Prevalence Of Global Acute Malnutrition Research Articles

A comprehensive analysis of food insecurity in the drought-prone rural areas of Tigray.

The number of globally food-insecure people is increasing since 2017. Sub-Saharan Africa has the highest proportion of severely food-insecure people in the world. Tigray region of Ethiopia is one of the food-insecure regions, which, over the past many decades has been affected by recurrent food insecurities. In the drought-prone rural areas of Tigray, many people are living under the condition of chronic hunger. Proper food security studies are vital for proper intervention mechanisms. Yet, previous food security studies have rarely addressed the four pillars of food security: availability, access, utilization, and stability. In this study, all components are duly considered to assess the food insecurity status in the drought-prone rural areas of Tigray, Ethiopia. Of the 34 rural districts in Tigray, 363 households from three drought-prone rural districts were studied. Household Food Insecurity Access Scale and Food Insecurity Experience Scale were adapted to measure the food availability, access to food, and stability components of food security; and, Household Dietary Diversity Score (HDDS), Food Consumption Score (FCS), mid-upper arm circumference, and Bitot's spot were used to analyze the food utilization aspect. Findings show that 68% of the studied community frequently ate less food than they felt they needed and 82.1% of the households have experienced hunger because of lack of food. The study rural districts were unconnected to road networks; hence, 87.9% of the elderly and 20.4% of the women and girls had no access to food markets. Regarding the food utilization, 81.5% of the studied households had poor FCS; and the average HDDS and FCS for the study areas were 2.47 and 18.9, respectively. The prevalence of Global acute malnutrition, severe acute malnutrition (SAM), and moderate acute malnutrition (MAM) for 6-59months of age children in the study areas were 50.3, 4.2, and 46.1%, respectively. More notably, the prevalence of SAM for children from the food-insecure households was 21.2%. The prevalence of MAM for pregnant and lactating women (PLW) in the study areas was 59.5. Further, the prevalence of Bitot's spot among 6-59months of age children was 1.9%. On the other hand, all the rural households had anxiety about their future food demands. The rural households living in the studied areas were critically food-insecure. All the measurements implied that the food insecurity situation in the study areas was unacceptably worrisome and life-threatening. This calls for an instant action to avert the occurrence of famine and starvation in the drought-prone rural areas of Tigray region. Thus, interventions should primarily target the vulnerable rural people and need to be planned based on attaining food availability first rather than concurrently addressing all components of food security. Further, due emphasis should be given to diversifying livelihood strategies of the vulnerable villagers.

Nutritional Status of Children in the PROFISEM Intervention Zone: Logone Occidental and Wadi-Fira in Chad

In Chad, as in most sub-Saharan African countries, the nutritional situation remains a major concern, and is an underlying cause of many other health problems. The aim of this study is to assess the nutritional status of children aged 6 to 59 months in the provinces of Logone Occidental and Wadi-Fira, in order to contribute to a better management of nutritional problems. The study was carried out between August 16 and October 10, 2022, and involved 207 children aged 6 to 59 months in Wadi-Fira, and 63 aged 6 to 59 months in Logone Occidental. Data collection was carried out using a questionnaire and measurements to collect data on the children's socio-demographic characteristics and anthropometry. Analysis of the children's nutritional status was based on the z-score of nutritional indices and edema according to 2006 WHO references. Analysis of the results showed that the prevalence of global acute malnutrition is 18.84%, chronic malnutrition affects 30.9% and underweight affects 32.9% of children in Wadi Fira. In Logone Occidental, about 1/10 child (9.20%) suffers from acute malnutrition, 33.6% from chronic malnutrition and 22.8% from underweight. In Wadi-Fira, the nutritional situation is considered critical, with more than one child on 15 suffering from global or moderate acute malnutrition. In Logone Occidental, the nutritional situation is precarious for both forms of acute malnutrition. The nutritional situation in both provinces needs a reinforcement of current actions in the fight against malnutrition.

