Does weight-for-height and mid upper-arm circumference diagnose the same children as wasted? An analysis using survey data from 2017 to 2019 in Mozambique.

BACKGROUND: Three different diagnostic criteria are used to identify children aged 6 to 59 months with acute malnutrition: weight-for-height (WHZ), middle upper arm circumference (MUAC) and bilateral pitting oedema. Prevalence of malnutrition from surveys is among the most-used decision support data, however not all diagnostic criteria are used to calculate need, creating a mismatch between programme planning and implementation. With this paper, we investigate if such discrepancies are observed in Mozambique. METHODS: Population-based nutritional anthropometric surveys from 45 districts in Mozambique conducted by the Technical Secretariat for Food Security and Nutrition (SETSAN) and UNICEF between 2017 and 2019 were analysed. We used Cohen's kappa coefficient to measure inter-rater agreement between WHZ and MUAC, Spearman's rank-order coefficient to assess the correlation, binary logistic regression to investigate factors influencing WHZ and MUAC diagnostic classification. We compared acute malnutrition caseload estimates by WHZ, MUAC and oedema to caseloads from combined prevalence estimates. RESULTS: WHZ and MUAC rarely agree on their diagnostic classification (κ = 0.353, ρ < 0.001) and results did not vary by province. We found positive correlation between WHZ and MUAC (rho = 0.593, ρ < 0.0001). Binary logistic regression explained 3.1% of variation in WHZ and 12.3% in the MUAC model. Girls (AOR = 1.6, ρ < 0.0001), children < 24 months (AOR = 5.3, ρ < 0.0001) and stunted children (AOR = 3.5, ρ < 0.0001) influenced the MUAC classification. In the WHZ model, children < 24 months (AOR = 2.4, ρ < 0.0001) and stunted children (AOR = 1.7, ρ < 0.0001) influenced the classification, sex had no effect. Caseload calculations of global acute malnutrition by WHZ and/oedema-only and by MUAC and/oedema-only yielded less children than caseload calculations using the combined prevalence estimates. Similarly, caseload calculations for SAM by WHZ and/oedema-only and SAM by MUAC and/oedema-only yielded less children than the respective combined prevalence calculations. CONCLUSIONS: Given the discrepancy in diagnostic classification between WHZ and MUAC in Mozambique, using either one alone for calculating burden underestimates the real number of children in need of treatment and negatively affects nutrition programme planning. We recommend that use of the combined prevalence estimates, based on the three diagnostic criteria of WHZ, MUAC and oedema, be officially adopted. Further analysis is needed to detail the programmatic impact of this change.

Quality of care of treatment for uncomplicated severe acute malnutrition provided by lady health workers in Pakistan.

OBJECTIVE: To assess the quality of care provided by lady health workers (LHW) managing cases of uncomplicated severe acute malnutrition (SAM) in the community. DESIGN: Cross-sectional quality-of-care study. SETTING: The feasibility of the implementation of screening and treatment for uncomplicated SAM in the community by LHW was tested in Sindh Province, Pakistan. An observational, clinical prospective multicentre cohort study compared the LHW-delivered care with the existing outpatient health facility model. SUBJECTS: LHW implementing treatment for uncomplicated SAM in the community. RESULTS: Oedema was diagnosed conducted correctly for 87·5 % of children; weight and mid upper-arm circumference were measured correctly for 60·0 % and 57·4 % of children, respectively. The appetite test was conducted correctly for 42·0 % of cases. Of all cases of SAM without complications assessed during the study, 68·0 % received the correct medical and nutrition treatment. The proportion of cases that received the correct medical and nutrition treatment and key counselling messages was 4·0 %. CONCLUSIONS: This quality-of-care study supports existing evidence that LHW are able to identify uncomplicated SAM, and a majority can provide appropriate nutrition and medical treatment in the community. However, the findings also show that their ability to provide the complete package with an acceptable level of care is not assured. Additional evidence on the impact of supervision and training on the quality of SAM treatment and counselling provided by LHW to children with SAM is required. The study has also shown that, as in other sectors, it is essential that operational challenges are addressed in a timely manner and that implementers receive appropriate levels of support, if SAM is to be treated successfully in the community.

Quality of care for treatment of uncomplicated severe acute malnutrition delivered by community health workers in a rural area of Mali.

An alternative Community-based Management of Acute Malnutrition model with community health workers (CHWs) delivering treatment for uncomplicated severe acute malnutrition (SAM) was piloted in Mali. The capacity of the CHWs to evaluate, classify, and treat cases of uncomplicated SAM, to provide nutritional counselling to caretakers of children receiving treatment for SAM, malaria, pneumonia or diarrhoea and to correctly refer cases of complicated SAM, was assessed. This was done using direct observation by trained enumerators of the management of SAM cases using checklists, re-diagnosing the cases admitted for treatment and reviewing admissions cards and registers. One hundred twenty-five cases, assessed and treated by the CHWs, were observed. The majority of children were correctly assessed for the presence of major clinical signs (cough, diarrhoea, fever, and vomiting; 97.6%), and similarly most children were checked for the presence of danger signs (95.2%). Mid-upper arm circumference was correctly assessed in 96.8% of children and oedema was correctly assessed in 78.4% (The composite indicator, which includes all essential tasks to provide high-quality treatment, was achieved in 79.5% of cases. This paper concludes that well-trained and supervised CHWs are capable of managing cases of uncomplicated SAM. This suggests that such a strategy is an opportunity to increase access to quality treatment in Mali for SAM cases. However, further evidence is required to ensure that this level of care can be achieved at scale.

