evidence-based blog of Filippo Dibari

Cost-effectiveness of community-based screening and treatment of moderate acute malnutrition in Mali

In Under-nutrition on May 6, 2019 at 3:20 pm

source: BMJ webpage

By Sheila Isanaka1, Dale A Barnhart2, Christine M McDonald3, Robert S Ackatia-Armah4, Roland Kupka5, Seydou Doumbia6, Kenneth H Brown4, Nicolas A Menzies7


Introduction Moderate acute malnutrition (MAM) causes substantial child morbidity and mortality, accounting for 4.4% of deaths and 6.0% of disability-adjusted life years (DALY) lost among children under 5 each year. There is growing consensus on the need to provide appropriate treatment of MAM, both to reduce associated morbidity and mortality and to halt its progression to severe acute malnutrition. We estimated health outcomes, costs and cost-effectiveness of four dietary supplements for MAM treatment in children 6–35 months of age in Mali.

Methods We conducted a cluster-randomised MAM treatment trial to describe nutritional outcomes of four dietary supplements for the management of MAM: ready-to-use supplementary foods (RUSF; PlumpySup); a specially formulated corn–soy blend (CSB) containing dehulled soybean flour, maize flour, dried skimmed milk, soy oil and a micronutrient pre-mix (CSB++; Super Cereal Plus); Misola, a locally produced, micronutrient-fortified, cereal–legume blend (MI); and locally milled flour (LMF), a mixture of millet, beans, oil and sugar, with a separate micronutrient powder. We used a decision tree model to estimate long-term outcomes and calculated incremental cost-effectiveness ratios (ICERs) comparing the health and economic outcomes of each strategy.

Results Compared to no MAM treatment, MAM treatment with RUSF, CSB++, MI and LMF reduced the risk of death by 15.4%, 12.7%, 11.9% and 10.3%, respectively. The ICER was US$9821 per death averted (2015 USD) and US$347 per DALY averted for RUSF compared with no MAM treatment.

Conclusion MAM treatment with RUSF is cost-effective across a wide range of willingness-to-pay thresholds.

Affiliation of the authors:

  1. Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
  2. Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
  3. Children’s Hospital Oakland Research Institute, Oakland, California, USA
  4. Department of Nutrition and Program in International and Community Nutrition, University of California, Davis, CA, USA
  5. United Nations Children’s Fund, Nutrition Section, New York, NY, USA
  6. Faculty of Medicine and Odontostomatology, University of Sciences, Techniques and Technology of Bamako, Bamako, Mali
  7. Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
  8. Correspondence toDr Sheila Isanaka; sisanaka@hsph.harvard.edu

Do Vegetarians Get Enough Protein?

In Over-nutrition on April 13, 2019 at 6:08 am

from NutritionFacts webage

The only nutrient Americans may be more deficient in than fiber is potassium. See 98% of American Diets Potassium-Deficient. For more on how S.A.D. the Standard American Diet is, see Nation’s Diet in Crisis.

Americans eating meat-free diets average higher intakes of nearly every nutrient. See my video Nutrient-Dense Approach to Weight Management.

Isn’t animal protein higher quality protein, though? See D Greger’s videos:

For more on protein, see: Plant Protein Preferable and Prostate Cancer Survival: The A/V Ratio.

And for a few on fiber:

If you haven’t yet, you can subscribe to Dr Greger’s videos for free by clicking here.

WHO/Cochrane/Cornell Summer Institute for Systematic Reviews in Nutrition for Global Policy Making

In Over-nutrition, Under-nutrition on April 12, 2019 at 12:12 pm

source: Cornell Uni webpage.

July 15 – July 26, 2019, Cornell University, Ithaca campus


This unique institute on the Cornell University campus brings together experts from the World Health Organization (WHO), Cochrane, and Cornell University to train participants in the development of systematic reviews of nutrition interventions in populations.

Systematic reviews following the Cochrane methodology are used to ensure that WHO recommendations are based on sound evidence. Participants will learn to apply the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) tool to assess the overall quality of evidence.

Who should attend

The institute is intended for nutrition scientists and practitioners with interest in the application of scientific evidence in policy making. Candidates must have a university degree in health or social sciences with interest in nutrition interventions for public health and be willing to be registered as authors in a Cochrane Group.

Applications from women and from nationals of low- and middle-income countries are particularly encouraged.

Program benefits

In this program, you will:

  • update and develop your technical skills and knowledge in systematic reviews of nutrition and nutrition-sensitive interventions;
  • build understanding of the process for global policy making, nutrition, and evidence assessment and its challenges;
  • complete hands-on training in the development of Cochrane systematic reviews on a topic of immediate global health relevance in nutrition and public health; and
  • develop confidence with the review methods and foster development of professional networks with fellow participants and faculty

In the news

Summer course trains experts in WHO policies, Institute launched in 2014

The following article from the Cornell Chronicle, published July 8, 2014, describes our experiences in the first year of the Institute. The 2018 Summer Institute was our 5th Institute.

More than 30 nutrition experts from around the globe gathered at Cornell July 7-18, 2014, for hands-on training in World Health Organization (WHO) procedures to retrieve, summarize and assess reliable, current evidence to inform WHO’s recommendations for nutrition and public health policy.

Institute focuses on global nutrition policy impact

When the Division of Nutritional Sciences at Cornell University hosted the 4th annual Summer Institute for Systematic Reviews in Nutrition for Global Policy Making  from July 24 to August 4, 2017, its participants included 29 experts from around the world, and 10 faculty members from the World Health Organization (WHO), Cornell University and Cochrane.

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