77 research outputs found
Recommended from our members
Comparison of Clinical Characteristics and Treatment Outcomes of Children Selected for Treatment of Severe Acute Malnutrition Using Mid Upper Arm Circumference and/or Weight-for-Height Z-Score
<div><p>Objectives</p><p>Debate for a greater role of mid-upper arm circumference (MUAC) measures in nutritional programming continues, but a shift from therapeutic feeding programs admitting children using MUAC and/or weight-for-height Z (WHZ) to a new model admitting children using MUAC only remains complicated by limited information regarding the clinical profile and response to treatment of children selected by MUAC vs. WHZ. To broaden our understanding of how children identified for therapeutic feeding by MUAC and/or WHZ may differ, we aimed to investigate differences between children identified for therapeutic feeding by MUAC and/or WHZ in terms of demographic, anthropometric, clinical, and laboratory and treatment response characteristics.</p><p>Methods</p><p>Using secondary data from a randomized trial in rural Niger among children with uncomplicated severe acute malnutrition, we compared children that would be admitted to a therapeutic feeding program that used a single anthropometric criterion of MUAC< 115 mm vs. children that are admitted under current admission criteria (WHZ< -3 and/or MUAC< 115 mm) but would be excluded from a program that used a single MUAC< 115 mm admission criterion. We assessed differences between groups using multivariate regression, employing linear regression for continuous outcomes and log-binomial regression for dichotomous outcomes.</p><p>Results</p><p>We found no difference in terms of clinical and laboratory characteristics and discharge outcomes evaluated between children that would be included in a MUAC< 115 mm therapeutic feeding program vs. children that are currently eligible for therapeutic feeding but would be excluded from a MUAC-only program.</p><p>Conclusions</p><p>A single anthropometric admission criterion of MUAC < 115 mm did not differentiate well between children in terms of clinical or laboratory measures or program outcomes in this context. If nutritional programming is to use a single MUAC-based criterion for admission to treatment, further research and program experience can help to identify the most appropriate criterion in a broad range of contexts to target children in most urgent need of treatment.</p></div
Comparison of individual- and population-level benefits of one- and two-dose campaigns by vaccination start time and relative single-dose efficacy.
<p>Colors in each panel represent the cumulative incidence ratio, comparing cumulative incidence among those ever receiving vaccine in one-dose campaigns (numerator) with the cumulative incidence among those ever receiving vaccine in two-dose campaigns (denominator). Solid lines in each panel outline the region where single-dose campaigns are better for vaccinees (a result of indirect effects). Dashed lines represent the population-level threshold above which overall cumulative incidence is lower in a one-dose campaign compared to a two-dose campaign. Panels illustrate settings where enough susceptibility-reducing vaccine is available to cover (A) 20%, (B) 40%, and (C) 100% of the population with a single dose. In each plot, region 1 corresponds to the area where two doses are better for both the vaccinees and population, region 2 is where one dose is better for the population but not the vaccinees, and region 3 is where one dose is better for vaccinees and the population. Similar plots for different forms of vaccine protection are shown in <a href="http://www.plosmedicine.org/article/info:doi/10.1371/journal.pmed.1001867#pmed.1001867.s005" target="_blank">S4 Text</a>. VE, vaccine efficacy.</p
Illustration of minimum relative single-dose efficacy in example vaccination campaigns starting at week 1 and week 12.
<p>Bars represent the final epidemic size for one-dose (green) and two-dose (orange) campaigns as a function of the RSE or the absolute single-dose efficacy (assuming a two-dose efficacy of 88%, in parentheses) on the <i>x</i>-axis for campaigns starting at week 1 (A) and week 12 (B) of the outbreak. The MRSE (dashed vertical line) is the RSE at which the final epidemic sizes for one- and two-dose campaigns are equal.</p
Mean projected epidemic trajectories from simulated one- and two-dose reactive vaccination campaigns compared to observed epidemics.
<p>(A) Zimbabwe. (B) Port-au-Prince, Haiti. (C) Conakry, Guinea. Simulated campaigns had enough vaccine to cover 50% of the population with a single dose of a severity-reducing vaccine. Shown are reported cholera cases (grey X’s), the mean number of cases at each time point in simulated epidemics with no vaccination (dashed grey line), simulated epidemics with a two-dose campaign (blue line), and simulated epidemics with a single-dose campaign (green line). See <a href="http://www.plosmedicine.org/article/info:doi/10.1371/journal.pmed.1001867#pmed.1001867.s004" target="_blank">S3 Text</a> for details and additional results.</p
Core parameters used in deterministic transmission models.
<p>Models described in more detail in <a href="http://www.plosmedicine.org/article/info:doi/10.1371/journal.pmed.1001867#pmed.1001867.s002" target="_blank">S1 Text</a>.</p><p><sup>§</sup>Vaccination rates varied to keep the duration of the campaigns constant.</p><p>Core parameters used in deterministic transmission models.</p
Reported sharing of RUSF and the protection ration within the family, July-October 2010, Guidam Roumdji and Madarounfa Districts, Niger.
1<p>No sharing was defined as the ration was reported to be consumed only by children 60 cm to 80 cm in length (target population).</p>2<p>Sharing with siblings <110 cm of height was defined as sharing siblings less than 110 cm of height (approximately 5 years of age).</p>3<p>Sharing within the family was defined as between children 60 cm to 80 cm in length, their siblings less than 110 cm of height and the rest of the family. A family or household was defined as the nuclear family.</p
Mean and median weight, height or length, age and WH indices upon admission for all children (n = 68,001).
*<p>data missing for 730 children (including presence of edema for 394 children).</p>**<p>data missing for 674 children.</p
Illustration of the susceptibility-reducing vaccine model.
<p>Circles represent states, with the variable letters representing susceptible, exposed, infectious, and removed states and the subscripts indicating the number of doses of vaccine those in that state have received. Arrows between states represent rates of transition between states, with values indicated in <a href="http://www.plosmedicine.org/article/info:doi/10.1371/journal.pmed.1001867#pmed.1001867.t001" target="_blank">Table 1</a>. More details can be found in <a href="http://www.plosmedicine.org/article/info:doi/10.1371/journal.pmed.1001867#pmed.1001867.s002" target="_blank">S1 Text</a>.</p
Map of locations of MSF inpatient centers and outpatient units in Maradi, Niger 2006.
<p>Map of locations of MSF inpatient centers and outpatient units in Maradi, Niger 2006.</p
Short-term protection from one and two doses of oral cholera vaccine.
<p>Reported estimates and results from random effects regression models (filled diamonds) for both one (bottom) and two (top) doses of OCV. VE, vaccine efficacy.</p
- …