Severely malnourished children with a low weight-for-height have a higher mortality than those with a low mid-upper-arm-circumference: III. Effect of case-load on malnutrition related mortality– policy implications
Abstract Background Severe acute malnutrition (SAM) is diagnosed when the weight-for-height Z-score (WHZ) is <−3Z of the WHO2006 standards, or a mid-upper-arm circumference (MUAC) of < 115 mm or there is nutritional oedema. Although there has been a move to eliminate WHZ as a diagnostic criter...
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doaj-6346151ccaa645ea85573b32a7dab6a22020-11-25T00:19:16ZengBMCNutrition Journal1475-28912018-09-0117111010.1186/s12937-018-0382-6Severely malnourished children with a low weight-for-height have a higher mortality than those with a low mid-upper-arm-circumference: III. Effect of case-load on malnutrition related mortality– policy implicationsEmmanuel Grellety0Michael H. Golden1Research Center Health Policy and Systems - International Health, School of Public Health, Université Libre de BruxellesDepartment of Medicine and Therapeutics, University of AberdeenAbstract Background Severe acute malnutrition (SAM) is diagnosed when the weight-for-height Z-score (WHZ) is <−3Z of the WHO2006 standards, or a mid-upper-arm circumference (MUAC) of < 115 mm or there is nutritional oedema. Although there has been a move to eliminate WHZ as a diagnostic criterion we have shown that children with a low WHZ have at least as high a mortality risk as those with a low MUAC. Here we take the estimated case fatality rates and published case-loads to estimate the proportion of total SAM related deaths occurring in children that would be excluded from treatment with a MUAC-only policy. Methods The effect of varying case-load and mortality rates on the proportion of all deaths that would occur in admitted children was examined. We used the same calculations to estimate the proportion of all SAM-related deaths that would be excluded with a MUAC-only policy in 48 countries with very different relative case loads for SAM by only MUAC, only WHZ and children with both deficits. The case fatality rates (CFR) are taken from simulations, empirical data and the literature. Results The relative number of cases of SAM by MUAC alone, WHZ alone and those with both criteria have a dominant effect on the proportion of all SAM-related deaths that would occur in children excluded from treatment by a MUAC-only program. Many countries, particularly in the Sahel, West Africa and South East Asia would fail to identify the majority of SAM-related deaths if a MUAC only program were to be implemented. Globally, the estimated minimum number of deaths that would occur among children excluded from treatment in our analyses is 300,000 annually. Conclusions The number, proportion or attributable fraction of children excluded from treatment with any change of current policy are the correct indicators to guide policy change. CRFs alone should not be used to guide policy in choosing whether or not to drop WHZ as a diagnostic for SAM. All the criteria for diagnosis of malnutrition need to be retained. It is critical that methods are found to identify those children with a low WHZ, but not a low MUAC, in the community so that they will not remain undetected.http://link.springer.com/article/10.1186/s12937-018-0382-6NutritionAcute malnutritionSevere acute malnutritionSAMMid-upper-arm circumferenceMUAC |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Emmanuel Grellety Michael H. Golden |
spellingShingle |
Emmanuel Grellety Michael H. Golden Severely malnourished children with a low weight-for-height have a higher mortality than those with a low mid-upper-arm-circumference: III. Effect of case-load on malnutrition related mortality– policy implications Nutrition Journal Nutrition Acute malnutrition Severe acute malnutrition SAM Mid-upper-arm circumference MUAC |
author_facet |
Emmanuel Grellety Michael H. Golden |
author_sort |
Emmanuel Grellety |
title |
Severely malnourished children with a low weight-for-height have a higher mortality than those with a low mid-upper-arm-circumference: III. Effect of case-load on malnutrition related mortality– policy implications |
title_short |
Severely malnourished children with a low weight-for-height have a higher mortality than those with a low mid-upper-arm-circumference: III. Effect of case-load on malnutrition related mortality– policy implications |
title_full |
Severely malnourished children with a low weight-for-height have a higher mortality than those with a low mid-upper-arm-circumference: III. Effect of case-load on malnutrition related mortality– policy implications |
title_fullStr |
Severely malnourished children with a low weight-for-height have a higher mortality than those with a low mid-upper-arm-circumference: III. Effect of case-load on malnutrition related mortality– policy implications |
title_full_unstemmed |
Severely malnourished children with a low weight-for-height have a higher mortality than those with a low mid-upper-arm-circumference: III. Effect of case-load on malnutrition related mortality– policy implications |
title_sort |
severely malnourished children with a low weight-for-height have a higher mortality than those with a low mid-upper-arm-circumference: iii. effect of case-load on malnutrition related mortality– policy implications |
publisher |
BMC |
series |
Nutrition Journal |
issn |
1475-2891 |
publishDate |
2018-09-01 |
description |
Abstract Background Severe acute malnutrition (SAM) is diagnosed when the weight-for-height Z-score (WHZ) is <−3Z of the WHO2006 standards, or a mid-upper-arm circumference (MUAC) of < 115 mm or there is nutritional oedema. Although there has been a move to eliminate WHZ as a diagnostic criterion we have shown that children with a low WHZ have at least as high a mortality risk as those with a low MUAC. Here we take the estimated case fatality rates and published case-loads to estimate the proportion of total SAM related deaths occurring in children that would be excluded from treatment with a MUAC-only policy. Methods The effect of varying case-load and mortality rates on the proportion of all deaths that would occur in admitted children was examined. We used the same calculations to estimate the proportion of all SAM-related deaths that would be excluded with a MUAC-only policy in 48 countries with very different relative case loads for SAM by only MUAC, only WHZ and children with both deficits. The case fatality rates (CFR) are taken from simulations, empirical data and the literature. Results The relative number of cases of SAM by MUAC alone, WHZ alone and those with both criteria have a dominant effect on the proportion of all SAM-related deaths that would occur in children excluded from treatment by a MUAC-only program. Many countries, particularly in the Sahel, West Africa and South East Asia would fail to identify the majority of SAM-related deaths if a MUAC only program were to be implemented. Globally, the estimated minimum number of deaths that would occur among children excluded from treatment in our analyses is 300,000 annually. Conclusions The number, proportion or attributable fraction of children excluded from treatment with any change of current policy are the correct indicators to guide policy change. CRFs alone should not be used to guide policy in choosing whether or not to drop WHZ as a diagnostic for SAM. All the criteria for diagnosis of malnutrition need to be retained. It is critical that methods are found to identify those children with a low WHZ, but not a low MUAC, in the community so that they will not remain undetected. |
topic |
Nutrition Acute malnutrition Severe acute malnutrition SAM Mid-upper-arm circumference MUAC |
url |
http://link.springer.com/article/10.1186/s12937-018-0382-6 |
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