A manual for the basic assessment of nutrition status in potential crisis situations

1980In crisis situations such as famine or war, protein energy malnutrition (PEM) is generally the most important nutrition problem. Severe PEM, usually seen as marasmus, kwashiorkor, or a combination of the two forms (marasmus-kwashiorkor), affects broad age groups and in crisis situations often progress quite rapidly from these acute forms to death. Other nutrition problems such as stunting, vitamin and mineral deficiencies are of lesser immediate importance when those populations are suffering from PEM. Problems of anemia, night blindness, beriberi, and scurvy should be addressed only after the extent of PEM has been characterized and programs for relief have been undertaken. This manual is intended for use by short-term consultants called upon to assess the nutrition status of population groups who may have been subjected to severe nutrition hardships due to events such as famine, drought or war. The guide is designed to be flexible enough for use in most situations, but quite specific so that the basic epidemiological questions of who? what? and where? can be answered and decisions can be made regarding subsequent surveys, relief efforts, and technical assistance. In this sense this guide is a first-level primer for nutrition status evaluation.Introduction -- Protein energy malnutrition -- Anthropomorphic assessment -- Conducting a nutrition status assessment -- Interpretation of the data -- Annex A. Bibliography -- Annex B. Measuring board and hanging scale -- Annex C. Random number table -- Annex D. Field nutrition assessment form and instruction -- Annex E. Weight for height reference values -- Annex F. A sample surveyPhilip L. Graitcer

Characteristics of Patients with Oseltamivir-Resistant Pandemic (H1N1) 2009, United States

During April 2009–June 2010, thirty-seven (0.5%) of 6,740 pandemic (H1N1) 2009 viruses submitted to a US surveillance system were oseltamivir resistant. Most patients with oseltamivir-resistant infections were severely immunocompromised (76%) and had received oseltamivir before specimen collection (89%). No evidence was found for community circulation of resistant viruses; only 4 (unlinked) patients had no oseltamivir exposure

Oseltamivir-Resistant Pandemic (H1N1) 2009 Virus Infection in England and Scotland, 2009–2010

Monitoring of antiviral resistance is strongly recommended for immunocompromised patients

Accuracy of clinical pallor in the diagnosis of anaemia in children: a meta-analysis

BACKGROUND: Anaemia is highly prevalent in children of developing countries. It is associated with impaired physical growth and mental development. Palmar pallor is recommended at primary level for diagnosing it, on the basis of few studies. The objective of the study was to systematically assess the accuracy of clinical signs in the diagnosis of anaemia in children. METHODS: A systematic review on the accuracy of clinical signs of anaemia in children. We performed an Internet search in various databases and an additional reference tracking. Studies had to be on performance of clinical signs in the diagnosis of anaemia, using haemoglobin as the gold standard. We calculated pooled diagnostic likelihood ratios (LR's) and odds ratios (DOR's) for each clinical sign at different haemoglobin thresholds. RESULTS: Eleven articles met the inclusion criteria. Most studies were performed in Africa, in children underfive. Chi-square test for proportions and Cochran Q for DOR's and for LR's showed heterogeneity. Type of observer and haemoglobin technique influenced the results. Pooling was done using the random effects model. Pooled DOR at haemoglobin <11 g/dL was 4.3 (95% CI 2.6–7.2) for palmar pallor, 3.7 (2.3–5.9) for conjunctival pallor, and 3.4 (1.8–6.3) for nailbed pallor. DOR's and LR's were slightly better for nailbed pallor at all other haemoglobin thresholds. The accuracy did not vary substantially after excluding outliers. CONCLUSION: This meta-analysis did not document a highly accurate clinical sign of anaemia. In view of poor performance of clinical signs, universal iron supplementation may be an adequate control strategy in high prevalence areas. Further well-designed studies are needed in settings other than Africa. They should assess inter-observer variation, performance of combined clinical signs, phenotypic differences, and different degrees of anaemia

Characteristics of a Widespread Community Cluster of H275Y Oseltamivir-Resistant A(H1N1)pdm09 Influenza in Australia

Background. Oseltamivir resistance in A(H1N1)pdm09 influenza is rare, particularly in untreated community cases. Sustained community transmission has not previously been reported