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Wasting Prevention Survey - Introduction

Background

The global burden of wasting (50.5 million children 0-59 months of age)1 is a major global public health crisis and progress in reducing levels towards World Health Assembly (WHA) targets has been poor. Wasting not only contributes to child deaths but also affects children’s subsequent prospects of surviving and thriving in all areas of their lives. The treatment of wasting has expanded beyond humanitarian emergencies, with more services integrated into health systems, but treatment coverage remains way below needs. Expanding treatment capabilities is only part of the solution however and there is an urgent need to focus on the prevention of wasting. An understanding of the factors that cause wasting and robust evidence of effective interventions to prevent it are currently lacking.

For this reason, the UK Department for International Development (DFID), through the MQSUN+ programme, is investing in efforts to support the wider nutrition community to accelerate coordinated action to address this gap. These efforts began with a review of the current thinking and evidence of what works to prevent wasting which culminated in two key documents; A summary of current thinking on ‘The Aetiology of Wasting’ and a report on 'The Current State of Evidence and Thinking on Wasting Prevention'.

The next stage is to prioritise the main outstanding research questions to guide wasting prevention research investments for the coming five years. To do this we are using the well-known Child Health and Nutrition Research Initiative (CHNRI) methodology.

Methods 

An international Expert Group (EG) in the areas of child nutrition and research has already:  

  1. Organised existing research gaps into 40 key questions: Drawing on recent evidence reviews, and other research prioritisation exercises the EG has compiled and then, through focussed discussion, honed down identified research gaps into 40 relevant, specific, clear and answerable research questions.
  2. Defined criteria to judge these questions: The EG group discussed all potential criteria laid out in the CHNRI methodology and agreed upon four appropriate criteria against which each question will be judged.  

These questions and judging criteria have been developed into an online survey which we are inviting you and a broad range of stakeholders to complete.

Important information on the scope of this exercise

  1. Time frame: Questions have been included in this research prioritisation exercise (RP) that could produce results within a five-year research period.
  2. Target group: The questions in this RP refer primarily to infants and children aged 0 to 59 months living in low and middle-income countries (LMIC). In some cases, research to be carried out in high income countries has been included where there is direct relevance to understanding how to prevent wasting in LMIC. Some questions also concern those groups indirectly affected by wasting in this age group (including adolescent girls, caretakers and communities where wasting is prevalent).
  3. Focus on prevention: The questions are focussed on wasting prevention and not on treatment (which has been comprehensively covered in previous global research prioritisation exercises).
  4. Anthropometric outcomes of interest: Wasting (characterised by low weight-for-height/length) can be relatively rapid in onset and resolution on an individual level, hence, the term acutely malnourished (divided into moderate and severe) is often used to describe children who are wasted. Other forms of acute undernutrition (characterised by the presence of bilateral oedema, low mid-upper arm circumference or low weight-for-age) are also considered due to the evidence of their relationship with mortality in infants and children. These measures are therefore all outcomes of interest for this RP despite being outside of the standard WHO definition of ‘wasted’ (WHO and UNICEF 2009).
  5. Definition of prevention: Wasting is a process which may or may not lead to a child becoming wasted. Anthropometric measures and indices are only proxies for this process, designed mainly to be applied to populations rather than individuals. Therefore, this RP considers two dimensions of prevention: primary prevention (prevention of any degree of wasting including from the initiation of the process that leads to an infant/child becoming wasted) and secondary prevention (prevention of worsening degrees of wasting).
  6. Relationship between wasting and stunting: Due to recent advances in understanding of the relationship between wasting and stunting, the RP questions also emphasise the importance of not researching wasting in isolation from other outcomes of undernutrition, stunting in particular.

Intended outputs and outcomes

The results of this RP exercise will be collated, presented and discussed within the EG and with DFID. Thereafter, a peer review journal paper will be prepared, in which all who participate in the survey and who wish to will be included in a list of group authors.

It is hoped that the results will inform the direction of research and investments in this important area of nutrition. Your views are needed to ensure the next five years of research helps us to make the advances we need to see.

What we are asking of you

Please set aside 45 minutes between now and the February 28th, 2019 to go through the following three stages:

  1. Read through the instructions first
  2. Familiarise yourself with the judging criteria
  3. Complete the survey 

                                      With thanks for your participation

 

                        Carmel Dolan, Tanya Khara, Severine Frison and Chloe Angood (ENN)

Read more...

1UNICEF, WHO, World Bank Group. Joint Child Malnutrition Estimates: Levels and Trends in Child Malnutrition. Key findings of the 2018 Edition of the Joint Child Malnutrition Estimates. World Health Organisation, Geneva: World Health Organisation;2018.

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Wasting Prevention Survey - Introduction. www.ennonline.net/wastingpreventionrp/introduction

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