Mid-Upper Arm Circumference based Nutrition Programming: evidence for a new approach in regions with high burden of Acute Malnutrition

In therapeutic feeding programs (TFP), mid-upper arm circumference (MUAC) shows advantages over weight-for-height Z score (WHZ) and is recommended by the World Health Organization (WHO) as an independent criterion for screening children 6-59 months old. Here we report outcomes and treatment response from a TFP using MUAC ≤118 mm or oedema as sole admission criteria for severe acute malnutrition (SAM)

Assessment of the PROBIT approach for estimating the prevalence of global, moderate and severe acute malnutrition from population surveys

Abstract Objective Prevalence of acute malnutrition is classically estimated by the proportion of children meeting a case definition in a representative population sample. In 1995 the WHO proposed the PROBIT method, based on converting parameters of a normally distributed variable to cumulative probability, as an alternative method requiring a smaller sample size. The present study compares classical and PROBIT methods for estimating the prevalence of global, moderate and severe acute malnutrition (GAM, MAM and SAM) defined by weight-for-height Z-score (WHZ) or mid-upper arm circumference (MUAC). Design Bias and precision of classical and PROBIT methods were compared by simulating a total of 1·26 million surveys generated from 560 nutrition surveys. Setting Data used for simulation were derived from nutritional surveys of children aged 6-59 months carried out in thirty-one countries around the world. Subjects Data of 459 036 children aged 6-59 months from representative samples were used to generate simulated populations. Results The PROBIT method provided an estimate of GAM, MAM and SAM using WHZ or MUAC proportional to the true prevalence with a small systematic overestimation. The PROBIT method was more precise than the classical method for estimating the prevalence for GAM, MAM and SAM by WHZ or MUAC for small sample sizes (i.e. n<150 for SAM and GAM; n<300 for MAM), but lost this advantage when sample sizes increased. Conclusions The classical method is preferred for estimating acute malnutrition prevalence from large sample surveys. The PROBIT method may be useful in sentinel-site surveillance systems with small sample size

Analysis of the genetic variation for adaptation to a short thermal stress on young « Bos taurus » cattle

In the present work, an attempt was made to determine the adaptation to heat of some cattle breeds, especially French ones. A total of 582 young male and female cattle, about 14 months old and coming from 41 elementary genetic combinations analyzed in 5 different non bioclimatological experiments, were subjected to a heat stress for 8 hours during which the room temperature was increased from 18°C to 38 °C. The usual reaction were observed i.e. increase in the rectal temperature during the stress (+ 0,54 °C), increase in the respiratory rate ( X 3), increase in the sweating rate, heart rate and skin temperature. The statistical analyses were made at three stages of stress (beginning, middle, end). In all cases, a very strong environmental effect was noticed, ie effect of the year and of experimental errors in the management of the theoretical schedule involving temperature and relative hygrometry. The data adjusted for environmental effects rather clearly show the genetic variability. However, a more accurate analysis shows that it is mainly proceeded from a between group variability when defining the groups according to « animal husbandry » parameters (dairy purpose, beef purpose, and local breed group). As a matter of fact, in most cases, there was no significant variability between the reactions of the genotypes belonging to the same group, whereas this variability existed between the groups..The satisfactory performance of the local breed group clearly appeared in comparison with the group including the improved dairy or beef breeds exhibiting only minor differences in the parameters analyzed. In the discussion, emphasis in laid ov the possible influence of thermogenesis on the results. Although our findings could have been afrected by disturbing events such as emotional stress, they agree rather well with data obtained is practice on the behaviour of the local French breeds in some hot countries.Le but de ce travail est d’essayer de caractériser l’adaptation à la chaleur d’un certain nombre de races bovines, notamment françaises. Pour cela, 582 jeunes bovins, mâles et femelles, d’environ 14 mois et issus de 41 combinaisons génétiques élémentaires analysées dans 5 expérimentations différentes, à objectif non bioclimatologique, sont soumis en chambre chaude, à un stress thermique de 8 heures pendant lequel la température externe a été portée de 11) De 18°C à 38 °C. Les réactions classiques sont observées : augmentation de la température rectale au cours du stress (+ 0,54°C), augmentation du rythme respiratoire ( X 3), augmentation du taux de sudation, du rythme cardiaque, de la température de la peau. Les analyses statistiques sont effectuées à trois stades du stress (début, milieu, fin). Dans tous les cas, on note de très forts effets dûs au milieu : effet de l’année et des erreurs expérimentales dans la conduite du protocole théorique, concernant la température et l’hygrométrie relative. Sur les données ajustées pour les effets de milieu, la variabilité génétique apparaît assez clairement. Cependant une analyse plus fine montre qu’elle provient essentiellement d’une variabilité inter groupe en définissant le groupe d’après des critères « zootechniques » ou «fonctionnels » (groupe à vocation laitière, groupe à vocation bouchère, groupe des races locales). En effet, dans la grande majorité des cas, il n’apparaît pas de variabilité significative entre les réactions des génotypes rangés dans le même groupe, alors qu’elle existe entre les groupes. La bonne performance du groupe des races locales apparaît en comparaison des groupes mettant en oeuvre les races améliorées, laitières ou bouchères, qui diffèrent peu entre eux pour les critères analysés. Dans la discussion, l’accent est mis sur l’incidence probable sur les résultats des phénomènes de thermogénèse. Si nos résultats ont pu être affectés par des phénomènes parasites, notamment ceux de stress émotionnel, il n’en reste pas moins qu’ils concordent assez bien avec l’expérience pratique acquise sur le comportement des races locales françaises dans certains pays chauds

