scholarly journals Diagnostic Measures for Severe Acute Malnutrition in Indian Infants Under 6 Months of Age: a Secondary Data Analysis

2020 ◽  
Author(s):  
Ranadip Chowdhury ◽  
Nitika Nitika ◽  
Tarun Shankar Choudhary ◽  
Sunita Taneja ◽  
Jose Carlos Martines ◽  
...  
Keyword(s):  
Severe Acute Malnutrition ◽  
Population Attributable Fraction ◽  
Secondary Data ◽  
Acute Malnutrition ◽  
Adjusted Relative Risk ◽  
Z Score ◽  
Likelihood Ratios ◽  
Predictive Values ◽  
Growth Standards ◽  
Diagnostic Measures

Abstract Background Weight for length z-score (WLZ) <- 3 is currently used to define severe acute malnutrition (SAM) among infants. However, this approach has important limitations for infants younger than 6 months of age as WLZ cannot be calculated using WHO growth standards if infant length is <45 cm. Moreover, length for age z-score (LAZ) and weight for length z-score (WLZ) are least reliable measures, with high chances of variation, and less chances of detecting undernutrition in under 6 months infants. The objective of the current analysis was to compare WLZ with WAZ and LAZ in a cohort of Indian infants in predicting the deaths between 6 weeks and 6 months of age. Methods The data was from an individually randomized trial conducted in slums of Delhi, India in which infants’ weight and length were measured at 6 weeks of age (at the time of the first immunization visit). Vital status of the infants was documented from 6 weeks to 6 months of age. The sensitivity, specificity, positive and negative predictive values, and positive and negative likelihood ratios, and area under curve (AUC) were calculated for WAZ<-3, WLZ<-3, and LAZ<-3 for deaths between 6 weeks and 6 months of age. Results For deaths occurring between 6 weeks to 6 months of age, the specificity ranged between 85.9-95.9% for all three anthropometric indicators. However, the sensitivity was considerably higher for WAZ; it was 64.6 % for WAZ<-3, 39.1% for LAZ<-3, and 25.0% for WLZ<-3. WAZ <-3 had higher AUC (0.75; 95% CI: 0.68, 0.82) and hence, better discriminated deaths between 6 weeks and 6 months of age than WLZ<-3. The adjusted relative risk (RR 10.6, 95% CI 5.9, 18.9) and the population attributable fraction (PAF 57.9%, 95% CI 38.8, 71.0%) of mortality was highest for WAZ<-3.Conclusions We found WAZ<-3 at 6 weeks of age to be a better predictor of death in the 6 weeks to 6 months of life in comparison to WLZ<-3 and LAZ<-3 and propose that it should be considered to diagnose SAM in this age group.

scholarly journals Diagnostic measures for severe acute malnutrition in Indian infants under 6 months of age: a secondary data analysis

2021 ◽  
Author(s):  
Ranadip Chowdhury ◽  
Nitika Nitika ◽  
Tarun Shankar Choudhary ◽  
Sunita Taneja ◽  
Jose Carlos Martines ◽  
...  
Keyword(s):  
Severe Acute Malnutrition ◽  
Population Attributable Fraction ◽  
Secondary Data ◽  
Acute Malnutrition ◽  
Adjusted Relative Risk ◽  
Z Score ◽  
Likelihood Ratios ◽  
Predictive Values ◽  
Growth Standards ◽  
Diagnostic Measures

