Malnourished children and supplementary feeding during the war emergency in Guinea-Bissau in 1998–1999

Nielsen, Jens; Valentiner‐Branth, Palle; Martins, Cesário; Cabral, Fernando Duarte; Aaby, Péter

doi:10.1093/ajcn/80.4.1036

Cited by 20 publications

(28 citation statements)

References 11 publications

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“…In these studies, treatment outcomes, including mortality, were similar to those recorded in our study. A study of the effect of a supplemental food programme in Guinea-Bissau found a mortality of 1 % (23) . Defourny et al evaluated the use of MUAC < 110 mm as an admission criterion for a TFP in Niger (22) .…”

Section: Discussionmentioning

confidence: 99%

Comparison of weight-for-height and mid-upper arm circumference (MUAC) in a therapeutic feeding programme in South Sudan: is MUAC alone a sufficient criterion for admission of children at high risk of mortality?

Grellety¹,

Krause²,

Eldin

et al. 2015

Public Health Nutr.

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Objective: The present study was performed to describe the operational implications of using mid-upper arm circumference (MUAC) as a single admission criterion for treatment of severe acute malnutrition in South Sudan. Design: We performed a retrospective analysis of routine programme data of children with severe acute malnutrition aged 6-59 months admitted to a therapeutic feeding programme using weight-for-height Z-score (WHZ) and/or MUAC. To understand the implications of using MUAC as a single admission criterion, we compared patient characteristics and treatment outcomes for children admitted with MUAC < 115 mm (irrespective of WHZ) v. children admitted with WHZ < −3 and MUAC ≥ 115 mm. Results: Of 2205 children included for analysis, 719 (32·6 %) were admitted to the programme with MUAC < 115 mm and 1486 (67·4 %) with WHZ < −3 and MUAC ≥ 115 mm. Children who would have been admitted using a single MUAC < 115 mm criterion were more severely malnourished and more likely to be female and younger. Compared with children admitted with WHZ < −3 and MUAC ≥ 115 mm, children who would have been admitted using MUAC < 115 mm were less likely to recover (54 % v. 69 %) and had higher risk of death (4 % v. 1 %), but responded to treatment with greater weight and MUAC gains. MUAC < 115 mm would have failed to identify 33 % of deaths, while 98 % were identified by WHZ < −3 alone and 100 % by MUAC < 130 mm. Conclusions: The study shows that MUAC < 115 mm identified more severely malnourished children with a higher risk of mortality but failed to identify a third of the children who died. Admission criteria for therapeutic feeding should be adapted to the programmatic context with consideration for both operational and public health implications. Keywords Child malnutrition Mid-upper arm circumferenceWeight-for-height Z-score Admission criteria Community-based management of acute malnutritionAcute malnutrition represents a major cause of childhood morbidity and mortality worldwide. The number of children under the age of 5 years with severe acute malnutrition (SAM) at any time is currently estimated from prevalence data to be nearly 19 million, with the burden or number of incident cases occurring each year presumably higher (1) . SAM contributes to over a million child deaths annually, as children with SAM are estimated to have an approximately ninefold increased risk of death compared with well-nourished children (2,3) . Traditionally, treatment for SAM was conducted exclusively in in-patient settings, an approach that was both costly and limited access to, and impact of, such programmes.In 2007, a new model for the community-based management of acute malnutrition (CMAM) was endorsed by the WHO, UNICEF, World Food Programme and the UN System Standing Committee on Nutrition, in which children with uncomplicated cases of SAM and appetite could be treated on an out-patient basis with the provision of ready-to-use therapeutic foods and weekly or biweekly follow-up (3) . Increasing evidence and operational experience ha...

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Section: Discussionmentioning

confidence: 99%

Comparison of weight-for-height and mid-upper arm circumference (MUAC) in a therapeutic feeding programme in South Sudan: is MUAC alone a sufficient criterion for admission of children at high risk of mortality?

Grellety¹,

Krause²,

Eldin

et al. 2015

Public Health Nutr.

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“…While many studies used WHO 2006 reference standards to define moderate and severe stunting and wasting (labelled ‘WHO’ in Table ), others used the National Center for Health Statistics (NCHS)/WHO international growth reference standards (labelled NCHS in Table ) . Wasting (WFH) was used as an outcome in 15 studies , stunting (HFA) in five studies , underweight (WFA) in five studies and MUAC in five studies . Four studies described weight gain and one described linear growth .…”

Section: Resultsmentioning

confidence: 99%

“…Recovery rates of 67–81% were seen in two studies examining take‐home selective supplementary feeding for those with mild or moderate malnutrition using millet gruel and corn–soy blend, respectively . Rates of over 90% were seen in therapeutic feeding studies using RUTF in those with severe malnutrition .…”

