Menu ENN Search

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 duration of episodes of severe wasting. A recent study has therefore set out to compare two situations of endemic malnutrition among under 5 year old children and to estimate the incidence, duration and case fatality of severe wasting episodes.

The study involved a secondary analysis of longitudinal studies, conducted several years ago, which allowed incidence and duration to be calculated from transition rates. The first site was Niakhar in Senegal, an area under demographic surveillance, where researchers followed a cohort of children in 1983-5. The second site was Bwamanda in the Democratic Republic of Congo (DRC), where a cohort of children was followed from 1989 to 1992. Both studies enrolled about 5000 children, who were followed by routine visits (every 6 months) and systematic anthropometric assessment (every 3 months).

Main findings

Niakhar had less stunting, more wasting and higher death rates than Bwamanda. Differences in cause-specific mortality included more diarrhoeal diseases, more marasmus, but less malaria and severe anaemia in Niakhar. Severe wasting had a higher incidence, a higher prevalence and a more marked age profile in Niakhar. However, despite the differences, the estimated mean durations of episodes of severe wasting, calculated by multi-state life table, were similar in the two studies (7.5 months). Noteworthy were the differences in the prevalence and incidence of severe wasting depending on the anthropometric indicator (weight-for-height Z-score (WHZ) ?3.0 or mid upper-arm circumference (MUAC) < 110mm) and the reference system (National Centre for Health Statistics 1977, Centres for Disease Control and Prevention 2000 or Multicentre Growth Reference Study 2006). Severe wasting in Niakhar and Bwamanda using WHZ was 3.2% and 2.9%, while using MUAC, the prevalence was 1.7% and 4.6% respectively.

Main findings Niakhar had less stunting, more wasting and higher death rates than Bwamanda. Differences in cause-specific mortality included more diarrhoeal diseases, more marasmus, but less malaria and severe anaemia in Niakhar. Severe wasting had a higher incidence, a higher prevalence and a more marked age profile in Niakhar. However, despite the differences, the estimated mean durations of episodes of severe wasting, calculated by multi-state life table, were similar in the two studies (7.5 months). Noteworthy were the differences in the prevalence and incidence of severe wasting depending on the anthropometric indicator (weight-for-height Z-score (WHZ) ?3.0 or mid upper-arm circumference (MUAC) < 110mm) and the reference system (National Centre for Health Statistics 1977, Centres for Disease Control and Prevention 2000 or Multicentre Growth Reference Study 2006). Severe wasting in Niakhar and Bwamanda using WHZ was 3.2% and 2.9%, while using MUAC, the prevalence was 1.7% and 4.6% respectively.

Genetic factors seemed also to play a role in the comparison. Sahelians of West Africa are usually taller than Congolese Bantus and in particular tend to have a low sitting-height to standing-height ratio (Cormic index). Their body shape therefore tends to underestimate stunting and overestimate wasting when compared to other indicators of muscular mass.

Finally, the authors consider that since these data were collected, HIV/AIDS has emerged, leading to an increase in the prevalence of severe wasting in many African countries. This relatively new disease is likely to change some of the parameters used in the present study.

The authors overall conclusions was that severe wasting appeared as one of the leading causes of death among underfives. It had a high incidence (about 2% per child-semester), long duration of episodes and high case fatality rates

Show footnotes

1Garenne. M et al (2009). Incidence and duration of severe wasting in two African populations. Public Health Nutrition, vol 12 (11), pp 1974-1982

More like this

en-net: Planning of CMAM services

The number of the children who need CMAM services is based on the prevalence data from nutrition surveys that indicate the numbers of children with SAM/MAM at a given time. For...

FEX: 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...

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...

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...

en-net: Advice on how much SQUEAC and LQAS coverage surveys cost and how long they take

Hi, We'd like to do a coverage survey in Darfur. We have 8 OTP sites with a total of 6,300 children under 5 in mainly rural areas and we hope to have at least 50% coverage....

FEX: Child wasting and concurrent stunting in low- and middle-income countries

View this article as a pdf Click here to listen to an interview with one of the authors on the ENN podcast channel Summary of research1 What we know: Cross-sectional,...

Resource: Changing sex differences in undernutrition of African children: findings from Demographic and Health Surveys

Abstract The study investigates sex differences in the prevalence of undernutrition in sub-Saharan Africa. Undernutrition was defined by Z-scores using the CDC-2000 growth...

FEX: Review of nutrition and mortality indicators for Integrated Phase Classification

Summary of technical review1 The Integrated Phase Classification (IPC) Technical Working Group and the Standing Committee on Nutrition (SCN) Task Force on Assessment,...

FEX: Improving screening for malnourished children at high risk of death

Research snapshot1 The purpose of this study was to investigate whether children with concurrent wasting and stunting (WaSt) require therapeutic feeding and to better...

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: 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: A reflection on the 2021 Lancet Maternal & Child Nutrition Series through a WaSt lens

View this article as a pdf This article provides a summary of the Lancet Maternal & Child Nutrition Series to date, reflecting upon the 2021 series from the perspective of the...

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...

Resource: Anthropometric deficits and the associated risk of death by age and sex in children aged 6-59 month: A meta-analysis

Abstract Risk of death from undernutrition is thought to be higher in younger than in older children, but evidence is mixed. Research also demonstrates sex differences whereby...

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: Effect of short-term RUTF distribution on children in Niger

Summary of published research1 Mothers and children arriving for their monthly surveillance visits, as part of the trial Researchers from the Harvard School of Public Health...

en-net: Is it valid to use similar cut-off points for prevalence of wasting using z scores for different countries and contexts?

Hi there, II faced this situation and want to to hear your ideas. We have a programme running for long, but the GAM rates during the hunger gap based on WHO standards 2006 is...

FEX: Concurrent wasting and stunting among under-five children in Senegal

Research snapshot1 The study describes the patterns of concurrent wasting and stunting (WaSt) among children age 6-59 months living in the 1980s in Niakhar, a rural area of...

FEX: Understanding sex differences in childhood malnutrition

View this article as a pdf This is a summary of the following paper: Thurstans S, Opondo C, Seal A, Wells J, Khara T, Dolan C et al (2021) Understanding sex differences in...

FEX: Relationships between wasting and stunting and their concurrent occurrence in Ghanaian pre-school children

Summary of research* Location: Ghana. What we know: Wasting is a short-term health issue, but repeated episodes may lead to stunting (long-term or chronic malnutrition). This...

Close

Reference this page

Incidence and duration of severe wasting in two African populations. Field Exchange 38, April 2010. p15. www.ennonline.net/fex/38/incidence

(ENN_4005)

Close

Download to a citation manager

The below files can be imported into your preferred reference management tool, most tools will allow you to manually import the RIS file. Endnote may required a specific filter file to be used.