Estimates of the duration of untreated acute malnutrition in children from Niger.

Expected incidence of acute malnutrition is the most appropriate measure for projecting the needs of a nutritional treatment program over time in terms of staffing, food, and other treatments, but direct estimation of incidence is rarely feasible at the onset of an intervention. While incidence may be approximated as prevalence/average duration, ethical constraints preclude measurement of the duration of acute malnutrition in the absence of treatment. The authors used a compartmental model to estimate the duration of untreated moderate acute malnutrition (MAM) and severe acute malnutrition (SAM) in children aged 6-60 months. The model was informed by data from a community-based cohort of children in Niger followed from August 2006 to March 2007. Maximum likelihood estimates for the duration of untreated MAM, defined by weight-for-height z score and middle upper arm circumference, were 75-81 days and 101-116 days, respectively. The duration of untreated SAM, defined by weight-for-height z score, was 45 days. The duration of untreated MAM appears to have been shorter among children aged 6-35 months compared with those aged 36-60 months. Such estimates of the duration, and thus incidence, of untreated malnutrition can be used to improve projections of program needs and estimates of the global burden of acute malnutrition

Assessing the impact of the introduction of the World Health Organization growth standards and weight-for-height z-score criterion on the response to treatment of severe acute malnutrition in children: Secondary data analysis

OBJECTIVE: The objective of our study was to assess the impact of adopting the World Health Organization growth standards and weight-for-height z-score criterion on the response to treatment of severe acute malnutrition in children compared with the use of the National Center for Health Statistics growth reference. METHODS: We used data from children aged 6 to 59 months with acute malnutrition who were admitted to the Médecins sans Frontières nutrition program in Maradi, Niger, during 2006 (N = 56214). Differences in weight gain, duration of treatment, recovery from malnutrition, mortality, loss to follow-up, and need for inpatient care were compared for severely malnourished children identified according to the National Center for Health Statistics reference and weight-for-height <70% of the median criterion versus the World Health Organization standards and the weight-for-height less than -3 z-score criterion. RESULTS: A total of 8 times more children (n = 25754) were classified as severely malnourished according to the World Health Organization standards compared with the National Center for Health Statistics reference (n = 2989). Children included according to the World Health Organization standards had shorter durations of treatment, greater rates of recovery, fewer deaths, and less loss to follow-up or need for inpatient care. CONCLUSIONS: The introduction of the World Health Organization standards with the z-score criterion to identify children for admission into severe acute malnutrition treatment programs would imply the inclusion of children who are younger but have relatively higher weight for height on admission compared with the National Center for Health Statistics reference. These children have fewer medical complications requiring inpatient care and are more likely to experience shorter durations of treatment and lower mortality rates. The World Health Organization standards with the z-score criterion might become a useful tool for the early detection of acute malnutrition in children, although additional research on the resource implications of this transition is required

Reducing wasting in young children with preventive supplementation: a cohort study in Niger

OBJECTIVE: To compare the incidence of wasting, stunting, and mortality among children aged 6 to 36 months who are receiving preventive supplementation with either ready-to-use supplementary foods (RUSFs) or ready-to-use therapeutic foods (RUTFs). SUBJECTS AND METHODS: Children aged 6 to 36 months in 12 villages of Maradi, Niger, (n = 1645) received a monthly distribution of RUSFs (247 kcal [3 spoons] per day) for 6 months or RUTFs (500-kcal sachet per day) for 4 months. We compared the incidence of wasting, stunting, and mortality among children who received preventive supplementation with RUSFs versus RUTFs. RESULTS: The effectiveness of RUSF supplementation depended on receipt of a previous preventive intervention. In villages in which a preventive supplementation program was previously implemented, the RUSF strategy was associated with a 46% (95% confidence interval [CI]: 6%-69%) and 59% (95% CI: 17%-80%) reduction in wasting and severe wasting, respectively. In contrast, in villages in which the previous intervention was not implemented, we found no difference in the incidence of wasting or severe wasting according to type of supplementation. Compared with the RUTF strategy, the RUSF strategy was associated with a 19% (95% CI: 0%-34%) reduction in stunting overall. CONCLUSION: We found that the relative performance of a 6-month RUSF supplementation strategy versus a 4-month RUTF strategy varied with receipt of a previous nutritional intervention. Contextual factors will continue to be important in determining the dose and duration of supplementation that will be most effective, acceptable, and sustainable for a given setting

Cost-effectiveness of community-based screening and treatment of moderate acute malnutrition in Mali.

