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Fagbamigbe AF, Kandala NB, Uthman OA. Mind the gap: What explains the poor-non-poor inequalities in severe wasting among under-five children in low- and middle-income countries? Compositional and structural characteristics. PLoS One 2020; 15:e0241416. [PMID: 33141831 PMCID: PMC7608875 DOI: 10.1371/journal.pone.0241416] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Accepted: 10/15/2020] [Indexed: 12/17/2022] Open
Abstract
A good understanding of the poor-non-poor gap in childhood development of severe wasting (SW) is a must in tackling the age-long critical challenge to health outcomes of vulnerable children in low- and middle-income countries (LMICs). There is a dearth of information about the factors explaining differentials in wealth inequalities in the distribution of SW in LMICs. This study is aimed at quantifying the contributions of demographic, contextual and proximate factors in explaining the poor-non-poor gap in SW in LMICs. We pooled successive secondary data from the Demographic and Health Survey conducted between 2010 and 2018 in LMICs. The final data consist of 532,680 under-five children nested within 55,823 neighbourhoods from 51 LMICs. Our outcome variable is having SW or not among under-five children. Oaxaca-Blinder decomposition was used to decipher poor-non-poor gap in the determinants of SW. Children from poor households ranged from 37.5% in Egypt to 52.1% in Myanmar. The overall prevalence of SW among children from poor households was 5.3% compared with 4.2% among those from non-poor households. Twenty-one countries had statistically significant pro-poor inequality (i.e. SW concentrated among children from poor households) while only three countries showed statistically significant pro-non-poor inequality. There were variations in the important factors responsible for the wealth inequalities across the countries. The major contributors to wealth inequalities in SW include neighbourhood socioeconomic status, media access, as well as maternal age and education. Socio-economic factors created the widest gaps in the inequalities between the children from poor and non-poor households in developing SW. A potential strategy to alleviate the burden of SW is to reduce wealth inequalities among mothers in the low- and middle-income countries through multi-sectoral and country-specific interventions with considerations for the factors identified in this study.
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Affiliation(s)
- Adeniyi Francis Fagbamigbe
- Department of Epidemiology and Medical Statistics, College of Medicine, University of Ibadan, Ibadan, Nigeria
- Division of Health Sciences, Populations, Evidence and Technologies Group, University of Warwick, Coventry, United Kingdom
- * E-mail:
| | - Ngianga-Bakwin Kandala
- Department of Mathematics, Physics & Electrical Engineering (MPEE), Northumbria University, Newcastle, United Kingdom
| | - Olalekan A. Uthman
- Division of Health Sciences, Populations, Evidence and Technologies Group, University of Warwick, Coventry, United Kingdom
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Tan R, Kagoro F, Levine GA, Masimba J, Samaka J, Sangu W, Genton B, D'Acremont V, Keitel K. Clinical Outcome of Febrile Tanzanian Children with Severe Malnutrition Using Anthropometry in Comparison to Clinical Signs. Am J Trop Med Hyg 2020; 102:427-435. [PMID: 31802732 DOI: 10.4269/ajtmh.19-0553] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Children with malnutrition compared with those without are at higher risk of infection, with more severe outcomes. How clinicians assess nutritional risk factors in febrile children in primary care varies. We conducted a post hoc subgroup analysis of febrile children with severe malnutrition enrolled in a randomized, controlled trial in primary care centers in Tanzania. The clinical outcome of children with severe malnutrition defined by anthropometric measures and clinical signs was compared between two electronic clinical diagnostic algorithms: ePOCT, which uses weight-for-age and mid-upper arm circumference to identify and manage severe malnutrition, and ALMANACH, which uses the clinical signs of edema of both feet and visible severe wasting. Those identified as having severe malnutrition by the algorithms in each arm were prescribed antibiotics and referred to the hospital. From December 2014 to February 2016, 106 febrile children were enrolled and randomized in the parent study, and met the criteria to be included in the present analysis. ePOCT identified 56/57 children with severe malnutrition using anthropometric measures, whereas ALMANACH identified 2/49 children with severe malnutrition using clinical signs. The proportion of clinical failure, defined as the development of severe symptoms by day 7 or persisting symptoms at day 7 (per-protocol), was 1.8% (1/56) in the ePOCT arm versus 16.7% (8/48) in the Algorithm for the MANagement of Childhood illnesses arm (risk difference -14.9%, 95% CI -26.0%, -3.8%; risk ratio 0.11, 95% CI 0.01, 0.83). Using anthropometric measures to identify and manage febrile children with severe malnutrition may have resulted in better clinical outcomes than by using clinical signs alone.
