly journals Potential consequences of expanded MUAC-only programs on targeting of acutely malnourished children and ready-to-use-therapeutic-food allocation: lessons from cross-sectional surveys

2019 ◽  
Author(s):  
Benjamin Guesdon ◽  
Alexia Couture ◽  
Danka Pantchova ◽  
Oleg Bilukha
Keyword(s):  
A Priori ◽  
Acute Malnutrition ◽  
Case Definitions ◽  
Cross Sectional ◽  
Number Of Children ◽  
Malnourished Children ◽  
Arm Circumference ◽  
Mid Upper Arm Circumference ◽  
The Impact ◽  
Therapeutic Food

Abstract Background: Some of the recently piloted innovative approaches for the management of acute malnutrition in children use the “expanded MUAC-only” approach, with Mid Upper Arm Circumference (MUAC) <125mm as the sole anthropometric criterion for screening and admission, classification of cases as severe using the 115mm cut-off, and use Ready-to-Use-Therapeutic-Food (RUTF) for the management of both moderate (MAM) and severe (SAM) cases of acute malnutrition. Our study aimed at exploring the potential consequences of this “expanded MUAC-only” program scenario on the eligibility for treatment and RUTF allocation, as compared with the existing WHO normative guidance. Methods: We analyzed data from 550 population representative cross-sectional cluster surveys conducted since 2007. We retrieved all children classified as SAM and MAM according to currently used case definitions, and calculated the proportions of SAM children who would be excluded from treatment, misclassified as MAM, or whose specific risks (because of having both MUAC and weight-for height deficits) would be ignored. We also analyzed the expected changes in the number and demographics (sex, age) of children meant to receive RUTF according to the new approach. Results: We found that approximately one quarter of SAM children would not be detected and eligible for treatment under the “expanded MUAC-only” scenario, and another 20% would be classified as MAM. A further 17% of the total SAM children would be admitted and followed only according to their MUAC or oedema status, while they also present with a severe weight-for height deficit on admission. Considering MAM targeting, about half of the MAM children would be left undetected. This scenario also shows a 2.5 time increase in the number of children targeted with RUTF, with approximately 70% of MAM and 30% of SAM cases among this new RUTF target. Conclusions: This empirical evidence suggests that adoption of “expanded MUAC-only” programs would likely lead to a priori exclusion from treatment or misclassifying as MAM a large proportion of SAM cases, while redirecting programmatic costs in favor of those less in need. It underscores the need to explore other options for improving the impact of programs addressing the needs of acutely malnourished children.

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 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.

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 Impact of temperature and relative humidity on the transmission of COVID-19: a modelling study in China and the United States

BMJ Open ◽  
2021 ◽  
Vol 11 (2) ◽  
pp. e043863
Author(s):  
Jingyuan Wang ◽  
Ke Tang ◽  
Kai Feng ◽  
Xin Lin ◽  
Weifeng Lv ◽  
...  
Keyword(s):  
Regression Analysis ◽  
Relative Humidity ◽  
Human Mobility ◽  
The United States ◽  
Reproductive Number ◽  
Cross Sectional ◽  
The Usa ◽  
Higher Temperature ◽  
Potential Impact ◽  
The Impact

ObjectivesWe aim to assess the impact of temperature and relative humidity on the transmission of COVID-19 across communities after accounting for community-level factors such as demographics, socioeconomic status and human mobility status.DesignA retrospective cross-sectional regression analysis via the Fama-MacBeth procedure is adopted.SettingWe use the data for COVID-19 daily symptom-onset cases for 100 Chinese cities and COVID-19 daily confirmed cases for 1005 US counties.ParticipantsA total of 69 498 cases in China and 740 843 cases in the USA are used for calculating the effective reproductive numbers.Primary outcome measuresRegression analysis of the impact of temperature and relative humidity on the effective reproductive number (R value).ResultsStatistically significant negative correlations are found between temperature/relative humidity and the effective reproductive number (R value) in both China and the USA.ConclusionsHigher temperature and higher relative humidity potentially suppress the transmission of COVID-19. Specifically, an increase in temperature by 1°C is associated with a reduction in the R value of COVID-19 by 0.026 (95% CI (−0.0395 to −0.0125)) in China and by 0.020 (95% CI (−0.0311 to −0.0096)) in the USA; an increase in relative humidity by 1% is associated with a reduction in the R value by 0.0076 (95% CI (−0.0108 to −0.0045)) in China and by 0.0080 (95% CI (−0.0150 to −0.0010)) in the USA. Therefore, the potential impact of temperature/relative humidity on the effective reproductive number alone is not strong enough to stop the pandemic.

scholarly journals Contraception and Sexsual Activity as Factor Influenced Leucorrhea

2017 ◽  
Vol 5 (3) ◽  
pp. 371
Author(s):  
Sari Priyanti
Keyword(s):  
Hormonal Contraception ◽  
Cross Sectional Study ◽  
Childbearing Age ◽  
Cross Sectional ◽  
The Public ◽  
First Sexual Intercourse ◽  
Number Of Children ◽  
Study Population ◽  
The Impact ◽  
First Time

