BACKGROUND METHODS WHAT IS KNOWN Child malnutrition is a major public health problem in developing...
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BACKGROUND METHODS WHAT IS KNOWN WHAT IS KNOWN Child malnutrition is a major public health problem in developing countries New WHO Growth Standards result in more children aged 6- 59 months being labelled as acutely malnourished Malnutrition in infants aged <6 months is often neglected • Recent Demographic & Health Survey datasets for 21 countries with a high burden of malnutrition were analysed. • Weight-for-height z-scores were calculated using both, the NCHS and the WHO-GS. • Country prevalence of malnutrition was classified by WHO criteria: (<5% =acceptable; 5-10% GAM=poor;10-15% GAM=serious; 15% ≥ GAM=critical) • Figure 2 (right) Increases in malnutrition prevalence, WHO criteria: -17/21 countries increased the severity category on infant GAM - 2/21 countries increased the severity category on 6-59 months GAM • If WHO-GS are used together with established diagnostic criteria, the numbers of infants <6 months labelled with GAM malnutrition will increase significantly compared to: - previous diagnoses based on NCHS growth references - older children aged 6-59 months who are diagnosed with WHO- GS Policy makers urgently need to consider possible risk-benefit implications for young infants aged <6 months: RISKS of over-diagnosis are potentially serious: if concerned carers start ‘top-up’ foods or formula milks, exclusive breastfeeding will be undermined. BENEFITS are uncertain: the evidence base for treating infant malnutrition is weak; skilled breastfeeding support is scarce; current treatment models are inpatient-based, resource intensive, and cannot easily be scaled-up. We thank the UNICEF led Inter Agency Standing Committee (IASC) Nutrition Cluster for funding the MAMI project (Management of Acute Malnutrition in Infants), from which this work arose. www.humanitarianreform.org/humanitarianreform/Default.aspx?tabid=74 , www.ucl.ac.uk/cihd/research/nutrition/mami We also thank MEASURE DHS (Macro International Inc., Calverton, USA) & all countries WHAT THIS STUDY ADDS WHAT THIS STUDY ADDS Acute Malnutrition burden of disease is high in infants aged <6 months Using WHO growth standards to diagnose malnutrition has a much greater effect on infants <6 months than on children aged 6-59 months Potentially adverse risk-benefit implications of diagnosing more infants with malnutrition need to be addressed References: 1) Black RE, Allen LH, Bhutta ZA, et al, for the Maternal and Child Undernutrition Study Group. Maternal and child undernutrition: global and regional exposures and health consequences. Lancet 2008; published online Jan 17. DOI: 10.1016/S0140-6736(07)61690-0. 2) Collins S, Sadler K, Dent N, et al. Key issues in the success of community-based management of severe malnutrition. Food Nutr Bull 2006; 27: S49–82 3) Infant and Young Child Feeding in Emergencies. Making it Matter. Proceedings of an International Strategy Meeting, 1-2 November 2006. IFE Core Group. Available at http://www.ennonline.net 4) Seal A, Kerac M (2007) Operational implications of using 2006 World Health Organization growth standards in nutrition programmes: Secondary data analysis. Brit Med J 334: 733 5) Transitioning to the WHO Growth Standards: Implications for Emergency Nutrition Programmes. IASC Nutrition Cluster Informal Consultation, Geneva, 25-27 June 2008 CONCLUSIONS Acute Malnutrition in infants aged <6 months: Developing country disease burden and implications of the new WHO Child Growth Standards Hannah Blencowe * , Marko Kerac † , Marie McGrath ‡ , Carlos Grijalva-Eternod † , Andrew Seal † * London School of Hygiene & Tropical Medicine , ‡ Emergency Nutrition Network, † UCL Centre for International Health & Development, Institute of Child Health RESULTS • Global Acute Malnutrition (GAM) is a major cause of developing country child mortality and is defined by a weight-for-height z-score (WHZ) of <-2 or nutritional oedema. • If established z-score* criteria are used, new 2006 World Health Organization child growth standards (WHO-GS) label more children aged 6-59 months with malnutrition than do the widely used 1978 National Centre for Health Statistics child growth references (NCHS). • Acutely malnourished infants aged <6 months are often neglected in feeding programmes. One reason is that malnutrition prevalence is assumed to be low because of breastfeeding. • WHO-GS are currently being rolled out for international use – yet the impact on GAM prevalence for <6 months infants has not to date been reviewed. * Z-scores represent the number of standard deviations away from the median of a normally-distributed reference population. e.g. –1 z-score = 1 SD less than the reference population median . • N =163,230 total, of which: 15,537 aged <6 months; 147,695 aged 6-59 months Mean sample size per country: 7,771. Range: 1,710 to 45,398 Using the WHO-GS instead of NCHS: • Figure 1 (below) Increases in GAM by age group % GAM in infants <6 months increased markedly: Odds ratio = 3.1 (95%CI 2.57 to 3.34) % GAM in children 6-59 months increased slightly: Odds ratio = 1.1 (95% CI 1.04 to 1.09)
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Transcript of BACKGROUND METHODS WHAT IS KNOWN Child malnutrition is a major public health problem in developing...
