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

TY - JOUR

T1 - Improving screening for malnourished children at high risk of death

T2 - A study of children aged 6-59 months in rural Senegal

AU - Myatt, Mark

AU - Khara, Tanya

AU - Dolan, Carmel

AU - Garenne, Michel

AU - Briend, André

N1 - CURIS 2019 NEXS 111

PY - 2019/4/1

Y1 - 2019/4/1

N2 - 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.

AB - 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.

KW - Anthropometry

KW - Child survival

KW - Mid-upper arm circumference

KW - Mortality

KW - Stunting

KW - Therapeutic feeding

KW - Underweight

KW - Wasting

U2 - 10.1017/S136898001800318X

DO - 10.1017/S136898001800318X

M3 - Journal article

C2 - 30501655

AN - SCOPUS:85057607859

SN - 1368-9800

VL - 22

SP - 862

EP - 871

JO - Public Health Nutrition

JF - Public Health Nutrition

IS - 5

ER -