Do children with uncomplicated severe acute malnutrition need antibiotics? A systematic review and meta-analysis.

Current (1999) World Health Organization guidelines recommend giving routine antibiotics (AB) for all children with severe acute malnutrition (SAM), even if they have uncomplicated disease with no clinically obvious infections. We examined the evidence behind this recommendation

Boys are more likely to be undernourished than girls: a systematic review and meta-analysis of sex differences in undernutrition

BACKGROUND: Excess male morbidity and mortality is well recognised in neonatal medicine and infant health. In contrast, within global nutrition, it is commonly assumed that girls are more at risk of experiencing undernutrition. We aimed to explore evidence for any male/female differences in child undernutrition using anthropometric case definitions and the reasons for differences observed. METHODS: We searched: Medline, Embase, Global health, Popline and Cochrane databases with no time limits applied. Eligible studies focused on children aged 0–59 months affected by undernutrition where sex was reported. In the meta-analysis, undernutrition-specific estimates were examined separately for wasting, stunting and underweight using a random-effects model. RESULTS: 74 studies were identified: 44/74 studies were included in the meta-analysis. In 20 which examined wasting, boys had higher odds of being wasted than girls (pooled OR 1.26, 95% CI 1.13 to 1.40). 38 examined stunting: boys had higher odds of stunting than girls (pooled OR 1.29 95% CI 1.22 to 1.37). 23 explored underweight: boys had higher odds of being underweight than girls (pooled OR 1.14, 95% CI 1.02 to 1.26). There was some limited evidence that the female advantage, indicated by a lower risk of stunting and underweight, was weaker in South Asia than other parts of the world. 43/74 (58%) studies discussed possible reasons for boy/girl differences; 10/74 (14%) cited studies with similar findings with no further discussion; 21/74 (28%) had no sex difference discussion. 6/43 studies (14%) postulated biological causes, 21/43 (49%) social causes and 16/43 (37%) to a combination. CONCLUSION: Our review indicates that undernutrition in children under 5 is more likely to affect boys than girls, though the magnitude of these differences varies and is more pronounced in some contexts than others. Future research should further explore reasons for these differences and implications for nutrition policy and practice