Abstract Background Weight for length z-score (WLZ) <- 3 is currently used to define severe acute malnutrition (SAM) among infants. However, this approach has important limitations for infants younger than 6 months of age as WLZ cannot be calculated using WHO growth standards if infant length is <45 cm. Moreover, length for age z-score (LAZ) and weight for length z-score (WLZ) are least reliable measures, with high chances of variation, and less chances of detecting undernutrition in under 6 months infants. The objective of the current analysis was to compare WLZ with WAZ and LAZ in a cohort of Indian infants in predicting the deaths between 6 weeks and 6 months of age. Methods The data was from an individually randomized trial conducted in slums of Delhi, India in which infants’ weight and length were measured at 6 weeks of age (at the time of the first immunization visit). Vital status of the infants was documented from 6 weeks to 6 months of age. The sensitivity, specificity, positive and negative predictive values, and positive and negative likelihood ratios, and area under curve (AUC) were calculated for WAZ<-3, WLZ<-3, and LAZ<-3 for deaths between 6 weeks and 6 months of age. Results For deaths occurring between 6 weeks to 6 months of age, the specificity ranged between 85.9-95.9% for all three anthropometric indicators. However, the sensitivity was considerably higher for WAZ; it was 64.6 % for WAZ<-3, 39.1% for LAZ<-3, and 25.0% for WLZ<-3. WAZ <-3 had higher AUC (0.75; 95% CI: 0.68, 0.82) and hence, better discriminated deaths between 6 weeks and 6 months of age than WLZ<-3. The adjusted relative risk (RR 10.6, 95% CI 5.9, 18.9) and the population attributable fraction (PAF 57.9%, 95% CI 38.8, 71.0%) of mortality was highest for WAZ<-3. Conclusions We found WAZ<-3 at 6 weeks of age to be a better predictor of death in the 6 weeks to 6 months of life in comparison to WLZ<-3 and LAZ<-3 and propose that it should be considered to diagnose SAM in this age group.

scholarly journals Diagnostic measures for severe acute malnutrition in Indian infants under 6 months of age: a secondary data analysis

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Ranadip Chowdhury ◽  
Nitika ◽  
Tarun Shankar Choudhary ◽  
Sunita Taneja ◽  
Jose Martines ◽  
...  
Keyword(s):  
Severe Acute Malnutrition ◽  
Population Attributable Fraction ◽  
Acute Malnutrition ◽  
Adjusted Relative Risk ◽  
Z Score ◽  
Operating Characteristics ◽  
Likelihood Ratios ◽  
Predictive Values ◽  
Growth Standards ◽  
Anthropometric Indicators

Abstract Background Weight for length z-score (WLZ) < − 3 is currently used to define severe acute malnutrition (SAM) among infants. However, this approach has important limitations for infants younger than 6 months of age as WLZ cannot be calculated using WHO growth standards if infant length is < 45 cm. Moreover, length for age z-score (LAZ) and weight for length z-score (WLZ) are least reliable measures, with high chances of variation, and less chances of detecting undernutrition in under 6 months infants. The objective of the current analysis was to compare WLZ with WAZ and LAZ in a cohort of Indian infants in predicting the deaths between 6 weeks and 6 months of age. Methods The data was from an individually randomized trial conducted in slums of Delhi, India in which infants’ weight and length were measured at 6 weeks of age (at the time of the first immunization visit). Vital status of the infants was documented from 6 weeks to 6 months of age. The sensitivity, specificity, positive and negative predictive values, and positive and negative likelihood ratios were calculated for WAZ < -3, WLZ < -3, and LAZ < -3 for deaths between 6 weeks and 6 months of age. The receiver operating characteristics curve was calculated for each of the above anthropometric indicators. Results For deaths occurring between 6 weeks to 6 months of age, the specificity ranged between 85.9–95.9% for all three anthropometric indicators. However, the sensitivity was considerably higher for WAZ; it was 64.6% for WAZ < -3, 39.1% for LAZ < -3, and 25.0% for WLZ < -3. WAZ < -3 had higher area under curve (0.75; 95% CI: 0.68, 0.82) and hence, better discriminated deaths between 6 weeks and 6 months of age than WLZ < -3. The adjusted relative risk (RR 10.6, 95% CI 5.9, 18.9) and the population attributable fraction (PAF 57.9, 95% CI 38.8, 71.0%) of mortality was highest for WAZ < -3. Conclusions We found WAZ < -3 at 6 weeks of age to be a better predictor of death in the 6 weeks to 6 months of life in comparison to WLZ < -3 and LAZ < -3 and propose that it should be considered to diagnose SAM in this age group.