BACKGROUND
METHODS
WHAT IS KNOWNWHAT IS KNOWN Child malnutrition is a major public health problem in developing countries
New WHO Growth Standards result in more children aged 6-59 months being labelled as acutely malnourished
Malnutrition in infants aged <6 months is often neglected
• Recent Demographic & Health Survey datasets for 21 countries with a high burden of malnutrition were analysed.
• Weight-for-height z-scores were calculated using both, the NCHS and the WHO-GS.
• Country prevalence of malnutrition was classified by WHO criteria: (<5% =acceptable; 5-10% GAM=poor;10-15% GAM=serious; ≥15% GAM=critical)
• Figure 2 (right) Increases in malnutrition prevalence, WHO criteria:-17/21 countries increased the severity category on infant GAM - 2/21 countries increased the severity category on 6-59 months GAM
• If WHO-GS are used together with established diagnostic criteria, the numbers of infants <6 months labelled with GAM malnutrition will increase significantly compared to:
- previous diagnoses based on NCHS growth references- older children aged 6-59 months who are diagnosed with WHO-GS
Policy makers urgently need to consider possible risk-benefit implications for young infants aged <6 months:
RISKS of over-diagnosis are potentially serious: if concerned carers start ‘top-up’ foods or formula milks, exclusive breastfeeding will be undermined.
BENEFITS are uncertain: the evidence base for treating infant malnutrition is weak; skilled breastfeeding support is scarce; current treatment models are inpatient-based, resource intensive, and cannot easily be scaled-up.
We thank the UNICEF led Inter Agency Standing Committee (IASC) Nutrition Cluster for funding the MAMI project (Management of Acute Malnutrition in Infants), from which this work arose. www.humanitarianreform.org/humanitarianreform/Default.aspx?tabid=74, www.ucl.ac.uk/cihd/research/nutrition/mami We also thank MEASURE DHS (Macro International Inc., Calverton, USA) & all countries surveyed for DHS datasets.
WHAT THIS STUDY ADDSWHAT THIS STUDY ADDS Acute Malnutrition burden of disease is high in infants aged <6 months
Using WHO growth standards to diagnose malnutrition has a much greater effect on infants <6 months than on children aged 6-59 months
Potentially adverse risk-benefit implications of diagnosing more infants with malnutrition need to be addressed
References:1) Black RE, Allen LH, Bhutta ZA, et al, for the Maternal and Child Undernutrition Study Group. Maternal and child undernutrition: global and regional exposures and health consequences. Lancet 2008; published online Jan 17. DOI: 10.1016/S0140-6736(07)61690-0.2) Collins S, Sadler K, Dent N, et al. Key issues in the success of community-based management of severe malnutrition. Food Nutr Bull 2006; 27: S49–823) Infant and Young Child Feeding in Emergencies. Making it Matter. Proceedings of an International Strategy Meeting, 1-2 November 2006. IFE Core Group. Available at http://www.ennonline.net 4) Seal A, Kerac M (2007) Operational implications of using 2006 World Health Organization growth standards in nutrition programmes: Secondary data analysis. Brit Med J 334: 7335) Transitioning to the WHO Growth Standards: Implications for Emergency Nutrition Programmes. IASC Nutrition Cluster Informal Consultation, Geneva, 25-27 June 2008
CONCLUSIONS
Acute Malnutrition in infants aged <6 months:Developing country disease burden and implications of the new WHO Child Growth StandardsHannah Blencowe*, Marko Kerac†, Marie McGrath‡, Carlos Grijalva-Eternod†, Andrew Seal†
*London School of Hygiene & Tropical Medicine , ‡ Emergency Nutrition Network,†UCL Centre for International Health & Development, Institute of Child Health
RESULTS
• Global Acute Malnutrition (GAM) is a major cause of developing country child mortality and is defined by a weight-for-height z-score (WHZ) of <-2 or nutritional oedema.
• If established z-score* criteria are used, new 2006 World Health Organization child growth standards (WHO-GS) label more children aged 6-59 months with malnutrition than do the widely used 1978 National Centre for Health Statistics child growth references (NCHS).
• Acutely malnourished infants aged <6 months are often neglected in feeding programmes. One reason is that malnutrition prevalence is assumed to be low because of breastfeeding.
• WHO-GS are currently being rolled out for international use – yet the impact on GAM prevalence for <6 months infants has not to date been reviewed.* Z-scores represent the number of standard deviations away from the median of a normally-distributed reference population. e.g. –1 z-score = 1 SD less than the reference population median .
• N =163,230 total, of which: 15,537 aged <6 months; 147,695 aged 6-59 months Mean sample size per country: 7,771. Range: 1,710 to 45,398
Using the WHO-GS instead of NCHS:
• Figure 1 (below) Increases in GAM by age group% GAM in infants <6 months increased markedly:
Odds ratio = 3.1 (95%CI 2.57 to 3.34) % GAM in children 6-59 months increased slightly:
Odds ratio = 1.1 (95% CI 1.04 to 1.09)
