Impact of the shift from NCHS growth reference to WHO(2006) growth standards in a therapeutic feeding programme in Niger.

OBJECTIVES: To describe the implementation of the WHO(2006) growth standards in a therapeutic feeding programme. METHODS: Using programme monitoring data from 21,769 children 6-59 months admitted to the Médecins Sans Frontières therapeutic feeding programme during 2007, we compared characteristics at admission, type of care and outcomes for children admitted before and after the shift to the WHO(2006) standards. Admission criteria were bipedal oedema, MUAC <110 mm, or weight-for-height (WFH) of <-70% of the median (NCHS) before mid-May 2007, and WFH <-3 z score (WHO(2006)) after mid-May 2007. RESULTS: Children admitted with the WHO(2006) standards were more likely to be younger, with a higher proportion of males, and less malnourished (mean WFH -3.6 z score vs. mean WFH -4.6 z score). They were less likely to require hospitalization or intensive care (28.4%vs. 77%; 12.8%vs. 36.5%) and more likely to be treated exclusively on an outpatient basis (71.6%vs. 23%). Finally, they experienced better outcomes (cure rate: 89%vs. 71.7%, death rate: 2.7%vs. 6.4%, default rate: 6.7%vs. 12.3%). CONCLUSIONS: In this programme, the WHO(2006) standards identify a larger number of malnourished children at an earlier stage of disease facilitating their treatment success

The humanitarian emergency in Burundi: evaluation of the operational strategy for management of nutritional crisis

AbstractObjectiveTo evaluate the impact and appropriateness of programmes for the management and treatment of severe malnutrition in emergency situations.DesignA central unified database was set up with all data and statistics provided by nutritional centres (NC) active in Burundi.SettingThe paper describes the case of Burundi as an example of the response of the humanitarian community to nutritional crisis.SubjectsSince 1999, more than one million (1 054 210) severely malnourished patients were treated in NC established in Burundi.ResultsPeaks of beneficiaries were registered in 2000 and 2001; the admission rate started to decrease in 2002. In 2004, twenty therapeutic feeding centres (TFC) and 224 supplementary feeding centres (SFC) were active for the treatment of 127 420 beneficiaries. Nutritional programmes were present in every province with a coverage rate of 55 %. The most convincing impact of the nutritional programme in Burundi was the reduction of mortality rate in children under 5 years of age; an impact on the prevalence of acute malnutrition could not be demonstrated. Children under 5 years old accounted for 62 % of beneficiaries in TFC and 76 % in SFC. TFC performance indicators fulfilled the minimum standards in disaster response; the performance of SFC was not so optimal with a low recovery rate (69 % v. >80 %) and a high non-respondent rate (16 % v. <5 %). With the combination of coverage and cure rate, the programme met 44 % of the assessed needs in 2004.ConclusionsIn Burundi the stabilisation of security conditions permitted a combination of humanitarian responses ranging from emergency activities to strengthening of community-based initiatives that could correct the coverage and impact limitations

Performance of community-based management of children with severe acute malnutrition in a pastoral area of Ethiopia

The purpose of the study was to assess the coverage and effectiveness of the management of severe acute malnutrition project implemented in Dhas district of Borena zone, Ethiopia, from July 2010 to December 2010. Quantitative, descriptive study was conducted to assess the comparability of the outcome of community-based management of acute malnutrition in a pastoralist area to International Sphere standards using performance indicators. Data collection was done using data capturing sheet. Outpatient therapeutic programme (OPT) registers in all health facilities were the sources of data. Clinical records of children admitted to the programme (n=163) were analysed. Standard nutrition survey result was used to estimate the malnutrition prevalence and programme coverage. International Sphere standard was achieved for mortality rate but not for recovery rate, defaulter rate, length of stay and weight gainHealth StudiesM.A. (Public Health

Efficacy of mid-upper arm circumference in identification, follow-up and discharge of malnourished children during nutrition rehabilitation