Trends in malnutrition among children under 5 in Niger: a retrospective analysis of demographic and nutrition surveys comparing 2008–2014 with 2015–2021

ObjectivesFor decades, Niger, a Sahelian country in Africa, has faced serious food and nutrition crises. Policies and strategies have been implemented by the Government, with the support of its partners, to address this public health problem. The current study was conducted to assess trends in malnutrition among children under 5 years of age. By comparing results from 2008 to 2014 with results from 2015 to 2021, this study aimed to check the efficacy of strategies and policies that were implemented to combat malnutrition. Study designRetrospective study. MethodsData from the annual nutrition survey Standardized Monitoring and Assessment of Relief and Transitions and the Demographic and Health and Multiple Indicator Surveys were used. Meta-analyses were performed on the data as a whole and in each age group by time period. For analysis of age groups, the 95% confidence interval (CI) data were missing, thus an estimate was made from the ‘design effect’ calculated based on existing CIs. ResultsInstitutional arrangements had not changed from 2008 to 2014 to 2015–2021, and there were very few changes to existing strategies and policies. The prevalence of Global Acute Malnutrition and Global Chronic Malnutrition (GCM) both remained above critical thresholds for each year in both periods. GCM was above the emergency threshold for both periods, indicating that all regions of the country were affected by malnutrition. The most populated regions (40%) of Maradi and Zinder were the most affected by malnutrition. These two regions also had highest incidence of poverty and the least health service coverage. ConclusionsDespite the implementation of various policies and strategies, the nutritional status of children under 5 remains an important public health problem.

Assessment of the Nutritional and Infectious Status of Vulnerable Children Consulted at Beyla Hospital, Guinea

Introduction: Acute malnutrition is a primary health concern among vulnerable children. The objective of this work is to know the nutritional status of the 321 children of these vulnerable children and to assess their infectious states. Methodology: Smart nutritional survey according to a list drawn up by the community services of the Town Hall. Follow-up of a biological analysis of the stools with the Polymerase Chain Reaction to detect the germ involved. Statistical processing with Smart software. Results: Rate of acute malnutrition in Z-scores: Prevalence of global acute malnutrition of: (29) 9.03%. With: (17) 5.29% moderate and (12) 3.73% severe. Rate of acute malnutrition as a percentage of the median. Prevalence of global acute malnutrition: (12) 3.73% with (8) 2.49% moderate and (4) 1.24% severe plus edema. Chronic malnutrition rate in Z-scores. Prevalence of global chronic malnutrition: (91) 28.34%. Shigella sonnei DNA alone was found in 20 (6.2%) children. Malnutrition-shigellosis copathology was found in 120 (37.4%) of these children. A total of 140 (43.6%) cases of Shigella sonnei DNA detected (P = 1.4). Conclusion: Among the 321 vulnerable children, malnutrition was a reality against the backdrop of bloody Shigella sonnei dysentery. Contracted during the various gatherings.

Undernutrition among children living in refugee camps: a systematic review of prevalence

ObjectivesThis review aimed to provide an overview of the prevalence of undernutrition in children under 5 years old in refugee camps according to the different indicators. In addition, we aimed...

Malnutrition among hospitalized children 12–59 months of age in Abyan and Lahj Governorates / Yemen

BackgroundThe analysis of acute malnutrition in 2018 for the Integrated Phase Classification of Food Security in Yemen shows that high malnutrition rates are present in Abyan governorate (23%) and Lahj governorate (21%). This analysis was community based addressed all children and mostly due to problems related to food intake. The role of diseases was not yet addressed in Yemen. The aim of this study is to assess acute and chronic malnutrition among hospitalized children at 12–59 months of age in Lahj and Abyan governorates in Yemen.MethodologyA cross-sectional, multi-center study is designed. The assessment of the nutritional status was measured by standardized anthropometry of 951 sick children at 12–59 months of age.ResultsThe prevalence of Global acute malnutrition (GAM) among the sick children seeking care in health facilities in Lahj and Abyan is 21%. More specifically; the prevalence of moderate acute malnutrition (MAM) is 15.1% while the prevalence of severe acute malnutrition (SAM) is 6.2%. The prevalence of acute malnutrition (wasting) among the studied sick children in lahj is 23.4% while in Abyan is 19.3%. The prevalence of MAM in Lahj is 17.7% and the prevalence of SAM is 5.7%. The prevalence of acute malnutrition (wasting) in Abyan is 12.6% while the prevalence of SAM in Abyan is 6.7%. The prevalence of acute malnutrition among male children (25.2%) is significantly higher than among female children (17.5%). The prevalence of the chronic malnutrition (Stunting) in the studied sick children is 41.3%; the prevalence of stunting in Lahj is 41% while in Abyan is 41.7%.ConclusionsHigh acute and chronic malnutrition rates were identified among sick children seeking care in health facilities in lahj and Abyan, and higher than the SPHERE indicators of malnutrition. Boys are more exposed than girls to acute and chronic malnutrition.