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Affiliation(s)
- Rainer Tan
- Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland.,Swiss Tropical and Public Health Institute (SwissTPH), University of Basel, Switzerland
| | - Frank Kagoro
- Ifakara Health Institute, Dar es Salaam, Tanzania
| | - Gillian A Levine
- Swiss Tropical and Public Health Institute (SwissTPH), University of Basel, Switzerland
| | - John Masimba
- Ifakara Health Institute, Dar es Salaam, Tanzania
| | - Josephine Samaka
- Amana Hospital, Dar es Salaam, Tanzania.,Ifakara Health Institute, Dar es Salaam, Tanzania
| | - Willy Sangu
- Dar es Salaam City Council, Dar es Salaam, Tanzania
| | - Blaise Genton
- Swiss Tropical and Public Health Institute (SwissTPH), University of Basel, Switzerland.,Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
| | - Valérie D'Acremont
- Swiss Tropical and Public Health Institute (SwissTPH), University of Basel, Switzerland.,Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
| | - Kristina Keitel
- Department of Pediatric Emergency Medicine, University Hospital Bern, Bern, Switzerland.,Swiss Tropical and Public Health Institute (SwissTPH), University of Basel, Switzerland
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Stephens K, Orlick M, Beattie S, Snell A, Munsterman K, Oladitan L, Abdel-Rahman S. Examining Mid-Upper Arm Circumference Malnutrition z-Score Thresholds. Nutr Clin Pract 2019; 35:344-352. [PMID: 31175704 DOI: 10.1002/ncp.10324] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Anthropometric z-scores used commonly for diagnosis and determining degree of malnutrition, specifically body mass index (BMIz), weight-for-length (WLz), and mid-upper arm circumference (MUACz), are not wholly concordant, yet the proposed thresholds for classification are identical. This study was designed to critically examine MUACz thresholds and their ability to correctly classify nutrition status. METHODS This was a 2-year, prospective single-center study of children ≤18 years seen by registered dietitians within a large pediatric institution. The sensitivity, specificity, and predictive performance of the malnutrition classification thresholds were estimated against clinician-based classification. RESULTS Sixty-one dietitians enrolled 10,401 patients with distributions of z-scores for weight (-0.5 ± 1.9), length (-0.8 ± 1.6), BMI or WL (-0.1 ± 1.8), and MUAC (-0.4 ± 1.5), suggesting participants were smaller and shorter than the reference U.S. POPULATION Distributions of MUACz were broad and overlapped between nutrition classification groups, an observation that extended to BMIz and WLz as well. Consequently, existing thresholds do not accurately classify 100% of children. Misclassification rates increase, with increasing severity ranging from 8% in children with no malnutrition to 71% in children with severe malnutrition. Algorithm- and manually-based refinement of thresholds result in mixed improvements and can be explored by the reader with the associated supplement. CONCLUSION The sensitivity of proposed MUACz thresholds systematically decreases with increasing severity of malnutrition and will require optimization if we aim to limit the number of children at risk of misclassification. Indicators for overnutrition remain to be addressed but are explored herein.