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.

Predictors of recovery in children aged 6–59 months with uncomplicated severe acute malnutrition: a multicentre study

2020 ◽  
pp. 1-9
Author(s):  
Sam Marconi David ◽  
Preethi N Ragasudha ◽  
Sunita Taneja ◽  
Sanjana Brahmawar Mohan ◽  
Sharad D Iyengar ◽  
...  
Keyword(s):  
Peer Support ◽  
Employment Status ◽  
Tamil Nadu ◽  
Severe Acute Malnutrition ◽  
Controlled Trial ◽  
Secondary Data ◽  
Treatment Phase ◽  
Female Child ◽  
Hazard Ratio ◽  
Acute Malnutrition

Abstract Objective: To identify predictors of recovery in children with uncomplicated severe acute malnutrition (SAM). Design: This is a secondary data analysis from an individual randomised controlled trial, where children with uncomplicated SAM were randomised to three feeding regimens, namely ready-to-use therapeutic food (RUTF) sourced from Compact India, locally prepared RUTF or augmented home-prepared foods, under two age strata (6–17 months and 18–59 months) for 16 weeks or until recovery. Three sets of predictors that could influence recovery, namely child, family and nutritional predictors, were analysed. Setting: Rural and urban slum areas of three states of India, namely Rajasthan, Delhi and Tamil Nadu. Participants: In total, 906 children (age: 6–59 months) were analysed to estimate the adjusted hazard ratio (AHR) using the Cox proportional hazard ratio model to identify various predictors. Results: Being a female child (AHR: 1·269 (1·016, 1·584)), better employment status of the child’s father (AHR: 1·53 (1·197, 1·95)) and residence in a rental house (AHR: 1·485 (1·137, 1·94)) increased the chances of recovery. No hospitalisation (AHR: 1·778 (1·055, 2·997)), no fever, (AHR: 2·748 (2·161, 3·494)) and ≤ 2 episodes of diarrhoea (AHR: 1·579 (1·035, 2·412)) during the treatment phase; availability of community-based peer support to mothers for feeding (AHR: 1·61 (1·237, 2·097)) and a better weight-for-height Z-score (WHZ) at enrolment (AHR: 1·811 (1·297, 2·529)) predicted higher chances of recovery from SAM. Conclusion: The probability of recovery increases in children with better WHZ and with the initiation of treatment for acute illnesses to avoid hospitalisation, availability of peer support and better employment status of the father.

scholarly journals Lay-screeners and Use of WHO Growth Standards Increase Case Finding of Hospitalized Malawian Children with Severe Acute Malnutrition

2014 ◽  
Vol 61 (1) ◽  
pp. 44-53 ◽  
Author(s):  
S. M. LaCourse ◽  
F. M. Chester ◽  
G. Preidis ◽  
L. M. McCrary ◽  
M. Maliwichi ◽  
...  
Keyword(s):  
Severe Acute Malnutrition ◽  
Case Finding ◽  
Acute Malnutrition ◽  
Growth Standards

scholarly journals Maternal perception of malnutrition among infants using verbal and pictorial methods in Kenya

2014 ◽  
Vol 18 (5) ◽  
pp. 869-876 ◽  
Author(s):  
Martha K Mwangome ◽  
Gregory Fegan ◽  
Andrew M Prentice ◽  
James A Berkley
Keyword(s):  
Qualitative Study ◽  
Rural Community ◽  
Severe Acute Malnutrition ◽  
Acute Malnutrition ◽  
Verbal Description ◽  
Likelihood Ratios ◽  
Anthropometric Measures ◽  
Cross Sectional ◽  
Quantitative Survey ◽  
Maternal Perception