Predictors of exceeding emergency under-five mortality thresholds using small-scale survey data from humanitarian settings (1999 – 2020): considerations for measles vaccination, malnutrition, and displacement status

BackgroundQuantifying the effect of measles containing vaccine (MCV) coverage and the prevalence of global acute malnutrition (GAM) on mortality levels in populations of displaced and crisis-affected resident children is important for intervention programming in humanitarian emergencies.MethodsA total of 1597 surveys containing data on under-five death rate, population status (internally displaced, refugee, or crisis-affected resident), measles containing vaccine coverage, and global acute malnutrition were extracted from the Complex Emergency Database (CE-DAT). Under-five mortality rates were dichotomized to those exceeding critical levels or otherwise. A Bayesian multivariable mixed-effect logistic regression model was used to assess the association between an under-five death rate (U5DR) exceeding this threshold and population status (i.e., internally displaced, refugees or residents), GAM prevalence (proxy for food security), and MCV coverage.ResultsThe prevalence of GAM, MCV and U5DR were higher in internally displaced children (IDC) with values of 14.6%, 69.9% and 2.07 deaths per 10 000 per day, respectively. Refugee populations had lower average under-five mortality rate (0.89 deaths per 10 000 per day), GAM of 12.0% and the highest measles containing vaccine coverage (80.0%). In crisis-affected residents the prevalence of GAM, MCV and average U5DR are 11.1%, 65.5% and 1.20 deaths per 10 000 per day respectively. In mixed-effect logistic model taking 2 deaths per 10 000 children less than five years old per as emergency threshold (Model III); MCV (AOR = 0.66, 95% Highest Density Interval (HDI): 0.57, 0.78), GAM (AOR = 1.79, 95% HDI: 1.52, 2.12) were associated with a reduction of the odds of U5DR exceeding critical level accounting for country-specific levels of variability. The odds of U5DR exceeding critical level (2/10000/day) in crisis-affected resident children and refugees were 0.36 (95% HDI: 0.22, 0.58) and 0.25(95% HDI: 0.11, 0.55) less than amongst IDP children adjusting for GAM and MCV. In considering country specific yearly median U5DR (model IV) the odds of U5DR exceeding twice the median U5DR were associated with MCV (AOR = 0.72, 95% HDI: 0.64, 0.82), GAM (AOR = 1.53, 95%HDI: 1.34, 1.76). The odds of U5DR exceeding critical level in crisis-affected resident children was 0.30(95% HDI: 0.20, 0.45) less than IDP children, after adjusting for MCV and GAM. We found no difference between the odds of U5DR exceeding twice the country level median U5DR in the refugee population compared to the IDPs.ConclusionsIn this study vaccination coverage and global acute malnutrition (proxy for food security) were associated with U5DR exceeding critical level. The emergency threshold for IDPs and affected residents is significantly different and consistent across the different outcomes, whereas the result is inconsistent for IDPs and refugees. Continued improvement in measles vaccination coverage and reduction of malnutrition in humanitarian emergencies have the potential to minimize the deterioration of mortality level amongst children in emergency settings. To generate a robust understanding of the critical level of child mortality in displaced and affected resident populations, studies accounting for the impact of the duration of displacement, contextual factors in humanitarian settings, and the level of humanitarian assistance provided are needed.

Nutrition Status of Refugee and Host-Country Children: Negotiating for Equal Distribution of Relief Food During Emergencies in Uganda.

About 25.4 million people worldwide are living as refugees of whom 1.36 million are in Uganda. The refugees in this study were from South Sudan. The objective of this study was to determine the nutrition status of the refugee children and elucidate the factors that contribute to poor nutrition status among the host. The study used comparative analytical cross-sectional design on 340 children aged 6-59months. The overall prevalence of global acute malnutrition was 3.9%, underweight 14.1%, and stunting 24.7%. Five factors contributed to poor nutrition status; household size (ORa 1.34, 1.92), illness in wasted, stunted and underweight (ORa 1.47, 1.49, 1.97) children, being a host in relation to wasting and stunting (ORa 1.81, 1.36) and deworming (ORa 3.2, 2.13). Although the host had good nutrient intake, the refugee children had better nutrition status. Therefore, the Uganda government should formulate a policy that allows the host to benefit equally from food relief during emergencies.

