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Choosing Anthropometric Indicators to Monitor the Response to Treatment for Severe Acute Malnutrition in Rural Southern Ethiopia: Empirical Evidence
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH), International Child Health and Nutrition. Addis Continental Institute of Public Health, Addis Ababa, Ethiopia.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH), International Child Health and Nutrition. Addis Continental Institute of Public Health, Addis Ababa, Ethiopia.ORCID iD: 0000-0002-2030-5309
Addis Continental Institute of Public Health, Addis Ababa, Ethiopia.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH), International Child Health and Nutrition.
2017 (English)In: Nutrients, ISSN 2072-6643, E-ISSN 2072-6643, Vol. 9, no 12, article id 1339Article in journal (Refereed) Published
Abstract [en]

The World Health Organization (WHO) recommends the assessment of nutritional recovery using the same anthropometric indicator that was used to diagnose severe acute malnutrition (SAM) in children. However, related empirical evidence from low-income countries is lacking. Non-oedematous children (n = 661) aged 6–59 months admitted to a community-based outpatient therapeutic program for SAM in rural southern Ethiopia were studied. The response to treatment in children admitted to the program based on the mid-upper arm circumference (MUAC) measurement was defined by calculating the gains in average MUAC and weight during the first four weeks of treatment. The children showed significant anthropometric changes only when assessed with the same anthropometric indicator used to define SAM at admission. Children with the lowest MUAC at admission showed a significant gain in MUAC but not weight, and children with the lowest weight-for-height/length (WHZ) showed a significant gain in weight but not MUAC. The response to treatment was largest for children with the lowest anthropometric status at admission in either measurement. MUAC and weight gain are two independent anthropometric measures that can be used to monitor sufficient recovery in children treated for SAM. This study provides empirical evidence from a low-income country to support the recent World Health Organization recommendation.

Place, publisher, year, edition, pages
2017. Vol. 9, no 12, article id 1339
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
URN: urn:nbn:se:uu:diva-336874DOI: 10.3390/nu9121339ISI: 000419188600064OAI: oai:DiVA.org:uu-336874DiVA, id: diva2:1167415
Available from: 2017-12-18 Created: 2017-12-18 Last updated: 2018-04-08Bibliographically approved
In thesis
1. Identification and Community Management of Severe Acute Malnutrition: Empirical evidence in rural Southern Ethiopia
Open this publication in new window or tab >>Identification and Community Management of Severe Acute Malnutrition: Empirical evidence in rural Southern Ethiopia
2018 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The current recommended standard management for all children with severe acute malnutrition (SAM) is Community-based Management of Acute Malnutrition (CMAM). CMAM has a community-based outpatient therapeutic program (OTP) to treat uncomplicated SAM and has been scaled-up and integrated with government health services in low-resource settings. How-ever, the context in which such large-scale programs are implemented modifies their effective-ness. This study aims at assessing factors of importance for the effectiveness of management of SAM in the community.

A population-based survey of households with children aged under five years and a longitu-dinal study among children admitted to the integrated OTPs of rural Southern Ethiopia was undertaken. For Study I, children aged 6-59 months (n=4,297) from randomly selected house-holds were examined for differences between children identified as SAM by MUAC and WHZ. For Study II, subsets of 1,048 children admitted to OTPs were analyzed for program outcome and nutritional status at discharge (n=759) and 14 weeks after admission (n=991). For Study III, non-oedematous children (n=661) admitted to OTPs were analyzed for gains in anthropo-metric measures after 4 weeks of treatment. For Study IV, children with SAM (n=788) were studied in terms of factors of importance for their recovery. Home-visits were used to collect data and anthropometry was measured following standardized World Health Organization (WHO) techniques.

The degree of agreement between the two anthropometric indicators of severe wasting dif-fered depending on the sex and age of the children. The indicators’ response to treatment varied according to the indicator used to define SAM at admission. While 32.7% achieved the program’s recovery criteria at discharge, 29.6% had SAM at discharge and 72.1% of children were acutely malnourished at the end of 14 weeks of follow-up. Despite low recovery rate, children of caregivers with the highest decision-making autonomy recovered faster from SAM than children of caregivers with lower autonomy.

The poor agreement between MUAC and WHZ in diagnosing SAM within different groups of children indicates each anthropometric indicator may select different set of children for treatment. Our study provided empirical evidence that supports the current recommendation to use MUAC and WHZ independently for the management of SAM. Linking CMAM to other com-plementary programmes may improve the effectiveness of integrated large-scale nutrition programmes.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2018. p. 60
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 1457
Keyword
Severe acute malnutrition, children, anthropometric indicators, integrated outpatient therapeutic programme, recovery, Ethiopia
National Category
Medical and Health Sciences
Research subject
Nutrition
Identifiers
urn:nbn:se:uu:diva-347845 (URN)978-91-513-0316-1 (ISBN)
Public defence
2018-05-29, Rosénsalen, Ing 95/96, Akademiska sjukhuset, Uppsala, 13:15 (English)
Opponent
Supervisors
Available from: 2018-05-08 Created: 2018-04-08 Last updated: 2018-05-08

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