Evaluating the Validity of the Responses to Illness Severity Quantification Score to Discriminate Illness Severity and Level of Care Transitions in Hospitalized Children with Severe Acute Malnutrition.

Objective: To evaluate the validity of the Responses to Illness Severity Quantification (RISQ) score to discriminate illness severity and transitions between levels of care during hospitalization.

Study Design: A prospective observational study conducted in Maiduguri, Nigeria, enrolled inpatients aged 1-59 months with severe acute malnutrition. The primary outcome was the RISQ score associated with the patient state.

Development and an initial validation of the Responses to Illness Severity Quantification (RISQ) score for severely malnourished children.

Aim: To develop and perform an initial validation of a score to measure the severity of illness in hospitalised children with severe acute malnutrition (SAM).

Methods: A prospective study enrolled SAM children aged 6-59 months hospitalised in Borno State, Nigeria. Candidate items associated with inpatient mortality were combined and evaluated as candidate scores.

Recovery and relapse from severe acute malnutrition after treatment: a prospective, observational cohort trial in Pakistan.

Objective: Millions of children suffer from severe acute malnutrition (SAM) in low- and middle- income countries. Much is known about the effectiveness of community treatment programmes (CMAM) but little is known about post-discharge outcomes after successful treatment. The present study aimed to evaluate post-discharge outcomes of children cured of SAM.

Improving estimates of the burden of severe acute malnutrition and predictions of caseload for programs treating severe acute malnutrition: experiences from Nigeria.

Background: The burden of severe acute malnutrition (SAM) is estimated using unadjusted prevalence estimates. SAM is an acute condition and many children with SAM will either recover or die within a few weeks. Estimating SAM burden using unadjusted prevalence estimates results in significant underestimation.

Using cross-sectional surveys to estimate the number of severely malnourished children needing to be enrolled in specific treatment programmes.

Objective: When planning severe acute malnutrition (SAM) treatment services, estimates of the number of children requiring treatment are needed. Prevalence surveys, used with population estimates, can directly estimate the number of prevalent cases but not the number of subsequent incident cases. Health managers often use a prevalence-to-incidence conversion factor (J) derived from two African cohort studies to estimate incidence and add the expected number of incident cases to prevalent cases to estimate expected SAM caseload for a given period.

Safety and practicability of using mid-upper arm circumference as a discharge criterion in community based management of severe acute malnutrition in children aged 6 to 59 months programmes.

Background: The use of proportional weight gain as a discharge criterion for MUAC admissions to programs treating severe acute malnutrition (SAM) is no longer recommended by WHO. The critical limitation with the proportional weight gain criterion was that children who are most severely malnourished tended to receive shorter treatment compared to less severely malnourished children. Studies have shown that using a discharge criterion of MUAC ≥ 125 mm eliminates this problem but concerns remain over the duration of treatment required to reach this criterion and whether this discharge criterion is safe.

Relationship between mid upper arm circumference and weight changes in children aged 6-59 months.

Background: The objectives of this study were to (i) describe the relationship between weight changes and MUAC changes in children aged between 6 and 59 months during treatment for SAM in CMAM programmes in three country contexts (Malawi, Ethiopia and Bangladesh) admitted using MUAC and (ii) describe the sensitivity of both MUAC and weight to episodes of disease experienced during the SAM treatment episodes in CMAM programmes in three country contexts (Malawi, Ethiopia and Bangladesh) admitted using MUAC.

Methods: Data collected under research conditions in Malawi were analysed for the correlation between MUAC and weight changes using the Pearson product-moment correlation coefficient (Pearson's r). Further data from other CMAM programmes implemented under field conditions in Ethiopia and Bangladesh were similarly analysed.

Using mid-upper arm circumference to end treatment of severe acute malnutrition leads to higher weight gains in the most malnourished children.

Objective: The World Health Organization recommends discharging children admitted to nutrition programs treating severe acute malnutrition, with a low mid-upper arm circumference (MUAC <115 mm) when weight gain is >15%. When this recommendation is followed, the most severely malnourished children receive a shorter treatment compared to children that are less severely malnourished. This study assesses whether using MUAC >125 mm as discharge criteria eliminates this effect.

Assessment of the PROBIT approach for estimating the prevalence of global, moderate and severe acute malnutrition from population surveys.

Objective: Prevalence of acute malnutrition is classically estimated by the proportion of children meeting a case definition in a representative population sample. In 1995 the WHO proposed the PROBIT method, based on converting parameters of a normally distributed variable to cumulative probability, as an alternative method requiring a smaller sample size. The present study compares classical and PROBIT methods for estimating the prevalence of global, moderate and severe acute malnutrition (GAM, MAM and SAM) defined by weight-for-height Z-score (WHZ) or mid-upper arm circumference (MUAC).

An algorithm to assess methodological quality of nutrition and mortality cross-sectional surveys: development and application to surveys conducted in Darfur, Sudan.

Background: Nutrition and mortality surveys are the main tools whereby evidence on the health status of populations affected by disasters and armed conflict is quantified and monitored over time. Several reviews have consistently revealed a lack of rigor in many surveys. We describe an algorithm for analyzing nutritional and mortality survey reports to identify a comprehensive range of errors that may result in sampling, response, or measurement biases and score quality.

Comparison of the new World Health Organization growth standards and the National Center for Health Statistics growth reference regarding mortality of malnourished children treated in a 2006 nutrition program in Niger.

Objective: To compare the National Centre for Health Statistics (NCHS) international growth reference with the new World Health Organization (WHO) growth standards for identification of the malnourished (wasted) children most at risk of death.

Design: Retrospective data analysis.

Setting: A Médecins Sans Frontières (Doctors Without Borders) nutrition program in Maradi, Niger, in 2006 that treated moderately and severely malnourished children.