Effective Factors on Acute Malnutrition in Children Aged 6 to 59 Months in the Centre-West Region of Burkina Faso

Background: In Burkina Faso, malnutrition is a public health problem. Despite the significant drop in the prevalence of malnutrition since 2009 according to the Directorate of Nutrition, malnutrition is still a major concern with regard to its consequences. The objective of this study was to determine the factors associated with acute malnutrition in children aged 6 to 59 months in the Sabou Health District, Burkina Faso.
 Methods: This was a descriptive, cross-sectional study conducted among 343 children aged 6 to 59 months in Sabou Health District, Burkina Faso from August 1st to 30th, 2016. Factors associated with acute malnutrition were dietary factors, family factors, environmental factors, and infectious factors determined using SPSS version 21.0 software. The difference was statistically significant for P-value of less than 0.05.
 Results: The prevalence of global acute malnutrition in the district was 9.0%, of which 2.6% was severe according to the Brachial Perimeter. Several factors were associated with acute malnutrition in children under 5 years of age in the Sabou health district. Indeed, morbidity was a factor associated with acute malnutrition in children with a P-value of 0.007. The low dietary diversity experienced by food-insecure households was also associated with acute malnutrition in children. Infant and young child feeding practices, i.e., inadequate introduction of complementary foods and low dietary diversity to children were among the factors associated with nutritional status (P = 0.007). Among mothers, 87.5% had heard of malnutrition, 66.5% did not recognize the signs of malnourished in their children, and 92.4% were unaware of the consequences of malnutrition.
 Conclusion: Based on the results, initiatives and programmes should be established for women, the bearers of life, to enhance their empowerment and educate them with regard to the integral growth of children, the builders of tomorrow.

Nutritional Status and Infant and Young Child Feeding (IYCF) Practices among Buhid Mangyan Tribe, Occidental Mindoro Philippines

Nutritionally adequate and safe complementary feeding starting from the age of 6 months up to 59 months is one of the effective intervention to reduce infant and child morbidity and malnutrition. This study aims to determine the nutritional status of children ages 6-59 months and their caregiver’s infant and young child feeding (IYCF) practices of the Buhid community in Rizal, Occidental Mindoro. The design used in this study was a descriptive cross-sectional carried out between December 2016-February 2017. A survey questionnaire was utilized as an instrument in this study. It includes an anthropometric survey of 6-59 months old and infant and young child feeding practices using WHO and UNICEF IYCF indicators. Vaccination, vitamin A supplementation and deworming coverage were also measured. Findings revealed a prevalence of global acute malnutrition (GAM) at a critical level. There is a low but significant prevalence of stunting and underweight among children. There is a good infant and young feeding practice in the community except for the minimum acceptable diet during complementary feeding. Lastly, there is low BCG and measles vaccination coverage in the community that could be a threat to the impending disease outbreak.

Malnutrition trends in Rohingya children aged 6-59 months residing in informal settlements in Cox's Bazar District, Bangladesh: An analysis of cross-sectional, population-representative surveys.