Ingresos hospitalarios por infecciones meningocócicas en la Comunidad de Madrid (1997–2005) / Hospital admissions for meningococcal infections in Madrid, Spain (1997–2005)

Fundamento y objetivos: La infección por Neisseria meningitidis causa una importante morbimortalidad y hospitalización en España. El presente estudio tiene por objetivo cuantificar la incidencia de hospitalizaciones debidas a infecciones por meningococo en la Comunidad Autónoma de Madrid de 1997 a 2005 mediante las bases de datos del Sistema de Vigilancia Hospitalaria. Material y métodos: Se realizó un estudio epidemiológico retrospectivo utilizando el Sistema Nacional de Vigilancia Epidemiológica para datos hospitalarios (conjunto mínimo básico de datos [CMBD]); se obtuvo información sobre la incidencia de hospitalizaciones, la edad, la estancia media en el hospital, la mortalidad y los costes asociados. Resultados: En este período se registraron 1.137 hospitalizaciones por enfermedad meningocócica (novena revisión de la Clasificación Internacional de Enfermedades [modificación clínica] [CIE-9-MC] código 036 en cualquier posición diagnóstica), lo que supone una tasa anual de hospitalización de 2,41 casos por 100.000 habitantes. La tasa anual de mortalidad y la letalidad fueron de 0,19 casos por 100.000 habitantes y del 7,7%, respectivamente. La estancia media hospitalaria de los pacientes fue de 12 días. Los grupos de edad más jóvenes mostraron una mayor incidencia de hospitalización (24,42 hospitalizaciones anuales por cada 100.000 habitantes menores de 4 años) pero la letalidad fue mayor en los adultos (el 11% en los pacientes mayores de 30 años). Todas estas hospitalizaciones suponen un coste anual medio para la sanidad de Madrid de 592.980 euros. Conclusiones: El estudio epidemiológico realizado indica que la infección meningocócica es aún una importante causa de hospitalización y morbimortalidad en la Comunidad de Madrid, lo que conlleva un elevado consumo de recursos sanitarios y un gran coste para la sanidad madrileña (AU)

Background and objectives: Neisseria meningitidis infection causes an important morbidity and mortality in Spain. Our study aims to estimate the burden of hospital admissions for meningococcal infection in Spain during a nine-year period (1997–2005) by analyzing the Spanish hospital surveillance system. Methods: An epidemiological retrospective study was conducted. Data were obtained from the national surveillance system for hospital data (Conjunto Mínimo Básico de Datos) maintained by the Ministry of Health. Information about hospitalizations, age, length of stay in hospital, mortality and cost per patient was obtained. Results: There were 1137 hospital discharges for meningococcal disease (International Classification of Diseases 9th Clinical Modification: ICD 9 CM code 036 in any listed diagnosis) during the study period. Annual incidence was 2.41 cases per 100,000 individuals. Mortality rate and case-fatality rate were 0.19 cases per 100,000 population and 7.7%, respectively. The average length of hospitalization was 12 days. The youngest age group showed the highest hospitalizations incidence (24.42 hospitalizations per 100,000 population in those under 4 years of age) but the case-fatality rate was higher in the oldest group (11% in patients over 30 years). These hospitalizations imply an annual cost of 592,980 euro to the Madrid Health System. Conclusions: Our study shows that meningococcal infection is still an important cause of hospital admissions and mortality in Madrid, resulting in a high cost to the Health Care System (AU)

[Hospital admissions for meningococcal infections in Madrid, Spain (1997-2005)]. / Ingresos hospitalarios por infecciones meningocócicas en la Comunidad de Madrid (1997-2005).

BACKGROUND AND OBJECTIVES: Neisseria meningitidis infection causes an important morbidity and mortality in Spain. Our study aims to estimate the burden of hospital admissions for meningococcal infection in Spain during a nine-year period (1997-2005) by analyzing the Spanish hospital surveillance system. METHODS: An epidemiological retrospective study was conducted. Data were obtained from the national surveillance system for hospital data (Conjunto Mínimo Básico de Datos) maintained by the Ministry of Health. Information about hospitalizations, age, length of stay in hospital, mortality and cost per patient was obtained. RESULTS: There were 1137 hospital discharges for meningococcal disease (International Classification of Diseases 9th Clinical Modification: ICD 9 CM code 036 in any listed diagnosis) during the study period. Annual incidence was 2.41 cases per 100,000 individuals. Mortality rate and case-fatality rate were 0.19 cases per 100,000 population and 7.7%, respectively. The average length of hospitalization was 12 days. The youngest age group showed the highest hospitalizations incidence (24.42 hospitalizations per 100,000 population in those under 4 years of age) but the case-fatality rate was higher in the oldest group (11% in patients over 30 years). These hospitalizations imply an annual cost of 592,980 euro to the Madrid Health System. CONCLUSIONS: Our study shows that meningococcal infection is still an important cause of hospital admissions and mortality in Madrid, resulting in a high cost to the Health Care System.