Improving screening for malnourished children at high risk of death: a study of children aged 6–59 months in rural Senegal

Public Health Nutrition

Mark Myatt^1¹  Tanya Khara^2³  André Briend^7^8⁴  Carmel Dolan^2⁵  Michel Garenne^3^4^5^6⁶ 

[1] Brixton Health,Cilfach Greigiog,Fford Celynin, Llwyngwril, Gwynedd, LL37 2JD,UK^1;Department of Nutrition, Exercise and Sports,University of Copenhagen,Copenhagen,Denmark^8;Emergency Nutrition Network,Oxford,UK^2;FERDI, Université d’Auvergne,Clermont-Ferrand,France,^5;IRD, UMI Résiliences,Paris,France,^3;Institut Pasteur, Epidémiologie des Maladies Emergentes,Paris,France,^4;MRC/Wits Rural Public Health and Health Transitions Research Unit, School of Public Health, Faculty of Health Sciences,University of the Witwatersrand,Johannesburg,South Africa^6;School of Medicine, Center for Child Health Research,University of Tampere,Tampere,Finland,^7

关键词: Wasting;    Stunting;    Underweight;    Mid-upper arm circumference;    Anthropometry;    Mortality;    Therapeutic feeding;    Child survival;   

DOI  :  10.1017/S136898001800318X

学科分类：卫生学

来源: Cambridge University Press

【 摘 要 】

Objective To investigate whether children with concurrent wasting and stunting require therapeutic feeding and to better understand whether multiple diagnostic criteria are needed to identify children with a high risk of death and in need of treatment. Design Community-based cohort study, following 5751 children through time. Each child was visited up to four times at 6-month intervals. Anthropometric measurements were taken at each visit. Survival was monitored using a demographic surveillance system operating in the study villages. Setting Niakhar, a rural area of the Fatick region of central Senegal. Participants Children aged 6–59 months living in thirty villages in the study area. Results Weight-for-age Z -score (WAZ) and mid-upper arm circumference (MUAC) were independently associated with near-term mortality. The lowest WAZ threshold that, in combination with MUAC, detected all deaths associated with severe wasting or concurrent wasting and stunting was WAZ −2·8. Performance for detecting deaths was best when only WAZ and MUAC were used. Additional criteria did not improve performance. Risk ratios for near-term death in children identified using WAZ and MUAC suggest that children identified by WAZ −2·8 but with MUAC≥115 mm may require lower-intensity treatment than children identified using MUAC 115 mm. Conclusions A combination of MUAC and WAZ detected all near-term deaths associated with severe anthropometric deficits including concurrent wasting and stunting. Therapeutic feeding programmes may achieve higher impact if WAZ and MUAC admission criteria are used.

【 授权许可】

CC BY