BackgroundMore than 700,000 ethnic Rohingya have crossed the border from Rakhine State, Myanmar to Cox’s Bazar District, Bangladesh, following escalated violence by Myanmar security forces. The majority of these displaced Rohingya settled in informal sites on previously forested land, in areas without basic infrastructure or access to services.Methods and findingsThree cross-sectional population-representative cluster surveys were conducted, including all informal settlements of Rohingya refugees in the Ukhia and Teknaf Upazilas of Cox’s Bazar District. The first survey was conducted during the acute phase of the humanitarian response (October–November 2017), and the second and third surveys were conducted 6 (April–May 2018) and 12 (October–November 2018) months later. Anthropometric indices (weight, height, mid-upper arm circumference [MUAC], oedema) and haemoglobin (Hb) were measured in children aged 6–59 months following standard procedures. Final samples for survey rounds 1, 2, and 3 (R1, R2, and R3) included 1,113, 628, and 683 children, respectively, of which approximately half were male (50.7%–53.5% per round) and a third were 6–23 months of age (32.4%–33.3% per round). Prevalence of global acute malnutrition (GAM) as assessed by weight for height in R2 (12.1%, 95% CI: 9.6–15.1) and R3 (11.0%, 95% CI: 8.4–14.2) represent a significant decline from the observed prevalence in R1 (19.4%, 95% CI: 16.8–22.3) (p < 0.001 for both comparisons). Overall, the prevalence of anaemia significantly declined (p < 0.001) between the first 2 rounds (47.9%, 95% CI: 44.1–51.7 and 32.3%, 95% CI: 27.8–37.1, respectively); prevalence increased significantly (p = 0.04) to 39.8% (95% CI, 34.1–45.4) during R3 but remained below R1 levels. Reported receipt of both fortified blended foods (12.8%) and micronutrient powders (10.3%) were low during R1 but increased significantly (p < 0.001 for both) within the first 6 months to 49.8% and 29.9%, respectively. Although findings demonstrate improvement in anthropometric indicators during a period in which nutrition programme coverage increased, causation cannot be determined from the cross-sectional design.ConclusionsThese data document significant improvements in both acute and micronutrient malnutrition among Rohingya children in makeshift settlements. These declines coincide with a scaleup of services aimed at prevention and treatment of malnutrition. Ongoing activities to improve access to nutritional services may facilitate further reductions in malnutrition levels to sustained below-crisis levels.

Inclusion and exclusion errors in the targeted supplementary feeding programme of Ethiopia.

Ethiopia's targeted supplementary feeding (TSF) programme aims to rehabilitate moderately malnourished children and pregnant and lactating women in selected chronically food-insecure districts. Screening for malnutrition is made by health extension workers through the quarterly community health days (CHD) events based on mid-upper arm circumference (MUAC) thresholds. This validation study examined the extent of targeting errors of inclusion (providing aid to the nonneedy) and exclusion (failure to reach the needy) in the TSF programme, among preschool children in 6 TSF districts. The study was conducted within 7days after the completion of the CHD event. Multistage cluster sampling was employed to recruit 1,104 children. Data were collected using interviewer-administered questionnaire and by reviewing CHD registers. A paired t test was used to compare the MUAC measurements taken during the CHD and during the survey. The study found a global acute malnutrition prevalence of 13.0%. During the CHD, only 54.8% of the children were screened for malnutrition. The overall inclusion and exclusion errors of the TSF were 16.5% and 40.3%, respectively. The reasons for the exclusion errors were low coverage of the screening programme (67.2%) and MUAC measurement errors (32.8%). The mean including standard deviation (M±SD) of the MUAC measured by health extension workers (11.8±0.9cm) was significantly lower than the measurements made by fieldworkers in the survey (12.1±1.0cm; p<.001). The study concluded that high targeting errors are committed in the TSF programme of Ethiopia. Targeting can be enhanced through accurate measurement of MUAC and maximization of the coverage of the screening programme.

Findings from a cluster randomised trial of unconditional cash transfers in Niger.

Unconditional cash transfers (UCTs) are used as a humanitarian intervention to prevent acute malnutrition, despite a lack of evidence about their effectiveness. In Niger, UCT and supplementary feeding are given during the June–September “lean season,” although admissions of malnourished children to feeding programmes may rise from March/April. We hypothesised that earlier initiation of the UCT would reduce the prevalence of global acute malnutrition (GAM) in children 6–59 months old in beneficiary households and at population level. We conducted a 2‐armed cluster‐randomised controlled trial in which the poorest households received either the standard UCT (4 transfers between June and September) or a modified UCT (6 transfers from April); both providing 130,000 FCFA/£144 in total. Eligible individuals (pregnant and lactating women and children 6–<24 months old) in beneficiary households in both arms also received supplementary food between June and September. We collected data in March/April and October/November 2015. The modified UCT plus 4 months supplementary feeding did not reduce the prevalence of GAM compared with the standard UCT plus 4 months supplementary feeding (adjusted odds ratios 1.09 (95% CI [0.77, 1.55], p = 0.630) and 0.93 (95% CI [0.58, 1.49], p = 0.759) among beneficiaries and the population, respectively). More beneficiaries receiving the modified UCT plus supplementary feeding reported adequate food access in April and May (p < 0.001) but there was no difference in endline food security between arms. In both arms and samples, the baseline prevalence of GAM remained elevated at endline (p > 0.05), despite improved food security (p < 0.05), possibly driven by increased fever/malaria in children (p < 0.001). Nonfood related drivers of malnutrition, such as disease, may limit the effectiveness of UCTs plus supplementary feeding to prevent malnutrition in this context. Caution is required in applying the findings of this study to periods of severe food insecurity.