IntroductionModerate acute malnutrition (MAM) causes substantial child morbidity and mortality, accounting for 4.4% of deaths and 6.0% of disability-adjusted life years (DALY) lost among children under 5 each year. There is growing consensus on the need to provide appropriate treatment of MAM, both to reduce associated morbidity and mortality and to halt its progression to severe acute malnutrition. We estimated health outcomes, costs and cost-effectiveness of four dietary supplements for MAM treatment in children 6-35 months of age in Mali.MethodsWe conducted a cluster-randomised MAM treatment trial to describe nutritional outcomes of four dietary supplements for the management of MAM: ready-to-use supplementary foods (RUSF; PlumpySup); a specially formulated corn-soy blend (CSB) containing dehulled soybean flour, maize flour, dried skimmed milk, soy oil and a micronutrient pre-mix (CSB++; Super Cereal Plus); Misola, a locally produced, micronutrient-fortified, cereal-legume blend (MI); and locally milled flour (LMF), a mixture of millet, beans, oil and sugar, with a separate micronutrient powder. We used a decision tree model to estimate long-term outcomes and calculated incremental cost-effectiveness ratios (ICERs) comparing the health and economic outcomes of each strategy.ResultsCompared to no MAM treatment, MAM treatment with RUSF, CSB++, MI and LMF reduced the risk of death by 15.4%, 12.7%, 11.9% and 10.3%, respectively. The ICER was US$9821 per death averted (2015 USD) and US$347 per DALY averted for RUSF compared with no MAM treatment.ConclusionMAM treatment with RUSF is cost-effective across a wide range of willingness-to-pay thresholds.Trial registrationNCT01015950

How Can Nutrition Research Better Reflect the Relationship Between Wasting and Stunting in Children? Learnings from the Wasting and Stunting Project

Childhood wasting and stunting affect large numbers of children globally. Both are important risk factors for illness and death yet, despite the fact that these conditions can share common risk factors and are often seen in the same child, they are commonly portrayed as relatively distinct manifestations of undernutrition. In 2014, the Wasting and Stunting project was launched by the Emergency Nutrition Network. Its aim was to better understand the complex relationship and associations between wasting and stunting and examine whether current separations that were apparent in approaches to policy, financing, and programs were justified or useful. Based on the project's work, this article aims to bring a wasting and stunting lens to how research is designed and financed in order for the nutrition community to better understand, prevent, and treat child undernutrition. Discussion of lessons learnt focuses on the synergy and temporal relationships between children's weight loss and linear growth faltering, the proximal and distal factors that drive diverse forms of undernutrition, and identifying and targeting people most at risk. Supporting progress in all these areas requires research collaborations across interest groups that highlight the value of research that moves beyond a focus on single forms of undernutrition, and ensures that there is equal attention given to wasting as to other forms of malnutrition, wherever it is present

Effects on mortality of a nutritional intervention for malnourished HIV-infected adults referred for antiretroviral therapy: a randomised controlled trial.

Malnourished HIV-infected African adults are at high risk of early mortality after starting antiretroviral therapy (ART). We hypothesized that short-course, high-dose vitamin and mineral supplementation in lipid nutritional supplements would decrease mortality

Iron Status Predicts Treatment Failure and Mortality in Tuberculosis Patients: A Prospective Cohort Study from Dar es Salaam, Tanzania