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Affiliation(s)
- Karen Stephens
- Nutrition Services, Children's Mercy Hospital, Kansas City, Missouri, USA
| | - Meike Orlick
- Children's Mercy Hospital, Kansas City, Missouri, USA
| | | | - Audrey Snell
- Children's Mercy Hospital, Kansas City, Missouri, USA
| | | | - Leah Oladitan
- Children's Mercy Hospital, Kansas City, Missouri, USA
| | - Susan Abdel-Rahman
- UMKC School of Medicine, Kansas City, Missouri, USA.,Innovation in Health Care Delivery, Children's Research Institute, Kansas City, Missouri, USA.,Section of Therapeutic Innovation, Children's Mercy Hospital, Kansas City, Missouri, USA
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Grellety E, Golden MH. Severely malnourished children with a low weight-for-height have similar mortality to those with a low mid-upper-arm-circumference: II. Systematic literature review and meta-analysis. Nutr J 2018; 17:80. [PMID: 30217196 PMCID: PMC6138903 DOI: 10.1186/s12937-018-0383-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Accepted: 07/25/2018] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND The WHO recommended criteria for diagnosis of sever acute malnutrition (SAM) are weight-for-height/length Z-score (WHZ) of <- 3Z of the WHO2006 standards, a mid-upper-arm circumference (MUAC) of < 115 mm, nutritional oedema or any combination of these parameters. A move to eliminate WHZ as a diagnostic criterion has been made on the assertion that children with a low WHZ are healthy, that MUAC is a "superior" prognostic indicator of mortality and that adding WHZ to the assessment does not improve the prediction of death. Our objective was to examine the literature comparing the risk of death of SAM children admitted by WHZ or MUAC criteria. METHODS We conducted a systematic search for reports which examined the relationship of WHZ and MUAC to mortality for children less than 60 months. The WHZ, MUAC, outcome and programmatic variables were abstracted from the reports and examined. Individual study's case fatality rates were compared by chi-squared analysis and random effects meta-analyses for combined data. RESULTS Twenty-one datasets were reviewed. All the patient studies had an ascertainment bias. Most were inadequate because they had insufficient deaths, used obsolete standards, combined oedematous and non-oedematous subjects, did not report the proportion of children with both deficits or the deaths occurred remotely after anthropometry. The meta-analyses showed that the mortality risks for children who have SAM by MUAC < 115 mm only and those with SAM by WHZ < -3Z only are not different. CONCLUSIONS As the diagnostic criteria identify different children, this analysis does not support the abandonment of WHZ as an important independent diagnostic criterion for the diagnosis of SAM. Failure to identify such children will result in their being denied treatment and unnecessary deaths from SAM.
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Affiliation(s)
- Emmanuel Grellety
- Research Center Health Policy and Systems - International Health, School of Public Health, Université Libre de Bruxelles, Bruxelles, Belgium.
| | - Michael H Golden
- Department of Medicine and Therapeutics, University of Aberdeen, Aberdeen, Scotland, UK
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A Pilot of a UK Emergency Medical Team (EMT) Medical Record During a Deployment Training Course. Prehosp Disaster Med 2018; 33:441-447. [DOI: 10.1017/s1049023x18000468] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
AbstractIntroductionImproving medical record keeping is a key part of the World Health Organization’s (WHO’s; Geneva, Switzerland) drive to standardize and evaluate emergency medical team (EMT) response to sudden onset disasters (SODs).ProblemIn response to the WHO initiative, the UK EMT is redeveloping its medical record template in line with the WHO minimum dataset (MDS) for daily reporting. When changing a medical record, it is important to understand how well it functions before it is implemented.MethodsThe redeveloped medical record was piloted at a UK EMT deployment course using simulated patients in order to examine ease of use by practitioners, and rates of data capture for key MDS variables.ResultsSome parts of the form were consistently poorly filled in, and the way in which the form was completed suggested that the flow of the form did not align with the recorder’s natural thought processes when under pressure.Conclusion:Piloting of a single-sheet triplicate medical record during an EMT deployment simulation led to significant modifications to improve data capture and function.Jafar AJN, Fletcher RJ, Lecky F, Redmond AD. A pilot of a UK emergency medical team (EMT) medical record during a deployment training course. Prehosp Disaster Med. 2018;33(4):441–447.
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6
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3-D printing open-source click-MUAC bands for identification of malnutrition. Public Health Nutr 2017; 20:2063-2066. [PMID: 28488563 DOI: 10.1017/s1368980017000726] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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El Habashy SA, Mohamed MH, Amin DA, Marzouk D, Farid MN. Evaluation of validity of Integrated Management of Childhood Illness guidelines in identifying edema of nutritional causes among Egyptian children. J Egypt Public Health Assoc 2015; 90:150-156. [PMID: 26854895 DOI: 10.1097/01.epx.0000475420.59037.67] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
OBJECTIVE The aim of this study was to assess the validity of the Integrated Management of Childhood Illness (IMCI) algorithm to detect edematous type of malnutrition in Egyptian infants and children ranging in age from 2 months to 5 years. MATERIALS AND METHODS This study was carried out by surveying 23 082 children aged between 2 months and 5 years visiting the pediatric outpatient clinic, Ain Shams University Hospital, over a period of 6 months. Thirty-eight patients with edema of both feet on their primary visit were enrolled in the study. Every child was assessed using the IMCI algorithm 'assess and classify' by the same physician, together with a systematic clinical evaluation with all relevant investigations. RESULTS Twenty-two patients (57.9%) were proven to have nutritional etiology. 'Weight for age' sign had a sensitivity of 95.5%, a specificity of 56%, and a diagnostic accuracy of 78.95% in the identification of nutritional edema among all cases of bipedal edema. Combinations of IMCI symptoms 'pallor, visible severe wasting, fever, diarrhea', and 'weight for age' increased the sensitivity to 100%, but with a low specificity of 38% and a diagnostic accuracy of 73.68%. CONCLUSION AND RECOMMENDATIONS Bipedal edema and low weight for age as part of the IMCI algorithm can identify edema because of nutritional etiology with 100% sensitivity, but with 37% specificity. Revisions need to be made to the IMCI guidelines published in 2010 by the Egyptian Ministry of Health in the light of the new WHO guidelines of 2014.