MUAC-for-age more useful than absolute MUAC for nutritional surveillance in Somalia: results from nineteen cross-sectional surveys (2007\u20132016)

BackgroundSomalia is affected by a civil war and a protracted humanitarian crisis for more than two decades. The international community has put in place nutrition surveillance systems to monitor the situation and inform decisions. However, the indicators commonly used to identify acute malnutrition, weight-for-height Z-score (WHZ) and mid upper arm circumference (MUAC), do not always converge in their estimations of acute malnutrition, creating challenges for decision making. Furthermore, the divergences are not consistent across livelihood populations within the country. We explored the MUAC-for-age Z-score (MUACAZ) as an alternative indicator in Somalia to minimize the discrepancy.MethodsWe analyzed data from nineteen cross-sectional surveys conducted in Somalia between 2007 and 2016. We compared the acute malnutrition prevalence estimates by each of the indicators and the degree of overlap in the individual diagnosis of acute malnutrition between the WHZ and the MUAC-based indicators. We performed multivariate regression analysis with sex, age and stunting as independent variables and acute malnutrition as the dependent outcome, defined by WHZ, MUAC or MUACAZ. We performed all the analysis in the population overall and in each of the livelihood populations separately.ResultsA total 255,623 measurements of children 6–59 months of age were analyzed. The overall prevalence of global acute malnutrition by MUACAZ (15.8%) was similar to the one obtained using WHZ (16%), whereas prevalence based on MUAC was much lower (7.8%). These patterns of divergence were sustained throughout the nineteen surveys and the livelihoods studied, with only few exceptions. However, the proportion of overlap in the individual diagnosis of children as acutely malnourished was low between WHZ and absolute MUAC diagnosis (18.1%) and also between WHZ and MUACAZ (28.3%). Results show that age, sex and stunting status of the child affected the likelihood of being diagnosed as acutely malnourished to varying degrees, depending on the indicator used.ConclusionsThe MUAC-for-age (MUACZ) indicator yielded acute malnutrition prevalence estimates convergent with those obtained by WHZ indicator. However, the degree of overlap between these two indicators for individual diagnosis of acute malnutrition is low. Further studies of MUACAZ as an alternative indicator for nutrition surveillance are needed.

Assessment of Cocoa Producers’ Children Nutritional Status in the Nawa Region, Côte d’Ivoire

Foods are important as they provide nutrients for human being. However, in the world and particularly in Africa, several people suffer of under nutrition due to a lack of proteins, energy and micronutrients. Malnutrition affects the agricultural sector unfortunately. A survey was conducted in 2015 among cocoa producers’ households from 11 localities in the Nawa region which is the largest cocoa production region of Cote d’Ivoire. Anthropometric measurements were collected on 218 children between 6 and 59 months old and the data were used to calculate the following indices used to assess nutritional status: weight-for-height, height-for-age and weight-for-age. The results showed that global acute malnutrition prevalence was 17.5% (95% Confidence interval (CI): 13.0, 23.1%), with 12.4% (95% CI: 8.7, 17.5%) for the moderate form and 5.1% (95% CI: 2.9, 8.8%) for the severe one. Global chronic malnutrition prevalence was about 39% (95% CI: 32.8, 45.6%) and the moderate and the severe forms were respectively 22% (95% CI: 17, 28%) and 17% (95% CI: 12.6, 22.5%). Underweight prevalence was 25.2% (95% CI: 19.9, 31.4%) with 17% (95% CI: 12.6, 22.5%) for moderate underweight and 8.3% (95% CI: 5.3, 12.7%) for severe underweight. There were any statistical difference between boys and girls. The distribution curves of index are offset from the reference curve for all malnutrition forms. Children among 6-17 months were generally affected by acute malnutrition while chronic malnutrition concerned children aged from 18 to 53 months. Cocoa producers’ children are affected by malnutrition and the prevalence is important, indicating a possible lack of food diversification.

Nutritional situation among Syrian refugees hosted in Iraq, Jordan, and Lebanon: cross sectional surveys.