Experimental data suggest a role for iron in the course of tuberculosis (TB) infection, but there is limited evidence on the potential effects of iron deficiency or iron overload on the progression of TB disease in humans. The aim of the present analysis was to examine the association of iron status with the risk of TB progression and death.\ud We analyzed plasma samples and data collected as part a randomized micronutrient supplementation trial (not including iron) among HIV-infected and HIV-uninfected TB patients in Dar es Salaam, Tanzania. We prospectively related baseline plasma ferritin concentrations from 705 subjects (362 HIV-infected and 343 HIV-uninfected) to the risk of treatment failure at one month after initiation, TB recurrence and death using binomial and Cox regression analyses. Overall, low (plasma ferritin<30 µg/L) and high (plasma ferritin>150 µg/L for women and>200 µg/L for men) iron status were seen in 9% and 48% of patients, respectively. Compared with normal levels, low plasma ferritin predicted an independent increased risk of treatment failure overall (adjusted RR = 1.95, 95% CI: 1.07 to 3.52) and of TB recurrence among HIV-infected patients (adjusted RR = 4.21, 95% CI: 1.22 to 14.55). High plasma ferritin, independent of C-reactive protein concentrations, was associated with an increased risk of overall mortality (adjusted RR = 3.02, 95% CI: 1.95 to 4.67). Both iron deficiency and overload exist in TB patients and may contribute to disease progression and poor clinical outcomes. Strategies to maintain normal iron status in TB patients could be helpful to reduce TB morbidity and mortality

How Can Nutrition Research Better Reflect the Relationship Between Wasting and Stunting in Children? : Learnings from the Wasting and Stunting Project

Childhood wasting and stunting affect large numbers of children globally. Both are important risk factors for illness and death yet, despite the fact that these conditions can share common risk factors and are often seen in the same child, they are commonly portrayed as relatively distinct manifestations of undernutrition. In 2014, the Wasting and Stunting project was launched by the Emergency Nutrition Network. Its aim was to better understand the complex relationship and associations between wasting and stunting and examine whether current separations that were apparent in approaches to policy, financing, and programs were justified or useful. Based on the project's work, this article aims to bring a wasting and stunting lens to how research is designed and financed in order for the nutrition community to better understand, prevent, and treat child undernutrition. Discussion of lessons learnt focuses on the synergy and temporal relationships between children's weight loss and linear growth faltering, the proximal and distal factors that drive diverse forms of undernutrition, and identifying and targeting people most at risk. Supporting progress in all these areas requires research collaborations across interest groups that highlight the value of research that moves beyond a focus on single forms of undernutrition, and ensures that there is equal attention given to wasting as to other forms of malnutrition, wherever it is present.publishedVersionPeer reviewe

Outcome of HIV-exposed uninfected children undergoing surgery

<p>Abstract</p> <p>Background</p> <p>HIV-exposed uninfected (HIVe) children are a rapidly growing population that may be at an increased risk of illness compared to HIV-unexposed children (HIVn). The aim of this study was to investigate the morbidity and mortality of HIVe compared to both HIVn and HIV-infected (HIVi) children after a general surgical procedure.</p> <p>Methods</p> <p>A prospective study of children less than 60 months of age undergoing general surgery at a paediatric referral hospital from July 2004 to July 2008 inclusive. Children underwent age-definitive HIV testing and were followed up post operatively for the development of complications, length of stay and mortality.</p> <p>Results</p> <p>Three hundred and eighty children were enrolled; 4 died and 11 were lost to follow up prior to HIV testing, thus 365 children were included. Of these, 38(10.4%) were HIVe, 245(67.1%) were HIVn and 82(22.5%) were HIVi children.</p> <p>The overall mortality was low, with 2(5.2%) deaths in the HIVe group, 0 in the HIVn group and 6(7.3%) in the HIVi group (p = 0.0003). HIVe had a longer stay than HIVn children (3 (2-7) vs. 2 (1-4) days p = 0.02). There was no significant difference in length of stay between the HIVe and HIVi groups. HIVe children had a higher rate of complications compared to HIVn children, (9 (23.7%) vs. 14(5.7%) (RR 3.8(2.1-7) p < 0.0001) but a similar rate of complications compared to HIVi children 34 (41.5%) (RR = 0.6 (0.3-1.1) p = 0.06).</p> <p>Conclusion</p> <p>HIVe children have a higher risk of developing complications and mortality after surgery compared to HIVn children. However, the risk of complications is lower than that of HIVi children.</p