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Affiliation(s)
- Safinaz A El Habashy
- aPediatrics Department bCommunity Medicine Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt
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Kerac M, Mwangome M, McGrath M, Haider R, Berkley JA. Management of acute malnutrition in infants aged under 6 months (MAMI): current issues and future directions in policy and research. Food Nutr Bull 2015; 36:S30-4. [PMID: 25993754 PMCID: PMC4817215 DOI: 10.1177/15648265150361s105] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Globally, some 4.7 million infants aged under 6 months are moderately wasted and 3.8 million are severely wasted. Traditionally, they have been over-looked by clinicians, nutritionists, and policy makers. OBJECTIVE To present evidence and arguments for why treating acute malnutrition in infants under 6 months of age is important and outline some of the key debates and research questions needed to advance their care. METHODS Narrative review. RESULTS AND CONCLUSIONS Treating malnourished infants under 6 months of age is important to avoid malnutrition-associated mortality in the short-term and adverse health and development outcomes in the long-term. Physiological and pathological differences demand a different approach from that in older children; key among these is a focus on exclusive breastfeeding wherever possible. New World Health Organization guidelines for the management of severe acute malnutrition (SAM) include this age group for the first time and are also applicable to management of moderate acute malnutrition (MAM). Community-based breastfeeding support is the core, but not the sole, treatment. The mother-infant dyad is at the heart of approaches, but wider family and community relationships are also important. An urgent priority is to develop better case definitions; criteria based on mid-upper-arm circumference (MUAC) are promising but need further research. To effectively move forward, clinical trials of assessment and treatment are needed to bolster the currently sparse evidence base. In the meantime, nutrition surveys and screening at health facilities should routinely include infants under 6 months of age in order to better define the burden and outcomes of acute malnutrition in this age group.
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Abstract
Kwashiorkor and marasmus, collectively termed severe acute malnutrition (SAM), account for at least 10% of all deaths among children under 5 years of age worldwide, virtually all of them in low-income and middle-income countries. A number of risk factors, including seasonal food insecurity, environmental enteropathy, poor complementary feeding practices, and chronic and acute infections, contribute to the development of SAM. Careful anthropometry is key to making an accurate diagnosis of SAM and can be performed by village health workers or even laypeople in rural areas. The majority of children can be treated at home with ready-to-use therapeutic food under the community-based management of acute malnutrition model with recovery rates of approximately 90% under optimal conditions. A small percentage of children, often those with HIV, tuberculosis or other comorbidities, will still require inpatient therapy using fortified milk-based foods.