BACKGROUND/OBJECTIVES: Although it is crucial to identify those children likely to be treated in an appropriate nutrition rehabilitation programme and discharge them at the appropriate time, there is no golden standard for such identification. The current study examined the appropriateness of using Mid-Upper Arm Circumference for the identification, follow-up and discharge of malnourished children. We also assessed its discrepancy with the Weight-for-Height based diagnosis, the rate of recovery, and the discharge criteria of the children during nutrition rehabilitation. SUBJECTS/METHODS: The study present findings from 156 children (aged 6-59 months) attending a supplementary feeding programme at Makadara and Jericho Health Centres, Eastern District of Nairobi, Kenya. Records of age, weight, height and mid-upper arm circumference were selected at three stages of nutrition rehabilitation: admission, follow-up and discharge. The values obtained were then used to calculate z-scores as defined by WHO Anthro while estimating different diagnostic indices. RESULTS: Mid-upper arm circumference single cut-off (<12.5 cm) was found to exhibit high values of sensitivity, specificity, positive predictive value, negative predictive value, positive likelihood ratio, negative likelihood ratio at both admission and discharge. Besides, children recorded higher rate of recovery at 86 days, an average increment of 0.98 cm at the rate of 0.14mm/day, and a weight gain of 13.49gm/day, albeit higher in female than their male counterparts. Nevertheless, children admitted on basis of low MUAC had a significantly higher MUAC gain than WH at 0.19mm/day and 0.13mm/day respectively. CONCLUSIONS: Mid-upper arm circumference can be an appropriate tool for identifying malnourished children for admission to nutrition rehabilitation programs. Our results confirm the appropriateness of this tool for monitoring recovery trends and discharging the children thereafter. In principle the tool has potential to minimize nutrition rehabilitation costs, particularly in community therapeutic centres in developing countries

Pengukuran Weight for Height Z-Score (WHZ) dan Mid Upper Arm Circumstance (MUAC) di Berbagai Tempat di Dunia untuk Menentukan Status Gizi Balita dan Risiko Kematian – Sebuah Tinjauan Sistematis

AbstrakGizi buruk atau severe acute malnutrition (SAM) adalah salah satu permasalahan kurang gizi yang menyebabkan kematian balita setiap tahun. Pengukuran status gizi dibutuhkan untuk mengidentifikasi kasus malnutrisi dan sebagai indikator dalam kegiatan monitoring, baik kasus individu maupun dalam penanganan masalah di masyarakat. Pengukuran berat badan per tinggi badan atau weight-for-height Z-scores (WHZ) dan lingkar lengan atau mid-upper arm circumference measure (MUAC) menjadi indikator yang saat ini direkomendasikan World Health Oragnisation (WHO) untuk menentukan status gizi balita. Tetapi, beberapa penelitian menemukan bahwa pengukuran dengan WHZ dan MUAC menimbulkan kontradiksi untuk mendiagnosis SAM. Tujuan kajian ini adalah mengetahui penggunaan indikator WHZ dan MUAC untuk menentukan status gizi balita dan risiko kematiannya berdasarkan beberapa penelitian di seluruh dunia dan mengetahui indikator mana yang lebih disarankan oleh para peneliti tersebut. Metode melalui penelusuran artikel yang bersumber dari Medline, Google, dan PubMed dengan penuntun kata kunci. Hasil diperoleh artikel terseleksi sesuai kriteria inklusi ada 10 artikel yang memberikan informasi yang variatif. Simpulan dari kajian ini adalah beberapa penelitian merekomendasikan penggunaan WHZ atau MUAC sebagai indikator tunggal, tetapi penelitian lain menunjukkan bahwa WHZ dan MUAC sama-sama dapat digunakan mendeteksi status gizi sekaligus risiko kematian pada balita SAM. Pengukuran MUAC dianggap lebih baik untuk mengidentifikasi risiko kematian pada balita gizi buruk.Kata kunci: status gizi, gizi buruk, WHZ ,MUAC AbstractSevere acute malnutrition (SAM) is one of under nutrition problems that cause deaths of many children every year. The nutritional status of a child needs to be evaluated periodically to identify and monitor malnourished children, both at individual and community levels. Measurement of weight for height z-score (WHZ) and mid upper arm circumstance (MUAC) have been recommended by the World Health Oragnisation (WHO) as indicators to determine nutritional status and diagnose malnutrition in children aged between 6–59 months. However, there are contradictive results between WHZ and MUAC in assessing the nutritional status and risk of mortality risk of the children with SAM. We searched articles from Medline, Google, and PubMed. Ten articles were selected: some recommended the use of WHZ or MUAC as the only indicator, but some also stated that WHZ and MUAC can be used together to assess the nutritional status and risk of mortality in children with SAM. MUAC is assumed to identify better the risk of death among malnourished children.Keywords: Nutritional status, SAM, WHZ, MUA

