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dc.contributor.authorLapidus, N
dc.contributor.authorMinetti, A
dc.contributor.authorDjibo, A
dc.contributor.authorGuerin, P J
dc.contributor.authorHustache, S
dc.contributor.authorGaboulaud, V
dc.contributor.authorGrais, R
dc.date.accessioned2009-05-08T11:08:49Z
dc.date.available2009-05-08T11:08:49Z
dc.date.issued2009-01-29
dc.date.submitted2009-05-07
dc.identifier.citationPLoS ONE 2009;4(1):e4313en
dc.identifier.issn1932-6203
dc.identifier.pmid19177169
dc.identifier.doi10.1371/journal.pone.0004313
dc.identifier.urihttp://hdl.handle.net/10144/67636
dc.description.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.
dc.language.isoenen
dc.publisherPublic Library of Science (PLoS)en
dc.relation.urlhttp://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0004313en
dc.rightsPublished by Public Library of Science, [url]http://www.plosone.org/[/url] Archived on this site by Open Access permissionen
dc.subject.meshMalnutritionen
dc.subject.meshMortalityen
dc.subject.meshChilden
dc.subject.meshNigeren
dc.titleMortality risk among children admitted in a large-scale nutritional program in Niger, 2006en
dc.typeArticleen
dc.contributor.departmentEpicentre, Paris, France; Ministry of Health, Niamey, Nigeren
dc.identifier.journalPLoS Oneen
refterms.dateFOA2019-03-04T14:19:57Z
html.description.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.


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