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Affiliation(s)
- Indi Trehan
- Department of Pediatrics, Washington University in St. Louis, St. Louis, Missouri, USA Department of Paediatrics and Child Health, University of Malawi, Blantyre, Malawi
| | - Mark J Manary
- Department of Pediatrics, Washington University in St. Louis, St. Louis, Missouri, USA Department of Community Health, University of Malawi, Blantyre, Malawi Children's Nutrition Research Center, Baylor College of Medicine, Houston, USA
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10
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LaCourse SM, Chester FM, Preidis G, McCrary LM, Maliwichi M, McCollum ED, Hosseinipour MC. Lay-screeners and use of WHO growth standards increase case finding of hospitalized Malawian children with severe acute malnutrition. J Trop Pediatr 2015; 61:44-53. [PMID: 25477308 PMCID: PMC4375387 DOI: 10.1093/tropej/fmu065] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
OBJECTIVES Strategies to effectively identify and refer children with severe acute malnutrition (SAM) to Nutritional Rehabilitation units (NRU) can reduce morbidity and mortality. METHODS From December 2011 to May 2012, we conducted a prospective study task-shifting inpatient malnutrition screening of Malawian children 6-60 months to lay-screeners and evaluated World Health Organization (WHO) criteria vs. the National Center for Health Statistics (NCHS) guidelines for SAM. RESULTS Lay-screeners evaluated 3116 children, identifying 368 (11.8%) with SAM by WHO criteria, including 210 (6.7%) who met NCHS criteria initially missed by standard clinician NRU referrals. Overall case finding increased by 56.7%. Mid-upper arm circumference (MUAC) and bipedal edema captured 86% (181/210) NCHS/NRU-eligible children and 89% of those who died (17/19) meeting WHO criteria. Mortality of NCHS/NRU-eligible children was 10 times greater than those without SAM (odds ratio 10.5, 95% confidence interval 5.4-20.6). CONCLUSIONS Ward-based lay-screeners and WHO guidelines identified high-risk children with SAM missed by standard NRU referral. MUAC and edema detected the majority of NRU-eligible children.
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Affiliation(s)
- Sylvia M. LaCourse
- Department of Medicine, Division of Allergy and Infectious Diseases, University of Washington, Seattle, WA 98195, USA,UNC Project, Lilongwe, Malawi
| | | | - Geoffrey Preidis
- Department of Pediatrics, Baylor College of Medicine, Houston, TX 77030, USA
| | - Leah M. McCrary
- UNC Project, Lilongwe, Malawi,University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC 27516, USA
| | | | - Eric D. McCollum
- UNC Project, Lilongwe, Malawi,Department of Pediatrics, Division of Pulmonology, Johns Hopkins School of Medicine, Baltimore, MD 21287, USA
| | - Mina C. Hosseinipour
- UNC Project, Lilongwe, Malawi,Department of Medicine, Division of Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
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Salim N, Schindler T, Abdul U, Rothen J, Genton B, Lweno O, Mohammed AS, Masimba J, Kwaba D, Abdulla S, Tanner M, Daubenberger C, Knopp S. Enterobiasis and strongyloidiasis and associated co-infections and morbidity markers in infants, preschool- and school-aged children from rural coastal Tanzania: a cross-sectional study. BMC Infect Dis 2014; 14:644. [PMID: 25486986 PMCID: PMC4271451 DOI: 10.1186/s12879-014-0644-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2014] [Accepted: 11/20/2014] [Indexed: 11/24/2022] Open
Abstract
Background There is a paucity of data pertaining to the epidemiology and public health impact of Enterobius vermicularis and Strongyloides stercoralis infections. We aimed to determine the extent of enterobiasis, strongyloidiasis, and other helminth infections and their association with asymptomatic Plasmodium parasitaemia, anaemia, nutritional status, and blood cell counts in infants, preschool-aged (PSAC), and school-aged children (SAC) from rural coastal Tanzania. Methods A total of 1,033 children were included in a cross-sectional study implemented in the Bagamoyo district in 2011/2012. Faecal samples were examined for intestinal helminth infections using a broad set of quality controlled methods. Finger-prick blood samples were subjected to filariasis and Plasmodium parasitaemia testing and full blood cell count examination. Weight, length/height, and/or mid-upper arm circumference were measured and the nutritional status determined in accordance with age. Results E. vermicularis infections were found in 4.2% of infants, 16.7%, of PSAC, and 26.3% of SAC. S. stercoralis infections were detected in 5.8%, 7.5%, and 7.1% of infants, PSAC, and SAC, respectively. Multivariable regression analyses revealed higher odds of enterobiasis in children of all age-groups with a reported anthelminthic treatment history over the past six months (odds ratio (OR): 2.15; 95% confidence interval (CI): 1.22 - 3.79) and in SAC with a higher temperature (OR: 2.21; CI: 1.13 - 4.33). Strongyloidiasis was associated with eosinophilia (OR: 2.04; CI: 1.20-3.48) and with Trichuris trichiura infections (OR: 4.13; CI: 1.04-16.52) in children of all age-groups, and with asymptomatic Plasmodium parasitaemia (OR: 13.03; CI: 1.34 - 127.23) in infants. None of the investigated helminthiases impacted significantly on the nutritional status and anaemia, but moderate asymptomatic Plasmodium parasitaemia was a strong predictor for anaemia in children aged older than two years (OR: 2.69; 95% CI: 1.23 – 5.86). Conclusions E. vermicularis and S. stercoralis infections were moderately prevalent in children from rural coastal Tanzania. Our data can contribute to inform yet missing global burden of disease and prevalence estimates for strongyloidiasis and enterobiasis. The association between S stercoralis and asymptomatic Plasmodium parasitaemia found here warrants further comprehensive investigations. Electronic supplementary material The online version of this article (doi:10.1186/s12879-014-0644-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Nahya Salim
- Bagamoyo Research and Training Centre, Ifakara Health Institute, Bagamoyo, United Republic of Tanzania. .,Department of Pediatrics and Child Health, Muhimbili University Health and Allied Sciences, Dar es Salaam, United Republic of Tanzania. .,Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland. .,University of Basel, Basel, Switzerland.