The impact of integrated prevention and treatment on child malnutrition and health: the PROMIS project, a randomized control trial in Burkina Faso and Mali

Abstract Background Evidence suggests that both preventive and curative nutrition interventions are needed to tackle child acute malnutrition (AM) in developing countries. In addition to reducing the incidence of AM, providing preventive interventions may also help increase attendance (and coverage) of AM screening, a major constraint in the community-based management of child acute malnutrition (CMAM) model. There is a paucity of evidence-based strategies to deliver integrated preventive and curative interventions effectively and affordably at scale. The aim of the Innovative Approaches for the Prevention of Childhood Malnutrition (PROMIS) study is to assess the feasibility, quality of implementation, effectiveness and cost-effectiveness of an integrated child malnutrition prevention and treatment intervention package implemented through a community-based platform in Mali and a facility-based platform in Burkina Faso. Methods/Design The PROMIS intervention entails a comprehensive preventive package offered on a monthly basis to caregivers of children, while children are screened for acute malnutrition (AM). The package consists of behavior change communication on essential nutrition and hygiene actions, and monthly preventive doses of small quantity lipid-based nutrient supplements (SQ-LNS) for children aged 6 to 23.9 months. Positive AM cases are referred to treatment services offered by first-line health services according to the CMAM model. The PROMIS intervention will be evaluated using a mixed methods approach. The impact study encompasses two types of study design: i) repeated cross-sectional surveys conducted at baseline and at endline after 24 months of program implementation and ii) a longitudinal study with a monthly follow-up for 18 months. Primary study impact measures include the incidence and endpoint prevalence of AM, AM screening coverage and treatment compliance. A process evaluation will assess the feasibility and quality of implementation of the intervention guided by country specific program impact pathways (PIPs). Cost-effectiveness analysis will assess the economic feasibility of the intervention. Discussion The PROMIS study assesses the effectiveness of an innovative model to integrate prevention and treatment interventions for greater and more sustainable impacts on the incidence and prevalence of AM using a rigorous, theory-based randomized control trial approach. This type of programmatic research is urgently needed to help program implementers, policy makers, and investors prioritize, select and scale-up the best program models to prevent and treat AM and achieve the World Health Assembly goal of reducing childhood wasting to less than 5% globally by the year 2025. Trial registration Clinicaltrials.gov NCT02323815 (registered on December 18, 2014) and NCT02245152 (registered on September 16, 2014

Effect of Locally Produced Ready-to-Use Therapeutic Food on Children under Five Years with Severe Acute Malnutrition: A Systematic Review

This review assessed the effect of Ready-to-Use Therapeutic Food (RUTF) on children under five years with Severe Acute Malnutrition (SAM). The reviewed studies were obtained from six databases. Using the search strategy, 3,521 studies were selected. After title and abstract screening, 75 studies were obtained for further full article screening. The inclusion criteria were types of study (RCT, quasi-RCT, or crossover), participants (SAM children aged 6−60 months with no complications), interventions (locally produced RUTF and standard RUTF), and outcome measures (recovery rate, mortality rate, weight gain rate, height gain rate, length of stay, weight-for-age z score, height-for-age z score, weight-for-length z score, anemia status, blood iron status, serum albumin, plasma amino acid level, adverse effects and acceptability of RUTF). A total of 33 studies were included in this review. Nine out of twenty-two studies that used standard RUTF had positive effects on recovery outcomes in children with SAM. The alternative RUTF produced from local protein sources showed slightly lower positive effects on SAM treatment than those of standard RUTF. Since the studies used different methods to assess the outcome, no formula could be selected as the best formula and selection should be made based on individual research objectives. In conclusion, both standard and the alternative locally produced RUTF can be applied for treatment of SAM by considering the local preferences, ingredients availability, production sustainability and product safety

