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Phillips JF, Roy CM, Gebregziabher M. The international humanitarian response to famine in Tigray, Ethiopia:lessons from the Nigerian Civil War, 1967-1970. Glob Health Action 2022; 15:2107203. [PMID: 36106597 PMCID: PMC9481073 DOI: 10.1080/16549716.2022.2107203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
The Tigray crisis in Ethiopia is a grave humanitarian catastrophe with causes and consequences that resemble the Nigerian Civil War that ended with the defeat of secessionist Biafra five decades ago. As in the Biafra example, an ethnically distinct and embattled enclave is surrounded by hostile forces and cut off from commerce of any kind, producing starvation, forced migrant encampments, and pervasive dependence on externally provided food relief. Relief action strategies developed during the Nigerian Civil War were comprised of operational components that were often insufficiently integrated into a unified system for nutritional screening, referral, acute care, nutritional rehabilitation, and team deployment. This lack of strategic integration for post-conflict relief actions merits review for possible lessons that could avert its recurrence in Tigray. If evidence-based systems for relief organization had been comprehensively applied in Biafra, the pace of post-conflict nutritional recovery could have been accelerated. Although component strategies of the Biafra-Nigeria Relief Action are being replicated by various agencies that are providing humanitarian assistance in Tigray, their collective impact could be enhanced if these strategies were integrated into a unified, evidence-driven systems response to the emergency. The elements of such a systems approach for assisting Tigray are reviewed.
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Affiliation(s)
- James F. Phillips
- Heilbrunn Department of Population and Family Health, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Charlotte M. Roy
- Department of Emergency Medicine, Loma Linda University Medical Center, Loma Linda, CA, USA
| | - Mulugeta Gebregziabher
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, USA
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Jima BR, Hassen HY, Bahwere P, Gebreyesus SH. Diagnostic ability of mid-upper arm circumference-to-length ratio in detecting wasting among infants aged 1-6 months in Ethiopia. J Nutr Sci 2022; 11:e23. [PMID: 35399552 PMCID: PMC8943582 DOI: 10.1017/jns.2022.21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2021] [Revised: 02/15/2022] [Accepted: 02/18/2022] [Indexed: 11/26/2022] Open
Abstract
Mid-upper arm circumference (MUAC) is an age-sensitive anthropometric measurement in infants. However, exact age is difficult to know, particularly in low-income countries. We evaluated the diagnostic accuracy of an age-independent mid-upper arm circumference-to-length (MUAC/L) ratio measurement in detecting wasting among infants aged 1-6 months in Ethiopia. A facility-based diagnostic accuracy study was conducted on 467 in-patient infants aged 1-6 months from March to May 2019. The receiver operating characteristic (ROC) curve was used to evaluate the ability of MUAC/L to detect wasting. Sensitivity, specificity, positive likelihood ratio, negative likelihood ratio and positive and negative predictive values were calculated. The magnitude of severe wasting was 21⋅6 % and moderate wasting was 13⋅0 %. The area under the ROC curve (AUC) of MUAC/L was 0⋅77 (95 % CI 0⋅73, 0⋅81) for detecting moderate wasting and 0⋅92 (95 % CI 0⋅89, 0⋅94) for detecting severe wasting. MUAC/L had a sensitivity of 91⋅1 % (95 % CI 81⋅3, 94⋅4), a specificity of 84⋅7 % (95 % CI 80⋅6, 88⋅2), a positive likelihood ratio of 5⋅82 (95 % CI 4⋅53, 7⋅48) and a negative likelihood ratio of 0⋅13 (95 % CI 0⋅07, 0⋅22) in total infants. The optimal MUAC/L cut-off was <0⋅190 for boys and <0⋅185 for girls. MUAC/L had an AUC of 0⋅77 and 0⋅92 in predicting moderate and severe wasting in infants aged 1-6 months, respectively. Using MUAC/L to treat Ethiopian infants with severe wasting and infants with similar characteristics in other countries could improve treatment coverage.
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Affiliation(s)
- Beshada Rago Jima
- Department of Nutrition and Dietetics, School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia
| | - Hamid Yimem Hassen
- Department of Primary and Interdisciplinary Care, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Paluku Bahwere
- Centre of Research in Epidemiology, Biostatistics and Clinical Research, School of Public Health, Free University of Brussels, 808, Route de Lennik, 1070Brussels, Belgium
| | - Seifu Hagos Gebreyesus
- Department of Nutrition and Dietetics, School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia
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Abstract
Armed conflict regularly presents extremely adverse circumstances not only for combatants, but also for civilians. In fact, estimates from various wars over the past 70 years suggest that noncombatants comprise the majority of casualties. For survivors, war's effects are often embodied, leaving long-term effects on health and biology. Some of these effects, such as injuries and psychological trauma, are well known. Yet other effects may be subtle and may be elucidated by a developmental biological perspective. In early life, when growth rates are highest, conditions of war may have their greatest impact. Depending on local circumstances, a developing embryo, infant, or child growing in a place embroiled in armed conflict is likely to face—directly or indirectly—various stressors, including malnutrition, infectious disease, and/or psychological stress. Thus, the conditions of war and forced displacement may become embodied, getting under the skin for fundamental biological reasons.
