Impact of WHO Growth Standards on SAM response to treatment
Summary of published research1
More younger admissions to therapeutic feeding programmes are one of the implications of moving to the new WHO Growth Standards.
A recent study set out to assess the impact of adopting the World Health Organisation (WHO) growth standards and weight-forheight z-score (WHZ) criterion on the response to treatment of severe acute malnutrition in children compared with the use of the National Centre for Health Statistics (NCHS) growth reference.
The study used data from children aged 6-59 months with acute malnutrition who were admitted to the Medecins sans Frontieres (MSF) nutrition programme in Maradi, Niger, during 2006 (N= 56,216). Differences in weight gain, duration of treatment, recovery from malnutrition, mortality, loss to follow-up and need for inpatient care were compared for severely malnourished children identified according to the NCHS reference and weight-forheight <70% of the median (WHM) criterion versus the WHO standards and the WHZ <-3 criterion.
A total of eight times more children (n=25,754) were classified as severely malnourished according to the WHO standards compared to the NCHS reference (n=2,989). Children included according to the WHO standards had shorter durations of treatment, greater rates of recovery, fewer deaths, and less loss to follow-up or need for inpatient care. Previous estimates of the change in the prevalence of severe acute malnutrition range from increases of 1.5 to 2.5 times and 1.7 to 4.2 times, when applying the same WHZ of <-3 to both the NCHS reference and the WHO standards. Differences among estimates are likely because of the criterion used for comparison and will depend on the age, weight, and height profiles of the population.
The authors concluded that the introduction of the WHO standards with the z-score criterion to identify children for admission into severe acute malnutrition treatment programmes would imply the inclusion of children who are younger but have relatively higher weight for height on admission compared with the NCHS reference. These children have fewer medical complications requiring inpatient care and are more likely to experience shorter durations of treatment and lower mortality rates.
The WHO standards with the z-score criterion might become a useful tool for the early detection of acute malnutrition in children, although additional research on the resource implications of this transition is required. The implications of the introduction of the WHO standards should also be evaluated in the context of new community-based programmes for the management of severe acute malnutrition, because fewer children would require inpatient care according to the WHO standards and z-score criterion compared with the NCHS reference and percent of the median criterion.
1Isanaka. S et al (2008). Assessing the impact of the introduction of the WHO growth standards and weight for height z-scores criterion on the response to treatment of severe acute malnutrition in children: Secondary data analysis. Accessed at www.pediatrics.org on December 30, 2008. Preliminary findings of this research featured in issue 34 of Field Exchange, Impact of WHO Growth Standards on admissions in Niger. P6. Field Exchange 34. October 2008.
More like this
FEX: Impact of WHO Growth Standards on programme admissions in Niger
Summary of research1 Severely malnourished children managed in the MSF-run Centre de Récupération Nutritionnelle Intensive (CRENI) in Maradi, Niger A recent study by...
FEX: MUAC as discharge criterion and weight gain in malnourished children
Summary of published research1 A child on admission to the Gedaref nutrition programme In addition to guidance on admission criteria for nutrition programmes, the WHO...
FEX: Effectiveness of Integrated Outpatient Care of Severe Acute Malnutrition in Ethiopia
By Martin Eklund and Tsinuel Girma Martin Eklund holds an MSc in Clinical Nutrition from the University of Copenhagen. His specialisation is community-based management of...
FEX: MUAC Versus Weight-for-Height in Assessing Severe Malnutrition
Summary of published paper1 An infant having MUAC measured during the study in Kenya Current WHO guidelines for the management of severe malnutrition in children recommend...
FEX: Treatment of SAM and MAM in low- and middle-income settings: a systematic review
Summary of research1 Location: Global What we know: Worldwide, 33 million children under 5 years are moderately malnourished and 19 million are severely malnourished. The...
FEX: Follow-up of post-discharge growth and mortality after treatment for SAM in Malawi
Summary of research1 Location: Malawi What we know: There are limited data on long term outcomes following discharge from SAM treatment; what exists is largely pre-HIV....
FEX: MUAC vs WHZ in predicting mortality in hospitalised children under five years of age
Summary of research1 This research contributes to the evidence base regarding which anthropometric indicators identify malnourished sick children most at risk of death. Low...
FEX: Is MUAC alone a sufficient criterion for admission of children at high risk of mortality in South Sudan?
Summary of research 1 Location: South Sudan What we know: The operational implications of using MUAC as the sole anthropometric admission criterion to therapeutic feeding...
FEX: Letter on WHO 2006 Growth Standards, by Marko Kerac and Andrew Seal
This new 2006 WHO Growth standards: What will they mean for emergency nutrition programmes? Dear Editor Whilst welcoming the principles which have driven the development of...
FEX: Effect of adding RUSF to ageneral food distribution on child nutritional status and morbidity: a cluster randomised controlled trial
Summary of research1 Child during appetite test at a health facility offering treatment in Monrovia, Liberia The authors of a recent study hypothesized that including a daily...
en-net: Urgent: Weight for Height Z-scores: Unisex Z-score table used in West African countries vs. calculated Z score values
In the 2011 Guidelines for THE INTEGRATED MANAGEMENT OF SEVERE ACUTE MALNUTRITION published by ACF, Annex 4 depicts a Weight-for-Height table. This same table has been adopted...
FEX: Effect of nutrition survey ‘cleaning criteria’ on estimates of malnutrition prevalence and disease burden: secondary data analysis
Summary of research1 Location: Global What we know: Standardised methods for collection and reporting malnutrition prevalence data in nutrition surveys are used. What this...
FEX: Diagnostic criteria for severe acute malnutrition among infants under six months of age
Summary of research1 Location: Kenya What we know: Diagnosis of acute malnutrition in infants under six months old (U6M) is currently based on weight-for-length z score...
FEX: Integration of CMAM into routine health services in Nepal
By Regine Kopplow Regine is a former CMAM Advisor with Concern Nepal. She is a nutritionist with a background in rural development. She has worked in the field of nutrition...
FEX: Incidence and duration of severe wasting in two African populations
Summary of review1 A child being measured during the health survey in Niakhar A recent literature review did not reveal any publication with proper estimates of incidence and...
FEX: Death of children with SAM diagnosed by WHZ or MUAC: Who are we missing?
Summary of presentation1 View this article as a pdf By Michael H. Golden and Emmanuel Grellety Michael Golden is a retired professor of medicine with 45 years' experience of...
en-net: Implementation of 2006 WHO child growth standards
With the adoption and implementation of 2006 WHO Child growths standards for Emergency nutrition Programmes, It was also expected that - Treatment duration was to be shortened...
FEX: MUAC versus weight-for-height debate in the Philippines
By Bernardette Cichon Bernardette is a Public Health Nutritionist who at the time of the work described in this article, worked with Action Contre la Faim (ACF). She is...
FEX: Improving patient assessment: The ‘MOYO’ Weight-for-Height Chart
By Marko Kerac and Andrew Seal, UCL Centre for International Health & Development, UK We are pleased to include with this edition of Field Exchange, a complementary copy of...
FEX: Weight-for-height and mid-upper-arm circumference should be used independently to diagnose acute malnutrition: policy implications
Summary of research1 Location: Global What we know: Overlap between mid-upper-arm circumference (MUAC) and weight-for-height Z-scores (WHZ) when assessing acute malnutrition...
Reference this page
Impact of WHO Growth Standards on SAM response to treatment. Field Exchange 35, March 2009. p16. www.ennonline.net/fex/35/impact
(ENN_3875)