AbstractObjectiveTo compare mothers’ perceptions of their own infants’ nutritional status with anthropometric indicators of undernutrition.DesignA qualitative study and cross-sectional quantitative survey. The qualitative study involved developing tools to assess mother’s perception. Two methods of verbal description and a pictorial scale were developed. The quantitative survey involved measuring maternal perception and comparing it with the anthropometric measures of weight-for-age Z-score (WAZ) and mid-upper arm circumference-for-age Z-score (MUACZ).SettingA rural community setting in Kenya.SubjectsSeventy-four infants aged between 4 and 6 months, and their mothers, living in rural Kenya were enrolled.ResultsUsing verbal description, the positive and negative likelihood ratios were 3·57 (95 % CI 1·44, 9·98) and 0·69 (95 % CI 0·50, 0·96) respectively for MUACZ<−2; and 4·60 (95 % CI 1·60, 13·3) and 0·67 (95 % CI 0·49, 0·92) respectively for WAZ<−2. Using the pictorial scale, the positive and negative likelihood ratios were 8·30 (95 % CI 1·91, 36·3) and 0·69 (95 % CI 0·52, 0·93) respectively for MUACZ<−2; and 4·31 (95 % CI 1·22, 15·0) and 0·78 (95 % CI 0·61, 1·00) respectively for WAZ<−2.ConclusionsIn a rural community, mothers better identify undernutrition in their infants using a pictorial scale than verbal description. However, neither can replace formal anthropometric assessment. Objective anthropometric tools should be validated for identification of severe acute malnutrition among infants aged less than 6 months.

scholarly journals Nutrition Assessment of Under-Five Children in Sudan: Tracking the Achievement of the Global Nutrition Targets

Children ◽  
2021 ◽  
Vol 8 (5) ◽  
pp. 363
Author(s):  
Mohamed Abu-Manga ◽  
Ayoub Al-Jawaldeh ◽  
Abdul Baseer Qureshi ◽  
Amira M. Elmunier Ali ◽  
Damiano Pizzol ◽  
...  
Keyword(s):  
Severe Acute Malnutrition ◽  
Secondary Data ◽  
Well Being ◽  
Acute Malnutrition ◽  
Survey Method ◽  
Micronutrient Deficiencies ◽  
Severe Stunting ◽  
Under Five ◽  
The Government ◽  
Global Nutrition

Background: Malnutrition places a heavy burden on the health, well-being, and sustainable development of populations in Sudan, especially a country affected by conflict, which continues to experience high levels of food insecurity, undernutrition, and micronutrient deficiencies; 3.3 million are acutely malnourished, with 522,000 children suffering from severe acute malnutrition and approximately 2.2 million children requiring treatment for moderate acute malnutrition. This study aims to describe the nutritional status of children under five years old and identify the progress toward the achievement of the Global Nutrition Targets. Methods: This is a secondary data analysis of a quantitative survey, using the second-round of the Simple Spatial Survey Method (S3M II) in Sudan in the period 2018–2019. The analysis used an area-based sampling methodology in all 18 Sudanese states. Data from the WHO Tracking Tools of the Global Nutrition Targets was used to reflect the progress in achieving the targets in Sudan. Results: Global stunting prevalence was at 36.35 percent including moderate stunting prevalence and severe stunting prevalence (21.25 percent and 15.06 percent respectively). Global wasting prevalence was 13.6 percent including moderate wasting prevalence and severe wasting prevalence (10.8 percent and 2.7 percent respectively). Sudan has made great progress in achieving the target of increasing exclusive breastfeeding. However, despite the welcome commitments by the Government and all stakeholders, Sudan is still struggling to implement strategies, policies, and regulatory measures to address malnutrition and achieve the Global Nutrition Targets in 2025 and the Sustainable Developmental Goals in 2030. Therefore, more than ever, there is a need for comprehensive, multi-sectoral action to address malnutrition in all its forms.

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