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Affiliation(s)
- Patrick F. Clarkin
- Department of Anthropology, University of Massachusetts, Boston, Massachusetts 02125-3393, USA
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Frison S, Kerac M, Checchi F, Prudhon C. Anthropometric indices and measures to assess change in the nutritional status of a population: a systematic literature review. BMC Nutr 2016. [DOI: 10.1186/s40795-016-0104-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Myatt M, Khara T, Collins S. A Review of Methods to Detect Cases of Severely Malnourished Children in the Community for Their Admission into Community-Based Therapeutic Care Programs. Food Nutr Bull 2016; 27:S7-23. [PMID: 17076211 DOI: 10.1177/15648265060273s302] [Citation(s) in RCA: 179] [Impact Index Per Article: 22.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background The complexity and cost of measuring weight-for-height make it unsuitable for use by community-based volunteers. This has led community therapeutic care programs to adopt a two-stage screening and admission procedure in which mid-upper-arm circumference (MUAC) is used for referral and weight-for-height is used for admission. Such a procedure results in many individuals being referred for care on the basis of MUAC but subsequently being refused treatment because they do not meet the weight-for-height admission criterion. This “problem of rejected referrals” has proved to be a major barrier to program uptake. Objective To systematically review methods to detect cases of severely malnourished children in the community for their admission into community-based therapeutic care programs. Methods Clinical and anthropometric methods for case detection of severely malnourished children in the community were reviewed with regard to their ability to reflect both mortality risk and nutritional status. Results MUAC, with the addition of the presence of bipedal edema, was found to be the indicator best suited to screening and case detection of malnutrition in the community. The case definition “MUAC < 110 mm OR the presence of bipedal edema,” with MUAC measured by a color-banded strap, is suitable for screening and case detection of malnutrition in the community for children aged between 6 and 59 months. Monitoring and discharge criteria were also reviewed. Conclusions There is no compelling evidence to support a move away from using weight in combination with clinical criteria for monitoring and discharge.
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Affiliation(s)
- Mark Myatt
- Institute of Ophthalmology, 11-43 Bath St., London EC1V 9EL, UK.
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Mantilla-Hernández L, Niño-Bautista L, Prieto-Pinilla E, Galvis-Padilla D, Bueno-Pérez I. Validez de la cinta braquial para detección de desnutrición aguda en niñas y niños entre 6 y 59 meses de edad en escenarios de emergencias y desastres. Rev Salud Publica (Bogota) 2014. [DOI: 10.15446/rsap.v16n2.35426] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
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Del Cura I, Huertas R. Public health and nutrition after the Spanish Civil War. An intervention by the Rockefeller Foundation. Am J Public Health 2009; 99:1772-9. [PMID: 19696398 PMCID: PMC2741518 DOI: 10.2105/ajph.2007.124875] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/07/2009] [Indexed: 11/04/2022]
Abstract
We describe a nutritional intervention by the Rockefeller Foundation's International Health Division in Spain after the Spanish Civil War, delineating the relationships between the technicians sent by the Rockefeller Foundation and the Spanish health authorities. We analyze reports of the nutritional situation in Spain in the early 1940s and the design and outcomes of a nutrition survey conducted in a district of Madrid by American and Spanish nutritionists. This nutritional survey, which was based on food intake interviews and was complemented with anthropometric measurements, clinical examinations, and blood tests, found several symptoms and signs of malnutrition. The Rockefeller Foundation's nutritional research was an important historical precedent for later studies made in emergency situations or armed conflicts. Similar surveys have been carried out in the last several decades by distinguished academic departments of public health and epidemiology and by humanitarian aid agencies.
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Affiliation(s)
- Isabel Del Cura
- Consejo Superior de Investigaciones Científicas, C/ Albasanz 26-28, Madrid, Spain.
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Abstract
Public nutrition is a broad-based, problem-solving approach to addressing malnutrition in complex emergencies that combines analysis of nutritional risk and vulnerability with action-oriented strategies, including policies, programmes, and capacity development. This paper focuses on six broad areas: nutritional assessment, distribution of a general food ration, prevention and treatment of moderate malnutrition, treatment of severe malnutrition in children and adults, prevention and treatment of micronutrient deficiency diseases, and nutritional support for at-risk groups, including infants, pregnant and lactating women, elderly people, and people living with HIV. Learning and documenting good practice from previous emergencies, the promotion of good practice in current emergencies, and adherence to international standards and guidelines have contributed to establishing the field of public nutrition. However, many practical challenges reduce the effectiveness of nutritional interventions in complex emergencies, and important research and programmatic questions remain.
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Affiliation(s)
- Helen Young
- Friedman School of Nutrition Science and Policy of Tufts University, Medford, MA, USA.
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Goyet CDV, Jeannee E, Lechat MF, Bouckaert A. Anthropometric measurements in a relief programme in niger: a tool for decision making at the community level. DISASTERS 1977; 1:223-229. [PMID: 20958363 DOI: 10.1111/j.1467-7717.1977.tb00036.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Affiliation(s)
- C de V Goyet
- Centre de Recherche sur L' Epidemiologie des Désastres, Université Catholique de Louvain, Ecole de Santé Pulique, Clos Chapelle-aux-Champs 30, Bruxelles, Belgique
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Sauberlich HE, Dowdy RP, Skala JH. Laboratory tests for the assessment of nutritional status. CRC CRITICAL REVIEWS IN CLINICAL LABORATORY SCIENCES 1973; 4:215-340. [PMID: 4217238 DOI: 10.3109/10408367309151557] [Citation(s) in RCA: 45] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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