evidence-based blog of Filippo Dibari

Posts Tagged ‘children and their mothers’

Mothers screening for malnutrition by mid-upper arm circumference is non-inferior to community health workers: results from a large-scale pragmatic trial in rural Niger

In Under-nutrition on September 14, 2016 at 9:59 pm

by Franck G.B. Alé, Kevin P.Q. Phelan, Hassan Issa, Isabelle Defourny, Guillaume Le Duc, Geza Harczi, Kader Issaley, Sani Sayadi, Nassirou Ousmane, Issoufou Yahaya, Mark Myatt, André Briend, Thierry Allafort-Duverger, Susan Shepherd and Nikki Blackwell

Abstract

Background

Community health workers (CHWs) are recommended to screen for acute malnutrition in the community by assessing mid-upper arm circumference (MUAC) on children between 6 and 59 months of age. MUAC is a simple screening tool that has been shown to be a better predictor of mortality in acutely malnourished children than other practicable anthropometric indicators. This study compared, under program conditions, mothers and CHWs in screening for severe acute malnutrition (SAM) by color-banded MUAC tapes.

Methods

This pragmatic interventional, non-randomized efficacy study took place in two health zones of Niger’s Mirriah District from May 2013 to April 2014. Mothers in Dogo (Mothers Zone) and CHWs in Takieta (CHWs Zone) were trained to screen for malnutrition by MUAC color-coded class and check for edema. Exhaustive coverage surveys were conducted quarterly, and relevant data collected routinely in the health and nutrition program. An efficacy and cost analysis of each screening strategy was performed.

Results

A total of 12,893 mothers and caretakers were trained in the Mothers Zone and 36 CHWs in the CHWs Zone, and point coverage was similar in both zones at the end of the study (35.14 % Mothers Zone vs 32.35 % CHWs Zone, p = 0.9484). In the Mothers Zone, there was a higher rate of MUAC agreement (75.4 % vs 40.1 %, p <0.0001) and earlier detection of cases, with median MUAC at admission for those enrolled by MUAC <115 mm estimated to be 1.6 mm higher using a smoothed bootstrap procedure. Children in the Mothers Zone were much less likely to require inpatient care, both at admission and during treatment, with the most pronounced difference at admission for those enrolled by MUAC < 115 mm (risk ratio = 0.09 [95 % CI 0.03; 0.25], p < 0.0001). Training mothers required higher up-front costs, but overall costs for the year were much lower ($8,600 USD vs $21,980 USD.)

Conclusions

Mothers were not inferior to CHWs in screening for malnutrition at a substantially lower cost. Children in the Mothers Zone were admitted at an earlier stage of SAM and required fewer hospitalizations. Making mothers the focal point of screening strategies should be included in malnutrition treatment programs.

Trial registration

The trial is registered with clinicaltrials.gov (Trial number NCT01863394).

Maternal and Child Nutrition: Promoting Healthy Growth and Preventing Childhood Stunting

In Under-nutrition on September 14, 2014 at 6:06 am

Maternal and Child Nutrition Journal – Special Issue: Promoting Healthy Growth and Preventing Childhood Stunting

September 2013 – Volume 9, Issue Supplement S2 Pages 1–149

  • Editorial

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Promoting healthy growth and preventing childhood stunting: a global challenge (pages 1–5)

Adelheid W. Onyango

Article first published online: 18 SEP 2013 | DOI: 10.1111/mcn.12092

  • Original Article

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The World Health Organization’s global target for reducing childhood stunting by 2025: rationale and proposed actions (pages 6–26)

Mercedes de Onis, Kathryn G. Dewey, Elaine Borghi, Adelheid W. Onyango, Monika Blössner, Bernadette Daelmans, Ellen Piwoz and Francesco Branca

Article first published online: 18 SEP 2013 | DOI: 10.1111/mcn.12075

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Contextualising complementary feeding in a broader framework for stunting prevention (pages 27–45)

Christine P. Stewart, Lora Iannotti, Kathryn G. Dewey, Kim F. Michaelsen and Adelheid W. Onyango

Article first published online: 18 SEP 2013 | DOI: 10.1111/mcn.12088

  • Review Article

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Multi-sectoral interventions for healthy growth (pages 46–57)

Ma del Carmen Casanovas, Chessa K. Lutter, Nune Mangasaryan, Robert Mwadime, Nemat Hajeebhoy, Ana Maria Aguilar, Ciro Kopp, Luis Rico, Gonzalo Ibiett, Doris Andia and Adelheid W. Onyango

Article first published online: 18 SEP 2013 | DOI: 10.1111/mcn.12082

  • Original Articles

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Parental height and child growth from birth to 2 years in the WHO Multicentre Growth Reference Study (pages 58–68)

Cutberto Garza, Elaine Borghi, Adelheid W. Onyango, Mercedes de Onis and WHO Multicentre Growth Reference Study Group

Article first published online: 18 SEP 2013 | DOI: 10.1111/mcn.12085

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The economic rationale for investing in stunting reduction (pages 69–82)

John Hoddinott, Harold Alderman, Jere R. Behrman, Lawrence Haddad and Susan Horton

Article first published online: 18 SEP 2013 | DOI: 10.1111/mcn.12080

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The principles and practices of nutrition advocacy: evidence, experience and the way forward for stunting reduction (pages 83–100)

David Pelletier, Rukhsana Haider, Nemat Hajeebhoy, Nune Mangasaryan, Robert Mwadime and Satyajit Sarkar

Article first published online: 18 SEP 2013 | DOI: 10.1111/mcn.12081

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Key principles to improve programmes and interventions in complementary feeding (pages 101–115)

Chessa K Lutter, Lora Iannotti, Hilary Creed-Kanashiro, Agnes Guyon, Bernadette Daelmans, Rebecca Robert and Rukhsana Haider

Article first published online: 18 SEP 2013 | DOI: 10.1111/mcn.12087

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Designing appropriate complementary feeding recommendations: tools for programmatic action (pages 116–130)

Bernadette Daelmans, Elaine Ferguson, Chessa K. Lutter, Neha Singh, Helena Pachón, Hilary Creed-Kanashiro, Monica Woldt, Nuné Mangasaryan, Edith Cheung, Roger Mir, Rossina Pareja and André Briend

Article first published online: 18 SEP 2013 | DOI: 10.1111/mcn.12083

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Introducing infant and young child feeding indicators into national nutrition surveillance systems: lessons from Vietnam (pages 131–149)

Nemat Hajeebhoy, Phuong Hong Nguyen, Do Thanh Tran and Mercedes de Onis

Article first published online: 18 SEP 2013 | DOI: 10.1111/mcn.12086

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Why Is Child Malnutrition Lower in Urban Than in Rural Areas? Evidence from 36 Developing Countries

In Under-nutrition on June 23, 2013 at 8:01 pm

by LISA C. SMITH, MARIE T. RUEL and AIDA NDIAYE

World Development – Vol. 33, No. 8, pp. 1285–1305, 2005
(download the paper)
Abstract
This study asks whether key socioeconomic determinants of child nutritional status differ across urban and rural areas to investigate why urban malnutrition rates are lower. Little evidence of urban–rural differences in the nature of the determinants or the strength of their associations with nutritional status is found. However, marked differences in the levels of the determinants and in caring practices for children and women in favor of urban areas are documented. The study results suggest that lower urban malnutrition is due to a series of more favorable socioeconomic conditions, in turn leading to better caring practices for children and their mothers.
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