Development of a Local and Alternative Ready-to-Use Therapeutic Food (RUTF) suitable for Community-based Management of Severe Acute Malnutrition

In order to produce a local Ready-to-Use Therapeutic Food (RUTF) alternative to Plumpy 'Nut ® commercial, based on dehusked, roasted and pulverized soy and sorghum ingredients, Arthrospira maxima (Spirulina) dried and pulverized, sunflower oil and powdered sugar, based on nutritional specifications suggested by the Food and Agriculture Organization of the United Nations (FAO) and the United Nations International Children's Fund (UNICEF) for the RUTF for the treatment of Acute Severe Malnutrition (MAS), a experimental design D-Optimal Design with three variables (sorghum and soy flours, sugar, oil) Of the twenty RUTF formulations generated by the software, thanks to the analysis of the selected response variables for rheological-mechanical and technological instrumental discrimination, are four optimal formulations were hypothesized, subsequently submitted to validation. Moreover, on these creams oxidative stability tests have been carried out, assuming extreme conservation conditions (30 ° C, 40 ° C and 60 ° C, exposure to atmospheric oxygen, without any barrier), typical of developing countries , where this type of product is intended to be used. Two of the four optimal ones were found to be more stable than the others. Furthermore, following a scale up that involved the use of a discontinuous semi-industrial ball mill, sensorial analyzes were carried out on the four optimal formulations, in order to obtain a sensory profile useful for assessing the potential acceptability of creams. Of the four, two, in particular, were more welcome by a trained panel and then by a hundred-person consumer test. Still, on the four optimal creams obtained in the semi-industrial mill, nutritional analyzes were performed on macronutrients and micronutrients. Finally, a bibliographic analysis was carried out on the latest updates on the socio-economic aspects of food supply in developing countries and on the costs of ingredients used

BMJ Open

INTRODUCTION: Acute malnutrition (AM) is a continuum condition, arbitrarily divided into moderate and severe AM (SAM) categories, funded and managed in separate programmes under different protocols. Optimising acute MAlnutrition (OptiMA) treatment aims to simplify and optimise AM management by treating children with mid-upper arm circumference (MUAC) <125 mm or oedema with one product-ready-to-use therapeutic food-at a gradually tapered dose. Our main objective was to compare the OptiMA strategy with the standard nutritional protocol in children 6-59 months presenting with MUAC <125 mm or oedema without additional complications, as well as in children classified as uncomplicated SAM (ie, MUAC <115 mm or weight-for-height Z-score (WHZ) <-3 or with oedema). METHODS AND ANALYSIS: This study was a non-inferiority, individually randomised controlled clinical trial conducted at community level in the Democratic Republic of Congo. Children 6-59 months presenting with MUAC <125 mm or WHZ <-3 or with bipedal oedema and without medical complication were included after signed informed consent in outpatient health facilities. All participants were followed for 6 months. Success in both arms was defined at 6 months post inclusion as being alive, not acutely malnourished per the definition applied at inclusion and without an additional episode of AM throughout the 6-month observation period. Recovery among children with uncomplicated SAM was the main secondary outcome. For the primary objective, 890 participants were needed, and 480 children with SAM were needed for the main secondary objective. We will perform non-inferiority analyses in per-protocol and intention-to-treat basis for both outcomes. ETHICS AND DISSEMINATION: Ethics approvals were obtained from the National Health Ethics Committee of the Democratic Republic of Congo and from the Ethics Evaluation Committee of Inserm, the French National Institute for Health and Medical Research (Paris, France). We will submit results for publication to a peer-reviewed journal and disseminate findings in international and national conferences and meetings. TRIAL REGISTRATION NUMBER: NCT03751475. Registered 19 September 2018, https://clinicaltrials.gov/ct2/show/NCT03751475