ABSTRACTCervical cancer was non communicable desease that worries the public and causes an increase mortality in women. One of the first sign causes of cervical cancer is occourrence of Leucorrhoe. The incidence of Leucorrhoe in women Indonesia by 90% of which >75% of women experience once of leucorrhoe and experience ≥ 2 times by 25%. Leucorrhoe should not be considered an ordinary thing because can be caused to itchy on genetalia, pain during sexsual, infection  can be caused odema on genetalia, hot like burned on vagina even the impact if not treated promptly will caused infertility and cancer. Aims of study was to analyze factors of influenced on Leucorrhoe incident. Design of study was cross sectional study. Population was women of childbearing age who use contraceptives in the karang jeruk village, Jatirejo sub district, Mojokerto district in March of 2017. Sample in this study was 33 people. Data analyze with logistic regresion. Result of study showed contraceptive and sexsual activity has significant influenced with leucorrhoe (PR = 10.000; 95% CI= 1,732-57,722 dan PR=8,750; 95% CI=1,466-52,232). Suggestion: should be married and have first sexual intercourse for the first time at the age of  ≥ 20 years, limit the number of children not more than 2 as the greater the number of children the greater the risk of Leucorrhoe, and not using hormonal contraception for a along time that more than 2 years. Keywords: contraceptive,sexsual activity, leucorrhoe

scholarly journals New approach to simplifying and optimising acute malnutrition treatment in children aged 6–59 months: the OptiMA single-arm proof-of-concept trial in Burkina Faso

2019 ◽  
Vol 123 (7) ◽  
pp. 756-767 ◽  
Author(s):  
Maguy Daures ◽  
Kevin Phelan ◽  
Mariama Issoufou ◽  
Séni Kouanda ◽  
Ousmane Sawadogo ◽  
...  
Keyword(s):  
Burkina Faso ◽  
Real Life ◽  
Acute Malnutrition ◽  
Proof Of Concept ◽  
New Approach ◽  
Multivariate Survival ◽  
Arm Circumference ◽  
Mid Upper Arm Circumference ◽  
Programme Outcomes ◽  
Therapeutic Food

AbstractThe Optimising treatment for acute MAlnutrition (OptiMA) strategy trains mothers to use mid upper arm circumference (MUAC) bracelets for screening and targets treatment to children with MUAC < 125 mm or oedema with one therapeutic food at a gradually reduced dose. This study seeks to determine whether OptiMA conforms to SPHERE standards (recovery rate > 75 %). A single-arm proof-of-concept trial was conducted in 2017 in Yako district, Burkina Faso including children aged 6–59 months in outpatient health centres with MUAC < 125 mm or oedema. Outcomes were stratified by MUAC category at admission. Multivariate survival analysis was carried out to identify variables predictive of recovery. Among 4958 children included, 824 (16·6 %) were admitted with MUAC < 115 mm or oedema, 1070 (21·6 %) with MUAC 115–119 mm and 3064 (61·8 %) with MUAC 120–124 mm. The new dosage was correctly implemented at all visits for 75·9 % of children. Global recovery was 86·3 (95 % CI 85·4, 87·2) % and 70·5 (95 % CI 67·5, 73·5) % for children admitted with MUAC < 115 mm or oedema. Average therapeutic food consumption was 60·8 sachets per child treated. Recovery was positively associated with mothers trained to use MUAC prior to child’s admission (adjusted hazard ratio 1·09; 95 % CI 1·01, 1·19). OptiMA was successfully implemented at the scale of an entire district under ‘real-life’ conditions. Programme outcomes exceeded SPHERE standards, but further study is needed to determine if increasing therapeutic food dosages for the most severely malnourished will improve recovery.

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 Impact of Housing and Infrastructure on handwashing in Peru

2020 ◽  
Author(s):  
Nipher M Malika ◽  
Guisella Barbagelatta ◽  
Mary Penny ◽  
Kelly A Reynolds ◽  
Ryan Sinclair
Keyword(s):  
Length Of Stay ◽  
Metropolitan Area ◽  
Poisson Regression ◽  
Living Conditions ◽  
Cross Sectional ◽  
Number Of Children ◽  
Slum Dwellers ◽  
Water Disposal ◽  
Study Designs ◽  
The Impact

Abstract Background The metropolitan area of Lima, Peru has a third of the nation’s population living in slum dwellings that are hypothesized to contribute to inefficient household hygienic practices. The purpose of this study was to quantitatively assess which living conditions have the greatest impact on handwashing practices. Methods A cross-sectional epidemiological design of participants ≥16 y of age from San Juan de Miraflores, a slum on the outskirts of Lima, Peru, was used. Poisson regression was applied to assess the impact of living conditions on handwashing practices. Results We could not demonstrate a relationship between living conditions (home structure, overcrowding, water, grey water disposal) and reported handwashing. The reported lack of handwashing is associated with the number of children in the home (those with children &lt;5 y of age were more likely not to report washing their hands) and length of stay in the slum in years. Conclusions Living conditions play an important role in one’s health, therefore improved study designs are needed to determine which strategies are likely to be the most effective in improving outcomes for slum dwellers.

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