Download a PDF of this issue - Field Exchange - Emergency ...

More documents

Recommendations

Info

Summary of published research 1 Exclusive breastfeeding (EBF) is reported to be a life-saving intervention in lowincome settings. A recent cluster-randomised trial set out to assess the effect of breastfeeding counselling by peer counsellors in Africa. Twenty-four communities in Burkina Faso, 24 communities in Uganda, and 34 communities in South Africa were assigned in a 1:1 ratio, by use of a computer-generated randomisation sequence, to the control or intervention clusters. In the intervention group, the research team scheduled one antenatal breastfeeding peer counselling visit and four post-delivery visits by trained peers. The data gathering teams were masked to the intervention allocation. The primary outcomes were prevalence of EBF and diarrhoea reported by mothers for infants aged 12 weeks and 24 weeks. Country-specific prevalence ratios were adjusted for cluster effects and sites. Analysis was by intention to treat. A total of 2,579 mother-infants pairs were assigned to the intervention or control clusters in Burkina Faso (n=392 and n = 402, respectively), Uganda (n=396 and n=369, respectively), and South Africa (n=535 and 485, respectively). The prevalences of EBF at 12 and 24 weeks of age are given in Table 1, and the prevalences of diarrohea in Table 2. These show a much higher prevalence of EBF in the intervention groups in Burkino Faso and Uganda at both 12 and 24 weeks. The prevalence and differential between the intervention and control groups is much lower in South Africa. An impact on diarrhoea prevalence was not found. Table 1: EBF prevalence at 12 weeks and 24 weeks of age EBF (24 hour recall) at 12 weeks Intervention Control Prevalence ratio The results for South Africa must be viewed in the context of EBF being rare at baseline. Most people in rural and urban South Africa purchase most of their food and the Department of Health’s routine child health services have a history of promoting commercial infant formula as part of the protein energy malnutrition scheme, while the International Code of Marketing of breastmilk substitutes is not yet legislated in South Africa. The authors conclude that low-intensity individual breastfeeding peer counselling is achievable and, although it does not affect the diarrhoea prevalence, can be used to effectively increase EBF prevalence in many sub-Saharan African settings. The authors of the study caution that the community based approach could possibly have resulted in socially desirable answers. The results were based on self-reports so that a bias towards desirable answers cannot be ruled out. There was also some questionnaire fatigue in the Ugandan site, i.e. reluctance to fully engage in answering similar questions after a few interviews. Overall, however, the authors conclude that low-intensity individual breastfeeding peer counselling is achievable and, although it does not affect the diarrhoea prevalence, can be used to effectively increase EBF prevalence in many sub-Saharan African settings. 1 Tylleskar. T et al (2011). Exclusive breastfeeding promotion by peer counsellors in sub-Saharan Africa (PROMISE-EBF): a cluster-randomised trial. www.thelancet.com Vol 378, July 30, 2011, pp 420-427 EBF (24 hour recall) at 24 weeks 95% CI Intervention Control Prevalence ratio Mother and child health nutrition programme in Uganda Exclusive breastfeeding promotion by peer counsellors in sub-Saharan Africa 95% CI Burkino Faso 79% (310/392) 35% (139/402) 2.29 1.33-3.92 73% (286/392) 22% (88/402) 3.33 1.74-6.38 Uganda 82% (323/396) 44% (161/369) 1.89 1.70-2.11 59% (232/396) 15% (57/369) 3.83 2.97-4.95 South Africa 10% (56/535) 6% (30/485) 1.98 1.30-3.02) 2% (12/535)
Research A family enrolled in the cash transfer programme ©fotos de Bruno Spada/MDS MUAC and weight-for-height in identifying high risk children Summary of research 1 for 22,375 impoverished children under 5 years of age were employed to estimate nutritional outcomes among recipients of the BFP. All variables under study, namely child birth weight, lack of birth certificate, educational level and gender of family head, access to piped water and electricity, height for age, weight for age and weight for height, were converted into binary variables for regression analysis. The subsequent analysis found that children from families exposed to the BFP were 26% more likely to have normal height for age than those from nonexposed families. This difference also applied to weight for age. No statistically significant deficit in weight for height was found. Stratification by age group revealed 19% and 41% higher odds of having normal height for age at 12-35 months and 36-59 months of age, respectively in children receiving the programme and no difference at 0-11 months of age. The authors of the study note that others studies have found that the Gini index, an indicator of income distribution, remained stable in Brazil for many years but has dropped consistently since 2001. Almost one quarter of the drop is attributable to the BFP. Furthermore, propensity score analysis used in the baseline study for the BFP showed larger family expenditures among enrolled families than in the comparison groups, especially on food (US$172 more a year on food items). The authors conclude that the BFP can lead to better nutritional outcomes in children between 12-59 months of age. However, longitudinal studies designed to evaluate the impact of the BFP are necessary to determine if the nutritional effects observed in the study can be attributed to the conditional cash transfer programme. Furthermore, there is a need to guarantee families in the BFP increased access to goods and services conducive to improved nutrition, which should in turn result in improved health. Similarly, to guarantee programme effectiveness, the Brazilian government needs to provide more and better services in the spheres of basic education, health, social protection and inclusion in the labour market. 