Acute Malnutrition and Anemia Among Rohingya Children in Kutupalong Camp, Bangladesh

Leidman, Eva; Humphreys, Alexa; Cramer, Blanche Greene; Mil, Leonie Toroitich-Van; Wilkinson, Caroline; Narayan, Anuradhha; Bilukha, Oleg

doi:10.1001/jama.2018.2405

Cited by 37 publications

(43 citation statements)

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“…Of note, the difference in prevalence of wasting as assessed by WHZ versus the prevalence assessed by MUAC is greatest in crises when wasting by WHZ becomes more prevalent [48]. Drawbacks of the MUAC-only approach resulting in an underestimation of caseload and exclusion of those in need of treatment are thus expected to worsen in crisis, as confirmed by the field experiences in crises and higher caseload contexts [49]. Therefore, the higher the prevalence of wasting in the population (indicating a crisis), the higher proportion of MAM and SAM children will remain undetected by a MUAC-only program.…”

Section: Resultsmentioning

confidence: 89%

Potential consequences of expanded MUAC-only programs on targeting of acutely malnourished children and ready-to-use-therapeutic-food allocation: lessons from cross-sectional surveys

Guesdon

Couture²,

Pantchova

et al. 2019

Preprint

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Background: Some of the recently piloted innovative approaches for the management of acute malnutrition in children use the “expanded MUAC-only” approach, with Mid Upper Arm Circumference (MUAC) <125mm as the sole anthropometric criterion for screening and admission, classification of cases as severe using the 115mm cut-off, and use Ready-to-Use-Therapeutic-Food (RUTF) for the management of both moderate (MAM) and severe (SAM) cases of acute malnutrition. Our study aimed at exploring the potential consequences of this “expanded MUAC-only” program scenario on the eligibility for treatment and RUTF allocation, as compared with the existing WHO normative guidance. Methods: We analyzed data from 550 population representative cross-sectional cluster surveys conducted since 2007. We retrieved all children classified as SAM and MAM according to currently used case definitions, and calculated the proportions of SAM children who would be excluded from treatment, misclassified as MAM, or whose specific risks (because of having both MUAC and weight-for height deficits) would be ignored. We also analyzed the expected changes in the number and demographics (sex, age) of children meant to receive RUTF according to the new approach. Results: We found that approximately one quarter of SAM children would not be detected and eligible for treatment under the “expanded MUAC-only” scenario, and another 20% would be classified as MAM. A further 17% of the total SAM children would be admitted and followed only according to their MUAC or oedema status, while they also present with a severe weight-for height deficit on admission. Considering MAM targeting, about half of the MAM children would be left undetected. This scenario also shows a 2.5 time increase in the number of children targeted with RUTF, with approximately 70% of MAM and 30% of SAM cases among this new RUTF target. Conclusions: This empirical evidence suggests that adoption of “expanded MUAC-only” programs would likely lead to a priori exclusion from treatment or misclassifying as MAM a large proportion of SAM cases, while redirecting programmatic costs in favor of those less in need. It underscores the need to explore other options for improving the impact of programs addressing the needs of acutely malnourished children.

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Section: Resultsmentioning

confidence: 89%

Potential consequences of expanded MUAC-only programs on targeting of acutely malnourished children and ready-to-use-therapeutic-food allocation: lessons from cross-sectional surveys

Guesdon

Couture²,

Pantchova

et al. 2019

Preprint

Self Cite

View full text Add to dashboard Cite

show abstract

“…Of note, the difference in prevalence of wasting as assessed by WHZ versus the prevalence assessed by MUAC is greatest in crises when wasting by WHZ becomes more prevalent [48]. Drawbacks of the MUAConly approach resulting in an underestimation of caseload and exclusion of those in need of treatment are thus expected to worsen in crisis, as confirmed by the field experiences in crises and higher caseload contexts [49]. Therefore, the higher the prevalence of wasting in the population (indicating a crisis), the higher proportion of MAM and SAM children will remain undetected by a MUAC-only program.…”

Section: Discussionmentioning

confidence: 87%

Potential consequences of expanded MUAC-only programs on targeting of acutely malnourished children and ready-to-use-therapeutic-food allocation: lessons from cross-sectional surveys