Section: Resultsmentioning

confidence: 99%

Impact of nutrition interventions on pediatric mortality and nutrition outcomes in humanitarian emergencies: A systematic review

Balhara

Silvestri

Winders

et al. 2017

Tropical Med Int Health

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Abstractobjectives Malnutrition contributes to paediatric morbidity and mortality in disasters and complex emergencies, but summary data describing specific nutritional interventions in these settings are lacking. This systematic review aimed to characterise such interventions and their effects on paediatric mortality, anthropometric measures and serum markers of nutrition.methods A systematic search of OVID MEDLINE, Cochrane Library and relevant grey literature was conducted. We included all randomised controlled trials and observational controlled studies evaluating effectiveness of nutritional intervention(s) on defined health outcomes in children and adolescents (0-18 years) within a disaster or complex emergency. We extracted study characteristics, interventions and outcomes data. Study quality was assessed using Grading of Recommendations Assessment, Development and Evaluation (GRADE) criteria.results A total of 31 studies met inclusion criteria. Most were conducted in Africa (17), during periods of conflict or hunger gaps (14), and evaluated micronutrient supplementation (14) or selective feeding (10). Overall study quality was low, with only two high and four moderate quality studies. High-and medium-quality studies demonstrated positive impact of fortified spreads, ready-to-use therapeutic foods, micronutrient supplementation, and food and cash transfers.conclusion In disasters and complex emergencies, high variability and low quality of controlled studies on paediatric malnutrition limit meaningful data aggregation. If existing research gaps are to be addressed, the inherent unpredictability of humanitarian emergencies and ethical considerations regarding controls may warrant a paradigm shift in what constitutes adequate methods. Periodic hunger gaps may offer a generalisable opportunity for robust trials, but consensus on meaningful nutritional endpoints is needed.

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“…A national programme of therapeutic and supplementary feeding during a humanitarian emergency in Burundi seemingly failed to reduce the prevalence of wasting, perhaps because only 55% coverage was achieved [11]. Three different lines of evidence suggested that supplementary feeding programmes during a war in Guinea-Bissau prevented in increase in the prevalence of undernutrition [12]. But even if the evidence of the impact of supplementary feeding programmes is inevitably indirect because having an unfed control group is impossible, the experiences described here offer useful lessons that could be applied to improve the quality of data in future evaluations of blanket feeding programmes in Kenya and elsewhere.…”

Section: Discussionmentioning

confidence: 99%

The Practical Challenges of Evaluating a Blanket Emergency Feeding Programme in Northern Kenya

et al. 2011

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A blanket supplementary feeding programme for young children was implemented for four months in five northern districts of Kenya from January 2010 because of fears of food insecurity exacerbated by drought. An attempt to evaluate the impact of the food on children's anthropometric status was put in place in three districts. The main aim of the analysis was to assess the quality of the data on the cohort of children studied in the evaluation and to propose methods by which it could be improved to evaluate future blanket feeding programmes. Data on the name, age, sex, weight and height of a systematic sample of children recruited at 61 food distribution sites were collected at the first, second and third rounds and again at an extra, fifth food distribution, offered only to the evaluation subjects. Of the 3,544 children enrolled, 483 (13.63%) did not collect a fifth ration. Of the 2,640 children who were considered by their name to be the same at the first and fifth food distribution (13% were different), data on only 902 children (34.17%) were considered acceptable based on their age (an arbitrary ±3 months different) and their length or height (between >−1 or ≤4 cm different) at the two instances they were seen. Data on nearly two thirds of children were of questionable quality. The main reasons for the poor quality data were inconsistencies in estimating age or because caretakers may have brought different children. Recommendations are made about how to improve data quality including ensuring that entry to a blanket feeding programme is clearly based on height, not age, to avoid misreporting age; careful identification of subjects at all contacts; and using well-trained, specialist evaluation staff.

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Malnourished children and supplementary feeding during the war emergency in Guinea-Bissau in 1998–1999

Abstract: Our findings may be biased by changes in the cultural and socioeconomic background of the malnourished children. However, 3 different analyses indicated a beneficial effect of the SFP. Thus, the home-based SFP probably prevented nutritional deterioration during the war in Guinea-Bissau.

Cited by 20 publications

References 11 publications

Comparison of weight-for-height and mid-upper arm circumference (MUAC) in a therapeutic feeding programme in South Sudan: is MUAC alone a sufficient criterion for admission of children at high risk of mortality?

Comparison of weight-for-height and mid-upper arm circumference (MUAC) in a therapeutic feeding programme in South Sudan: is MUAC alone a sufficient criterion for admission of children at high risk of mortality?

Impact of nutrition interventions on pediatric mortality and nutrition outcomes in humanitarian emergencies: A systematic review

The Practical Challenges of Evaluating a Blanket Emergency Feeding Programme in Northern Kenya

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