Article

Prognostic accuracy of WHO growth standards to predict mortality in a large-scale nutritional program in Niger.

Epicentre, Paris, France.
PLoS Medicine (Impact Factor: 14). 03/2009; 6(3):e39. DOI: 10.1371/journal.pmed.1000039
Source: PubMed

ABSTRACT Important differences exist in the diagnosis of malnutrition when comparing the 2006 World Health Organization (WHO) Child Growth Standards and the 1977 National Center for Health Statistics (NCHS) reference. However, their relationship with mortality has not been studied. Here, we assessed the accuracy of the WHO standards and the NCHS reference in predicting death in a population of malnourished children in a large nutritional program in Niger.
We analyzed data from 64,484 children aged 6-59 mo admitted with malnutrition (<80% weight-for-height percentage of the median [WH]% [NCHS] and/or mid-upper arm circumference [MUAC] <110 mm and/or presence of edema) in 2006 into the Médecins Sans Frontières (MSF) nutritional program in Maradi, Niger. Sensitivity and specificity of weight-for-height in terms of Z score (WHZ) and WH% for both WHO standards and NCHS reference were calculated using mortality as the gold standard. Sensitivity and specificity of MUAC were also calculated. The receiver operating characteristic (ROC) curve was traced for these cutoffs and its area under curve (AUC) estimated. In predicting mortality, WHZ (NCHS) and WH% (NCHS) showed AUC values of 0.63 (95% confidence interval [CI] 0.60-0.66) and 0.71 (CI 0.68-0.74), respectively. WHZ (WHO) and WH% (WHO) appeared to provide higher accuracy with AUC values of 0.76 (CI 0.75-0.80) and 0.77 (CI 0.75-0.80), respectively. The relationship between MUAC and mortality risk appeared to be relatively weak, with AUC = 0.63 (CI 0.60-0.67). Analyses stratified by sex and age yielded similar results.
These results suggest that in this population of children being treated for malnutrition, WH indicators calculated using WHO standards were more accurate for predicting mortality risk than those calculated using the NCHS reference. The findings are valid for a population of already malnourished children and are not necessarily generalizable to a population of children being screened for malnutrition. Future work is needed to assess which criteria are best for admission purposes to identify children most likely to benefit from therapeutic or supplementary feeding programs.

1 Bookmark
 · 
80 Views
  • [Show abstract] [Hide abstract]
    ABSTRACT: RésuméLa dénutrition est un problème fréquent chez les patients hospitalisés dans les sociétés développées. Mais même si c’est un facteur de complication, elle restera ignorée tant qu’une évaluation systématique formalisée ne sera pas mise en place. L’équipe transversal de nutrition joue donc un rôle majeur dans la formation du personnel hospitalier à l’importance de la nutrition chez tous les patients, et dans une prise en charge nutritionnelle efficace et sûre. Les organisations de santé ont la responsabilité de rendre prioritaire la prise en charge nutritionnelle. Cette dernière sera efficace à l’hôpital si elle est la résultante d’un travail pluridisciplinaire, flexible, et d’une bonne communication.
    Annales Nestlé (Ed française) 01/2009; 67(2). DOI:10.1159/000278753
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: ResumenEn las sociedades desarrolladas se ha constatado repetidamente que la desnutrición es común en pacientes hospitalizados. A pesar de contribuir a desenlaces adversos, puede pasar inadvertida a menos que se emprenda sistemáticamente una evaluación formal. El equipo de apoyo nutricional desempeña papeles importantes en la formación del personal con respecto a la importancia de la nutrición para todos los pacientes y la garantía de intervenciones eficaces y seguras. Sobre las organizaciones de asistencia sanitaria recae la responsabilidad de fomentar el cuidado nutricional como prioridad fundamental. El trabajo multidisciplinario, la flexibilidad y la buena comunicación entre diferentes departamentos son requisitos para un apoyo nutricional efectivo en el hospital.
    Annales Nestlé (Ed española) 01/2009; 67(2). DOI:10.1159/000278701
  • [Show abstract] [Hide abstract]
    ABSTRACT: Globally, acute malnutrition triggers more than 50% of childhood mortality in children under 5 years old, which implies that about 3.5 million children die of malnutrition each year. Prior to the advent of ready-to-use therapeutic food (RUTF), the management of acute malnutrition was limited to hospitals, resulting in low coverage rates with high mortality, as malnourished cases were indentified at later stages often plagued with complications. However, current availability of RUTF has enabled malnourished children to be treated at communities. Further, because RUTF is dehydrated and sealed, it has the added advantage of a lower risk of bacterial contamination, thereby prolonging its storage life at room temperature. Recent data indicate that Community Management of Acute Malnutrition (CMAM) is as cost effective as other high-impact public health measures such as oral rehydration therapy for acute diarrheal diseases, vitamin A supplementation, and antibiotic treatment for acute respiratory infections. Despite the high efficacy of CMAM programs, CMAM still draws insufficient attention for global implementation, suggesting that CMAM programs should be integrated into local or regional routine health systems. Knowledge gaps requiring further research include: the definition of practical screening criteria for malnourished children at communities, the need for systematic antibiotic therapy during malnutrition treatment, and the dietary management of severe malnutrition in children below 6 months of age.
    12/2012; 15(4):210-219. DOI:10.5223/pghn.2012.15.4.210
    This article is viewable in ResearchGate's enriched format

Full-text (2 Sources)

Download
61 Downloads
Available from
Jun 2, 2014

Nael Lapidus