et al. 2020

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Background: Some of the recently piloted innovative approaches for the management of acute malnutrition in children use the "expanded MUAC-only" approach, with Mid Upper Arm Circumference (MUAC) < 125 mm as the sole anthropometric criterion for screening and admission, classification of cases as severe using the 115 mm cutoff, and use Ready-to-Use-Therapeutic-Food (RUTF) for the management of both moderate (MAM) and severe (SAM) cases of acute malnutrition. Our study aimed at exploring the potential consequences of this "expanded MUAC-only" program scenario on the eligibility for treatment and RUTF allocation, as compared with the existing WHO normative guidance. Methods:We analyzed data from 550 population representative cross-sectional cluster surveys conducted since 2007. We retrieved all children classified as SAM and MAM according to currently used case definitions, and calculated the proportions of SAM children who would be excluded from treatment, misclassified as MAM, or whose specific risks (because of having both MUAC and weight-for height deficits) would be ignored. We also analyzed the expected changes in the number and demographics (sex, age) of children meant to receive RUTF according to the new approach.Results: We found that approximately one quarter of SAM children would not be detected and eligible for treatment under the "expanded MUAC-only" scenario, and another 20% would be classified as MAM. A further 17% of the total SAM children would be admitted and followed only according to their MUAC or oedema status, while they also present with a severe weight-for height deficit on admission. Considering MAM targeting, about half of the MAM children would be left undetected. This scenario also shows a 2.5 time increase in the number of children targeted with RUTF, with approximately 70% of MAM and 30% of SAM cases among this new RUTF target.Conclusions: This empirical evidence suggests that adoption of "expanded MUAC-only" programs would likely lead to a priori exclusion from treatment or misclassifying as MAM a large proportion of SAM cases, while redirecting programmatic costs in favor of those less in need. It underscores the need to explore other options for improving the impact of programs addressing the needs of acutely malnourished children.

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“…We evaluated the potential effect of factors such as sex, age, number of OPV doses received in recent campaigns, and receipt of any OPV in Myanmar on seroprevalence using Fisher's test or Rao-Scott chi-squared test. For a subset of children aged 1-4 years for whom nutritional status was assessed [12,15], we also evaluated the potential effect of acute malnutrition (low weight for height, or wasting) or chronic malnutrition (low height for age, or stunting) using Rao-Scott chi-squared test [15].…”

Section: Discussionmentioning

confidence: 99%

“…Polio immunity among children in the older age group (7-14 years) would depend on tOPV doses received through routine immunization or campaigns conducted in Myanmar following cVDPV outbreaks [7]. The makeshift settlements and registered camp were treated as independent populations because access to health services, including immunization, was expected to be different between residents in makeshift settlements and the registered camp [12].…”

Section: Methodsmentioning

confidence: 99%

“…The final sample required for the nutrition survey was 715 households in the makeshift settlements (55 clusters with 13 households each) and 524 households in Nayapara. Based upon a survey conducted in November 2017 [12], we estimated that 60%-65% of households would have 1 child aged 1-14 years, and non-response would be 15%-30%. Therefore, we expected to enroll 367 and 226 children aged 1-6 years in the makeshift settlements and Nayapara, respectively, and 326 children aged 7-14 years in the makeshift settlements.…”

Section: Methodsmentioning

confidence: 99%

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Assessment of immunity to polio among Rohingya children in Cox’s Bazar, Bangladesh, 2018: A cross-sectional survey

et al. 2020

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Background We performed a cross-sectional survey in April-May 2018 among Rohingya in Cox's Bazar, Bangladesh, to assess polio immunity and inform vaccination strategies. Methods and findings Rohingya children aged 1-6 years (younger group) and 7-14 years (older group) were selected using multi-stage cluster sampling in makeshift settlements and simple random sampling in Nayapara registered camp. Surveyors asked parents/caregivers if the child received any oral poliovirus vaccine (OPV) in Myanmar and, for younger children, if the child received vaccine in any of the 5 campaigns delivering bivalent OPV (serotypes 1 and 3) conducted during September 2017-April 2018 in Cox's Bazar. Dried blood spot (DBS) specimens were tested for neutralizing antibodies to poliovirus types 1, 2, and 3 in 580 younger and 297 older children. Titers � 1:8 were considered protective. Among 632 children (335 aged 1-6 years, 297 aged 7-14 years) enrolled in the study in makeshift settlements, 51% were male and 89% had arrived after August 9, 2017. Among 245 children (all aged 1-6 years) enrolled in the study in Nayapara, 54% were male and 10% had arrived after August 9, 2017. Among younger children, 74% in makeshift settlements and 92% in Nayapara received >3 bivalent OPV doses in campaigns. Type 1 seroprevalence was 85% (95% CI 80%-89%) among younger children and 91% (95% CI 86%-95%) among older children in makeshift settlements, and 92% (88%-95%) among younger children in Nayapara. Type 2 seroprevalence was lower among younger children than older children in makeshift settlements (74% [95% CI 68%-79%] versus 97% [95% CI 94%-99%], p < 0.001), and was 69%

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Acute Malnutrition and Anemia Among Rohingya Children in Kutupalong Camp, Bangladesh

Cited by 37 publications

References 1 publication

Potential consequences of expanded MUAC-only programs on targeting of acutely malnourished children and ready-to-use-therapeutic-food allocation: lessons from cross-sectional surveys

Potential consequences of expanded MUAC-only programs on targeting of acutely malnourished children and ready-to-use-therapeutic-food allocation: lessons from cross-sectional surveys

Potential consequences of expanded MUAC-only programs on targeting of acutely malnourished children and ready-to-use-therapeutic-food allocation: lessons from cross-sectional surveys

Assessment of immunity to polio among Rohingya children in Cox’s Bazar, Bangladesh, 2018: A cross-sectional survey

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