BackgroundOngoing armed conflict in Syria has caused large scale displacement. Approximately half of the population of Syria have been displaced including the millions living as refugees in neighboring countries. We sought to assess the health and nutrition of Syrian refugees affected by the conflict.MethodsRepresentative cross-sectional surveys of Syrian refugees were conducted between October 2 and November 30, 2013 in Lebanon, April 12 and May 1, 2014 in Jordan, and May 20 and 31, 2013 in Iraq. Surveys in Lebanon were organized in four geographical regions (North, South, Beirut/Mount Lebanon and Bekaa). In Jordan, independent surveys assessed refugees residing in Za’atri refugee camp and refugees residing among host community nationwide. In Iraq, refugees residing in Domiz refugee camp in the Kurdistan region were assessed. Data collected on children aged 6 to 59 months included anthropometric indicators, morbidity and feeding practices. In Jordan and Lebanon, data collection also included hemoglobin concentration for children and non-pregnant women aged 15 to 49 years, anthropometric indicators for both pregnant and non-pregnant women, and household level indicators such as access to safe water and sanitation.ResultsThe prevalence of global acute malnutrition among children 6 to 59 months of age was less than 5 % in all samples (range 0.3–4.4 %). Prevalence of acute malnutrition among women 15 to 49 years of age, defined as mid-upper arm circumference less than 23.0 cm, was also relatively low in all surveys (range 3.5–6.5 %). For both children and non-pregnant women, anemia prevalence was highest in Za’atri camp in Jordan (48.4 % and 44.8 %, respectively). Most anemia was mild or moderate; prevalence of severe anemia was less than or equal to 1.1 % in all samples of children and women.ConclusionsDespite the ongoing conflict, results from all surveys indicate that global acute malnutrition is relatively low in the assessed Syrian refugee populations. However, prevalence of anemia suggests a serious public health problem among women and children, especially in Za’atri camp. Based on these findings, nutrition partners in the region have reprioritized response interventions, focusing on activities to address micronutrient deficiencies such as food fortification.Electronic supplementary materialThe online version of this article (doi:10.1186/s13031-016-0093-6) contains supplementary material, which is available to authorized users.

Omitting edema measurement: how much acute malnutrition are we missing?

Acute malnutrition is a major public health issue in low-income countries. It includes both wasting and edematous malnutrition, but the terms wasting and acute malnutrition are often used interchangeably. Little is known about the burden of edematous malnutrition, and few large-scale surveys measure it. Most acute malnutrition might be captured by the measurement of wasting alone, but this is unknown. This article aims to fill this gap. This article presents a secondary data analysis of 852 nutrition cross-sectional survey data sets of children aged 6-59 mo. The data sets assembled included surveys from East, West, South, and Central Africa; the Caribbean; and Asia. The overlap between edematous malnutrition and wasting was assessed, and the impact of including/excluding edema on acute malnutrition prevalence estimates was evaluated. The prevalence of edematous malnutrition varied from 0% to 32.9%, and children were more likely to have bilateral edema in Central and South Africa (OR: 4; 95% CI: 2.8, 5.6). A large proportion of children with edematous malnutrition were not wasted [62% and 66% based on midupper arm circumference (MUAC) and weight-for-height (WFH), respectively], and most were not severely wasted (83% and 86% based on MUAC and WFH, respectively). When wasting and global acute malnutrition prevalence estimates as well as severe wasting and severe acute malnutrition prevalence estimates overall were compared, the differences between estimates were small (median of 0.0% and mean of 0.3% based on WFH and MUAC for global estimates and slightly higher median of 0.1% and mean of 0.4% based on MUAC and WFH, respectively, for the severe forms), but the picture was different at the regional level. The terms acute malnutrition and wasting should not be used interchangeably. The omission of the measurement of edema can have important repercussions, especially at the nutrition program level.

Health and human rights in eastern Myanmar after the political transition: a population-based assessment using multistaged household cluster sampling.

