Mortality risk among children admitted in a large-scale nutritional program in Niger, 2006
AffiliationEpicentre, Paris, France; Ministry of Health, Niamey, Niger
MetadataShow full item record
AbstractBACKGROUND: In 2006, the Médecins sans Frontières nutritional program in the region of Maradi (Niger) included 68,001 children 6-59 months of age with either moderate or severe malnutrition, according to the NCHS reference (weight-for-height<80% of the NCHS median, and/or mid-upper arm circumference<110 mm for children taller than 65 cm and/or presence of bipedal edema). Our objective was to identify baseline risk factors for death among children diagnosed with severe malnutrition using the newly introduced WHO growth standards. As the release of WHO growth standards changed the definition of severe malnutrition, which now includes many children formerly identified as moderately malnourished with the NCHS reference, studying this new category of children is crucial. METHODOLOGY: Program monitoring data were collected from the medical records of all children admitted in the program. Data included age, sex, height, weight, MUAC, clinical signs on admission including edema, and type of discharge (recovery, death, and default/loss to follow up). Additional data included results of a malaria rapid diagnostic test due to Plasmodium falciparum (Paracheck) and whether the child was a resident of the region of Maradi or came from bordering Nigeria to seek treatment. Multivariate logistic regression was performed on a subset of 27,687 children meeting the new WHO growth standards criteria for severe malnutrition (weight-for-height<-3 Z score, mid-upper arm circumference<110 mm for children taller than 65 cm or presence of bipedal edema). We explored two different models: one with only basic anthropometric data and a second model that included perfunctory clinical signs. PRINCIPAL FINDINGS: In the first model including only weight, height, sex and presence of edema, the risk factors retained were the weight/height(1.84) ratio (OR: 5,774; 95% CI: [2,284; 14,594]) and presence of edema (7.51 [5.12; 11.0]). A second model, taking into account supplementary data from perfunctory clinical examination, identified other risk factors for death: apathy (9.71 [6.92; 13.6]), pallor (2.25 [1.25; 4.05]), anorexia (1.89 [1.35; 2.66]), fever>38.5 degrees C (1.83 [1.25; 2.69]), and age below 1 year (1.42 [1.01; 1.99]). CONCLUSIONS: Although clinicians will continue to perform screening using clinical signs and anthropometry, these risk indicators may provide additional criteria for the assessment of absolute and relative risk of death. Better appraisal of the child's risk of death may help orientate the child towards either hospitalization or ambulatory care. As the transition from the NCHS growth reference to the WHO standards will increase the number of children classified as severely malnourished, further studies should explore means to identify children at highest risk of death within this group using simple and standardized indicators.
PublisherPublic Library of Science (PLoS)
- Prognostic accuracy of WHO growth standards to predict mortality in a large-scale nutritional program in Niger.
- Authors: Lapidus N, Luquero FJ, Gaboulaud V, Shepherd S, Grais RF
- Issue date: 2009 Mar 3
- Impact of the shift from NCHS growth reference to WHO(2006) growth standards in a therapeutic feeding programme in Niger.
- Authors: Minetti A, Shams Eldin M, Defourny I, Harczi G
- Issue date: 2009 Oct
- Comparison of the new World Health Organization growth standards and the National Center for Health Statistics growth reference regarding mortality of malnourished children treated in a 2006 nutrition program in Niger.
- Authors: Dale NM, Grais RF, Minetti A, Miettola J, Barengo NC
- Issue date: 2009 Feb
- Preventing acute malnutrition among young children in crises: a prospective intervention study in Niger.
- Authors: Langendorf C, Roederer T, de Pee S, Brown D, Doyon S, Mamaty AA, Touré LW, Manzo ML, Grais RF
- Issue date: 2014 Sep
- Assessing the impact of the introduction of the World Health Organization growth standards and weight-for-height z-score criterion on the response to treatment of severe acute malnutrition in children: secondary data analysis.
- Authors: Isanaka S, Villamor E, Shepherd S, Grais RF
- Issue date: 2009 Jan