| | - Tobias Schindler
- Bagamoyo Research and Training Centre, Ifakara Health Institute, Bagamoyo, United Republic of Tanzania. .,University of Basel, Basel, Switzerland. .,Department of Medical Parasitology and Infection Biology, Swiss Tropical and Public Health Institute, Basel, Switzerland.
| | - Ummi Abdul
- Bagamoyo Research and Training Centre, Ifakara Health Institute, Bagamoyo, United Republic of Tanzania.
| | - Julian Rothen
- Bagamoyo Research and Training Centre, Ifakara Health Institute, Bagamoyo, United Republic of Tanzania. .,University of Basel, Basel, Switzerland. .,Department of Medical Parasitology and Infection Biology, Swiss Tropical and Public Health Institute, Basel, Switzerland.
| | - Blaise Genton
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland. .,University of Basel, Basel, Switzerland. .,Department of Ambulatory Care and Community Medicine, Infectious Disease Service, Lausanne University Hospital, Lausanne, Switzerland.
| | - Omar Lweno
- Bagamoyo Research and Training Centre, Ifakara Health Institute, Bagamoyo, United Republic of Tanzania.
| | - Alisa S Mohammed
- Bagamoyo Research and Training Centre, Ifakara Health Institute, Bagamoyo, United Republic of Tanzania.
| | - John Masimba
- Bagamoyo Research and Training Centre, Ifakara Health Institute, Bagamoyo, United Republic of Tanzania.
| | - Denis Kwaba
- Bagamoyo Research and Training Centre, Ifakara Health Institute, Bagamoyo, United Republic of Tanzania.
| | - Salim Abdulla
- Bagamoyo Research and Training Centre, Ifakara Health Institute, Bagamoyo, United Republic of Tanzania.
| | - Marcel Tanner
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland. .,University of Basel, Basel, Switzerland.
| | - Claudia Daubenberger
- University of Basel, Basel, Switzerland. .,Department of Medical Parasitology and Infection Biology, Swiss Tropical and Public Health Institute, Basel, Switzerland.
| | - Stefanie Knopp
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland. .,University of Basel, Basel, Switzerland. .,Department of Life Sciences, Wolfson Wellcome Biomedical Laboratories, Natural History Museum, London, United Kingdom.
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Becker P, Carney LN, Corkins MR, Monczka J, Smith E, Smith SE, Spear BA, White JV. Consensus Statement of the Academy of Nutrition and Dietetics/American Society for Parenteral and Enteral Nutrition. Nutr Clin Pract 2014; 30:147-61. [DOI: 10.1177/0884533614557642] [Citation(s) in RCA: 172] [Impact Index Per Article: 17.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Affiliation(s)
- Patricia Becker
- University of North Carolina Health Care, Chapel Hill, North Carolina
| | | | - Mark R. Corkins
- University of Tennessee Health Sciences Center, Memphis, Tennessee
| | | | - Elizabeth Smith
- The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | | | | | - Jane V. White
- University of Tennessee Graduate School of Medicine, Knoxville, Tennessee
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Pollach G, Bradley E, Cole A, Jung K. A new way to measure mid-upper-arm circumference in african villages. Pediatr Rep 2014; 6:5368. [PMID: 24987512 PMCID: PMC4076652 DOI: 10.4081/pr.2014.5368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2014] [Accepted: 03/11/2014] [Indexed: 11/25/2022] Open
Abstract
In 2011 we published a study on how to detect the threshold for malnutrition in children, simply using their own hands and without any technical tool. The fight against malnutrition can only be reached when its measurements involve every single child, almost continuously, in the affected villages. In this paper we try to show that, thanks to our method, it is possible to use mid-upper-arm-circumference as a measurement for malnutrition in children, discriminating between severe and moderate malnutrition and providing the basis for the decision on whether to admit a child to a nutritional rehabilitation unit or not. We trained 63 participants in four groups (Group 1: doctors and clinical officers; Group 2: nurses and students; as Group 3 we defined the 20 best participants and Group 4 consisted of 10 more intensely trained participants) to measure the circumference of 9 different artificial arms (between 9 and 13 cm) using their own fingers and hands. The training was short and consisted of an introduction of 5 min, a first training phase of 10-15 min, a test, the critical discussion of the results, a second training phase of 5 min and a final test. We found that 95.3% of participants in the general group and 97.9% in the intensely trained group have identified the severely malnourished child; 87.3% in the general group and 91.9% in the intensely trained group have additionally identified the moderately malnourished child. Both groups haven't admitted the well nourished child to a therapeutic feeding program retaining their resources. The third group reached without any additional training the results in the above categories. A subsequent discussion with the participants on the influence of procurement, maintenance and pricing of our tool, found our method much less vulnerable than others. We conclude that this method should be considered as a future training in the villages to detect the trend towards malnutrition early enough.