BackgroundMyanmar transitioned to a nominally civilian parliamentary government in March 2011. Qualitative reports suggest that exposure to violence and displacement has declined while international assistance for health services has increased. An assessment of the impact of these changes on the health and human rights situation has not been published.Methods and FindingsFive community-based organizations conducted household surveys using two-stage cluster sampling in five states in eastern Myanmar from July 2013-September 2013. Data was collected from 6, 178 households on demographics, mortality, health outcomes, water and sanitation, food security and nutrition, malaria, and human rights violations (HRV). Among children aged 6-59 months screened, the prevalence of global acute malnutrition (representing moderate or severe malnutrition) was 11.3% (8.0 – 14.7). A total of 250 deaths occurred during the year prior to the survey. Infant deaths accounted for 64 of these (IMR 94.2; 95% CI 66.5-133.5) and there were 94 child deaths (U5MR 141.9; 95% CI 94.8-189.0). 10.7% of households (95% CI 7.0-14.5) experienced at least one HRV in the past year, while four percent reported 2 or more HRVs. Household exposure to one or more HRVs was associated with moderate-severe malnutrition among children (14.9 vs. 6.8%; prevalence ratio 2.2, 95% CI 1.2-4.2). Household exposure to HRVs was associated with self-reported fair or poor health status among respondents (PR 1.3; 95% CI 1.1 – 1.5).ConclusionThis large survey of health and human rights demonstrates that two years after political transition, vulnerable populations of eastern Myanmar are less likely to experience human rights violations compared to previous surveys. However, access to health services remains constrained, and risk of disease and death remains higher than the country as a whole. Efforts to address these poor health indicators should prioritize support for populations that remain outside the scope of most formal government and donor programs.

Measuring local determinants of acute malnutrition in Chad: a case-control study

BackgroundIn 2010, Guéra District, Chad recorded a prevalence of global acute malnutrition of 16·1% and severe acute malnutrition (SAM) of 4·9%, both signs of a critical nutritional situation. To improve malnutrition, a problem-tree analysis is normally used to propose causal factors. We used a case-control study and qualitative methods to determine causes of SAM and their effect sizes with an aim of providing evidence for programming. MethodsA matched case-control study was conducted within a coverage assessment (the semi-quantitative evaluation of access and coverage [SQUEAC]) of a therapeutic feeding programme. Qualitative information on the determinants of SAM was translated into hypotheses and standardised indicators to be evaluated in the case-control study. Villages were selected using the centric systematic area sampling method. Within villages, all current or recovering SAM cases among children 6–59 months were found through snowball sampling with seed informants who had knowledge of children's health. Two to three controls meeting the matching criteria (within ±3 months and same neighbourhood) were selected. Interviews with carers were conducted with a structured questionnaire. A sample of 40 cases and two controls per case was sufficient to detect a fourfold increase in odds. Conditional logistic regression with backwards stepwise elimination of non-significant variables was used to evaluate potential causal factors. Findings62 cases and 157 controls were enrolled. The odds of reporting fever and diarrhoea in the previous 2 weeks was eight (odds ratio 7·55, 95% CI 2·64–21·62) and eleven times (10·72, 4·27–26·88) higher among SAM cases. InterpretationDiarrhoea and fever represent multiple causes that contribute, with other factors, to the development of SAM and warrant a specific focus for programmes. Preventative recommendations include hygiene promotion and the routine use of bednets for under-5s. Identification of the timing of the onset of disease and malnutrition is difficult and we may only show association and not cause. The ability of the matched study to detect differences among factors that do not vary at the community level (eg, use of an unprotected water source) needs to be considered. FundingHumanitarian Aid and Civil Protection department of the European Commission (ECHO) and the USAID Office of Foreign Disaster Assistance (OFDA).

Malnourished Children in Refugee Camps and Lack of Connection with Services After US Resettlement

Identifying and addressing malnutrition among US-bound refugee children is an important human rights issue. Failure to address childhood malnutrition can impair cognitive development and productivity. The target population was children aged 6-59 months, originating from eight countries representing 51 % of US-resettled refugees for 2005-2011, living in 22 camps prior to potential US-resettlement. The corresponding camp-level nutritional survey data were evaluated. State Refugee Health Coordinators were surveyed on nutritional assessment, reporting and referrals for their US-refugee medical screenings. From 2004 to 2010, half of the camps (63 total surveys) had global acute malnutrition prevalence over 15 % at least once (surveys not done annually) and anemia prevalence greater than 40 %. The majority of US-refugee medical screenings included height and weight measurements but few used national or WHO standards to evaluate presence or level of malnutrition. Improve overseas camp monitoring and link these nutritional data to US-resettling refugee children to inform potential nutritional interventions. Domestically, use WHO or US growth standards for anthropometrics to determine presence of malnutrition and need for corrective action.