evidence-based blog of Filippo Dibari

Use of Mid-Upper Arm Circumference by Novel Community Platforms to Detect, Diagnose, and Treat Severe Acute Malnutrition in Children: A Systematic Review

In Under-nutrition on September 6, 2018 at 5:48 am

from: the Journal of Global Health Science and Practice

by Jessica Bliss, Natasha Lelijveld, André Briend, Marko Kerac, Mark Manary, Marie McGrath, Zita Weise Prinzo, Susan Shepherd, Noël Marie Zagre, Sophie Woodhead, Saul Guerrero and Amy Mayberry

Limited studies suggest that with robust program inputs caregivers and CHWs can correctly use mid-upper arm circumference to detect severe acute malnutrition (SAM) and that properly trained and supported CHWs can treat uncomplicated SAM in communities.

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Abstract

Background: A stubborn persistence of child severe acute malnutrition (SAM) and continued gaps in program coverage have made identifying methods for expanding detection, diagnosis, and treatment of SAM an urgent public health need. There is growing consensus that making mid-upper arm circumference (MUAC) use more widely accessible among caregivers and community health workers (CHWs) is an important next step in further decentralizing SAM care and increasing program coverage, including the ability of CHWs to treat uncomplicated SAM in community settings.

 

Methods: We conducted a systematic review to summarize published and operational evidence published since 2000 describing the use of MUAC for detection and diagnosis of SAM in children aged 6–59 months by caregivers and CHWs, and of management of uncomplicated SAM by CHWs, all outside of formal health care settings. We screened 1,072 records, selected 43 records for full-text screening, and identified 22 studies that met our eligibility criteria. We extracted data on a number of items, including study design, strengths, and weaknesses; intervention and control; and key findings and operational lessons. We then synthesized the qualitative findings to inform our conclusions. The issue of treating children classified as SAM based on low weight-for-height, rather than MUAC, at household level, is not addressed in this review.

 

Findings: We found evidence that caregivers are able to use MUAC to detect SAM in their children with minimal risk and many potential benefits to early case detection and coverage. We also found evidence that CHWs are able to correctly use MUAC for SAM detection and diagnosis and to provide a high quality of care in the treatment of uncomplicated SAM when training, supervision, and motivation are adequate. However, the number of published research studies was small, their geographic scope was narrow, and most described intensive, small-scale interventions; thus, findings are not currently generalizable to public-sector health care systems.

 

Conclusions: Scaling up the use of MUAC by caregivers and CHWs to detect SAM in household and community settings is a promising step toward improving the coverage of SAM detection, diagnosis, and treatment. Further research on scalability, applicability across a wider range of contexts, coverage impact, and cost is needed. The primary use of MUAC for SAM detection should also be explored where appropriate.

Internship Opportunities with the WFP – Ethiopia

In Over-nutrition, Under-nutrition on September 5, 2018 at 7:00 pm

Background

Ethiopia has made important development gains over the past two decades, reducing poverty and expanding investments in basic social services. However, food insecurity and under-nutrition still hinder economic growth. In 2015 it ranked 174 out of 188 in the UNDP Human Development Report. The country is also home to the second largest refugee population on the continent; it currently hosts 909,000 registered refugees from South Sudan, Somalia, Sudan, Eritrea and Kenya. 2016 was a challenging year for Ethiopia as it suffered from the worst El Niño impact in the last 50 years. The onset of El Niño combined with failed Belg (spring harvest) and Meher (main harvest) rains in 2015 left 10.2 million people in need of emergency food and nutrition assistance. While the Government and partners averted a major humanitarian catastrophe, the drought has left a negative legacy on many families, who lost livestock and other productive assets. The residual needs from the past year have been compounded by a new and devastating drought which hit Ethiopia and other parts of the Horn of Africa in early 2017. In  August 2017, the Government of Ethiopia released the Mid-Year Humanitarian Requirements Document which outlined the need to support 8.5 million people with emergency food, nutrition, health, water and education programmes. WFP supports the Ethiopian Government through a range of life-saving and resilience-building activities as well as providing assistance in refugee camps. We use food, cash, nutrition assistance and innovative approaches to improve nutrition, empower women, build local capacities and enhance preparedness to climate-related shocks.

 

Opportunity – WFP Ethiopia Country Office seeks (1) graduate (BSc), and post-graduate (MSc) students looking for field-based dissertation topics, (2) BSc and MSc students already graduated within a year, looking for opportunity hands-on work experience, and (3) researchers looking for settings where to develop operational research topics. Background: Nutrition/Public Health/Epidemiology, Food Technology, Communication, Social Sciences, Logistics, Engineering, Economy and any other field related to food and nutrition.

 

More information

  • What? The interns will be integrated into WFP existing and/or about-to-start programmes. The potential areas include (1) integrated nutrition and food security surveillance, (2) treatment of moderate acute malnutrition, (3) development of social behavioural change communication to reduce stunting and wasting, (4) interlinkages between HIV and malnutrition, (5) food fortification, (6) nutrition advocacy, strategic evidence-based policy- and decision-making, (7) social protection in food insecure households.
  • When? Candidate can apply anytime during the year.
  • Where? According to the Terms of Reference (ToR) and the deliverables of the internship, the candidate will be placed either at WFP Country Office (Addis Abeba) and/or at the provincial Sub-Offices.
  • Supervised by who? Administratively the interns will be supervised by a WFP line manager. The ToR and the deliverables will be agreed by and with the candidate, eventually with the tutor of the institution of origin and WFP.
  • For how long? The duration of the internship will depend on the nature of the ToR and its deliverables.
  • Which kind of support? WFP has limited resources for support to internship programmes. Therefore, candidates are encouraged to rely on their own means of support for living, and international / national travel costs. WFP can cover at least the intern health insurance. Additional WFP support can be put under consideration in case of strong candidatures.
  • I am interested. How to apply? For an initial contact, get in touch with both Filippo Dibari (filippo.dibari@wfp.org) and Pauline Akabwai (pauline.akabwai@wfp.org). Note that the email subject should be reading exactlyinternship at WFP’). Be ready to submit curriculum vitae (one page max), provide specific evidence of your skills, undertake a written test and an interview, share reference contact details.

 

For further reading – Ethiopia nutrition profile – source: Global Nutrition Report 2017 (link  or under request) and WFP Ethiopia Country Profile (Link)

Impact of anthropogenic CO2 emissions on global human nutrition

In Under-nutrition on August 29, 2018 at 4:40 am

by Matthew R. Smith & Samuel S. Myers

Nature Climate Change volume 8pages 834–839 (2018) – link

Abstract

Atmospheric CO2 is on pace to surpass 550 ppm in the next 30–80 years. Many food crops grown under 550 ppm have protein, iron and zinc contents that are reduced by 3–17% compared with current conditions.

We analysed the impact of elevated CO2 concentrations on the sufficiency of dietary intake of iron, zinc and protein for the populations of 151 countries using a model of per-capita food availability stratified by age and sex, assuming constant diets and excluding other climate impacts on food production.

We estimate that elevated COcould cause an additional 175 million people to be zinc deficient and an additional 122 million people to be protein deficient (assuming 2050 population and CO2 projections).

For iron, 1.4 billion women of childbearing age and children under 5 are in countries with greater than 20% anaemia prevalence and would lose >4% of dietary iron.

Regions at highest riskSouth and Southeast Asia, Africa, and the Middle East—require extra precautions to sustain an already tenuous advance towards improved public health.

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