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Affiliation(s)
- Gregor Pollach
- Department of Anesthesia, Queen Elizabeth Central Hospital , Blantyre, Malawi ; Department of Anesthesia and Intensive Care, University of Malawi , Blantyre, Malawi
| | - Eleanore Bradley
- Department of Anesthesia, Queen Elizabeth Central Hospital , Blantyre, Malawi
| | - Abigail Cole
- Department of Anesthesia, Queen Elizabeth Central Hospital , Blantyre, Malawi
| | - Kai Jung
- Department of Anesthesia, Queen Elizabeth Central Hospital , Blantyre, Malawi ; Department of Anesthesia and Intensive Care, University of Malawi , Blantyre, Malawi
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Ahmad UN, Yiwombe M, Chisepo P, Cole TJ, Heikens GT, Kerac M. Interpretation of World Health Organization growth charts for assessing infant malnutrition: a randomised controlled trial. J Paediatr Child Health 2014; 50:32-9. [PMID: 24134409 DOI: 10.1111/jpc.12405] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
AIMS The study aims to assess the effects of switching from National Center for Health Statistics (NCHS) growth references to World Health Organization (WHO) growth standards on health-care workers' decisions about malnutrition in infants aged <6 months. METHODS We conducted a single blind randomised crossover trial involving 78 health-care workers (doctors, clinical officers, health service assistants) in Southern Malawi. Participants were offered hypothetical clinical scenarios with the same infant plotted on NCHS-based weight-for-age charts and again on WHO-based charts. Additional scenarios compared growth charts with a single final weight against charts with the same final weight plus a preceding growth trend. Reported (i) level of concern, (ii) referral suggestions and (iii) feeding advice were elicited with a questionnaire. RESULTS Even after adjusting for health-care worker type and experience, using WHO rather than NCHS charts increased: (i) concern: aOR 4.4 (95% CI 2.4-8.1); (ii) odds of referral: aOR 5.1 (95% CI 2.4-10.8); and (iii) odds of feeding advice which would interrupt exclusive breastfeeding (aOR 2.4, 95% CI 1.2-4.9). A preceding steady growth trend line did not affect concern, referral or feeding advice. CONCLUSIONS Health-care workers take insufficient account of linear growth trend, clinical and feeding status when interpreting a low weight-for-age plot. Because more infants <6 months fall below low centile lines on WHO growth charts, their use may increase inappropriate referrals and risks undermining already low rates of exclusive breastfeeding. To avoid their being misinterpreted in this way, WHO charts need accompanying guidelines and training materials that recognise and address this possible adverse effect.
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Affiliation(s)
- Umar N Ahmad
- UCL Institute for Global Health, University College London, London, United Kingdom
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Ali E, Zachariah R, Shams Z, Vernaeve L, Alders P, Salio F, Manzi M, Allaouna M, Draguez B, Delchevalerie P, Harries AD. Is mid-upper arm circumference alone sufficient for deciding admission to a nutritional programme for childhood severe acute malnutrition in Bangladesh? Trans R Soc Trop Med Hyg 2013; 107:319-23. [DOI: 10.1093/trstmh/trt018] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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