Diagnostic criteria for severe acute malnutrition among infants aged under 6 mo

Mwangome, Martha; Ngari, Moses; Fegan, Greg; Mturi, Neema; Mohammed, Shebe; Bauni, Evasius; Berkley, James A.

doi:10.3945/ajcn.116.149815

Cited by 54 publications

(74 citation statements)

References 26 publications

(38 reference statements)

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“…Similar to our ndings, a community-based study conducted in Burkina Faso showed that infants with WAZ <-3 at 2 months of age had increased risk of mortality during infancy; this was not observed with WLZ <-3 [12]. A study conducted in Kenya showed that WAZ measured in infants between 1-6 months of age was one of strongest predictors of inpatient and post-discharge mortality during infancy [1]. However, the study was done among hospitalized infants who had higher risk of mortality compared to community cohorts of healthy infants.…”

Section: Discussionsupporting

confidence: 87%

“…The rst 6 months of life are marked by rapid growth, and neurological development [1]. During this period, adequate nutrition is through exclusive breastfeeding [2].…”

Section: Introductionmentioning

confidence: 99%

“…The use of WLZ criteria in infants less than 6 months has some limitations. Firstly, the WLZ cannot be calculated using the WHO 2006 growth standards if length of an infant is less than 45 cm, so in a signi cant proportion of preterm or small for gestational age infants, WLZ cannot be measured [1,12]. Secondly, an accurate measurement of length is di cult in community settings in small infants as they tend to be in knee-bent position [13,14].…”

Section: Introductionmentioning

confidence: 99%

“…Realizing the importance, the WHO and a recent Child Health and Nutrition Research Initiative prioritized establishing diagnostic criteria for SAM among under 6 months infants as one of the priority research questions [10,17]. Limited evidence on the association between anthropometric indicators and mortality among under 6 months infants is available from South Asia where the burden of SAM is higher compared to other parts of the world [1,12].…”

Section: Introductionmentioning

confidence: 99%

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Diagnostic Measures for Severe Acute Malnutrition in Indian Infants Under 6 Months of Age: a Secondary Data Analysis

Chowdhury

Nitika

Choudhary

et al. 2020

Preprint

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Background Weight for length z-score (WLZ) <- 3 is currently used to define severe acute malnutrition (SAM) among infants. However, this approach has important limitations for infants younger than 6 months of age as WLZ cannot be calculated using WHO growth standards if infant length is <45 cm. Moreover, length for age z-score (LAZ) and weight for length z-score (WLZ) are least reliable measures, with high chances of variation, and less chances of detecting undernutrition in under 6 months infants. The objective of the current analysis was to compare WLZ with WAZ and LAZ in a cohort of Indian infants in predicting the deaths between 6 weeks and 6 months of age. Methods The data was from an individually randomized trial conducted in slums of Delhi, India in which infants’ weight and length were measured at 6 weeks of age (at the time of the first immunization visit). Vital status of the infants was documented from 6 weeks to 6 months of age. The sensitivity, specificity, positive and negative predictive values, and positive and negative likelihood ratios, and area under curve (AUC) were calculated for WAZ<-3, WLZ<-3, and LAZ<-3 for deaths between 6 weeks and 6 months of age. Results For deaths occurring between 6 weeks to 6 months of age, the specificity ranged between 85.9-95.9% for all three anthropometric indicators. However, the sensitivity was considerably higher for WAZ; it was 64.6 % for WAZ<-3, 39.1% for LAZ<-3, and 25.0% for WLZ<-3. WAZ <-3 had higher AUC (0.75; 95% CI: 0.68, 0.82) and hence, better discriminated deaths between 6 weeks and 6 months of age than WLZ<-3. The adjusted relative risk (RR 10.6, 95% CI 5.9, 18.9) and the population attributable fraction (PAF 57.9%, 95% CI 38.8, 71.0%) of mortality was highest for WAZ<-3.Conclusions We found WAZ<-3 at 6 weeks of age to be a better predictor of death in the 6 weeks to 6 months of life in comparison to WLZ<-3 and LAZ<-3 and propose that it should be considered to diagnose SAM in this age group.

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Section: Discussionsupporting

confidence: 87%

“…The rst 6 months of life are marked by rapid growth, and neurological development [1]. During this period, adequate nutrition is through exclusive breastfeeding [2].…”

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Diagnostic Measures for Severe Acute Malnutrition in Indian Infants Under 6 Months of Age: a Secondary Data Analysis

Chowdhury

Nitika

Choudhary

et al. 2020

Preprint

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“…Guidelines need to be reviewed to target highly vulnerable infants using alternative anthropometry. Research has shown that around the age of vaccination, MUAC and WAZ are better associated with mortality than WLZ at the same age (Mwangome et al, 2017). Our results indicate a need to consider MUAC and/or WAZ as alternatives to WFL in identifying growth failure in under 6 months.…”

Section: Discussionmentioning

confidence: 66%

Individualized breastfeeding support for acutely ill, malnourished infants under 6 months old

Mwangome

Murunga

Kahindi

et al. 2019

Maternal & Child Nutrition

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Reestablishing exclusive breastfeeding is the cornerstone of the 2013 World Health Organization (WHO) treatment guidelines for acute malnutrition in infants less than 6 months. However, no studies have investigated guideline implementation and subsequent outcomes in a public hospital setting in Africa. To facilitate implementation of the WHO 2013 guidelines in Kilifi County Hospital, Kenya, we developed standard operating procedure, recruited, and trained three breastfeeding peer supporters (BFPS). Between September 2016 and January 2018, the BFPS provided individual breastfeeding support to mothers of infants aged 4 weeks to 4 months admitted to Kilifi County Hospital with an illness and acute malnutrition (midupper-arm circumference < 11.0 cm OR weight-for-age z score < −2 OR weightfor-length z score < -2). Infants were followed daily while in hospital then every 2 weeks for 6 weeks after discharge with data collected on breastfeeding, infant growth, morbidity, and mortality. Of 106 infants with acute malnutrition at admission, 51 met the inclusion criteria for the study. Most enrolled mothers had multiple breastfeeding challenges, which were predominantly technique based. Exclusive breastfeeding was 55% at admission and 81% at discharge; at discharge 67% of infants had attained a weight velocity of >5 g/kg/day for three consecutive days on breastmilk alone. Gains in weight-for-length z score and weight-for-age z score were generally not sustained beyond 2 weeks after discharge. BFPS operated effectively in an inpatient setting, applying the 2013 updated WHO guidelines and increasing rates of exclusive breastfeeding at discharge. However, lack of continued increase in anthropometric Z scores after discharge suggests the need for more sustained interventions.This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

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