1 Paes-Sousa. R, Santos.L and Miazaki. E 2011). Effects of a conditional cash transfer programme on child nutrition in Brazil. Bulletin of the World Health Organisation 2011; 89: 496-503. Published online: 29th April 2011 The World Health Organisation (WHO) and UNICEF propose to use two independent criteria for diagnosing non-oedematous severe acute malnutrition (SAM) in children aged 6–60 months: mid-upper arm circumference (MUAC) less than 115 mm and weight-for-height z-score (WHZ) less than -3 (based on WHO growth standard). WHZ has been used for years in clinical settings for diagnosing SAM, but the use of MUAC was introduced more recently with the development of community-based management of SAM. In practice, large-scale programmes increasingly use MUAC as single diagnostic criteria as it is closely related to the risk of dying and is easy to implement at the community level after minimum training by health workers or even by volunteers. MUAC and WHZ, however, do not identify the same set of children as having malnutrition, and using only one of the diagnostic criteria proposed by WHO may potentially leave some high-risk children untreated. A newly published study used an old data set from Senegal to examine the risk of dying of children having either a low MUAC or a low WHZ or a combination of both in the absence of treatment. The specific objective was to test whether combining both MUAC less than 115 mm and WHZ less than -3 would improve the identification of high-risk children. The original study, which was conducted in 1983 and 1984, followed an open cohort of about 5000 children, comprising all children under 5 living in 30 villages. The team visited the children four times at sixmonth intervals in May and November of 1983 and 1984. At each visit, comprehensive anthropometric measurements were taken (weight, height, head circumference, arm circumference, triceps skin fold and subscapular skin fold). For this analysis, the data from all children aged 6–59 months at the time of anthropometric assessment were used. WHZ was calculated using the WHO growth standards. Receiver operating characteristic (ROC) curves (sensitivity vs. 1-specificity) were calculated for WHZ and for MUAC using death within six months as outcome. Only the part of the curve with a percentage of false positive less than 5% was explored, as these indicators are always used in a context of limited treatment capacity and a high specificity is required. The anthropometric index with the highest ROC was considered as more adapted to identify high-risk children. Specificity and sensitivity of ‘MUAC less than 115 mm AND WHZ less than -3’ and also for ‘MUAC less than 115 mm OR WHZ less than -3’ were also estimated and positioned in relation to the ROC curve of MUAC and WHZ. In total, 12,638 measures were made on 5,751 children, and 303 deaths occurred within six months of the nutritional assessment. The criteria ‘WHZ less than -3 AND MUAC less than 115’ had a specificity of 99.0% and a sensitivity of 5.9%. For ‘MUAC less than 115 mm OR WHZ less than -3’, the specificity was 96.9% and the sensitivity was 13.2%. Both points combining WHZ less than -3 and MUAC less than 115 mm were positioned above the WHZ ROC curve but below the MUAC curve. For a MUAC, the threshold of 112 mm had a specificity of 99.1, comparable with the specificity observed for ‘MUAC less than 115 AND WHZ less than -3’. However, the sensitivity of MUAC 112 mm was 6.0%, slightly higher than for these two indices combined. For a MUAC of 119 mm, the specificity was 96.9%, comparable with the specificity of ‘WHZ less than -3 OR MUAC less than 115 mm’. However, the sensitivity was higher at 14.9%. This study confirms that MUAC has a better ability than WHZ to assess the risk of dying. This is consistent with a previous analysis of the same data set, which showed that MUAC was superior to weight for- height (percentage of the National Centre for Health Statistics median) to identify high-risk children. This is also consistent with other reports from the literature. In addition to confirming previous findings, this study also shows that using WHZ equal to or
Page 1 and 2: January 2012 Issue 42 ISSN 1743-508
Page 3 and 4: Moving on, an article by Bernardett
Page 5 and 6: Field Article not adequate for dete
Page 7 and 8: Qualitative review of an alternativ
Page 9 and 10: Research of questions and a scoring
Page 11 and 12: Research of the crisis still caught
Page 13 and 14: Research provided 175-200 kcal/kg/d
Page 15: Research Acting in the face of risk
Page 19 and 20: approaches. In other cases where th
Page 21 and 22: Research benefits to programmes and
Page 23 and 24: in most of households, particularly
Page 25 and 26: Research The average per recipient
Page 27 and 28: their capacity to interpret and ana
Page 29 and 30: Research Figure 2: The observed and
Page 31 and 32: Field Article Clients collect their
Page 33 and 34: Agency Profile Name: Centres for Di
Page 35 and 36: Focus on coverage assessment Data c
Page 37 and 38: Focus on coverage assessment charge
Page 39 and 40: Focus on coverage assessment requir
Page 41 and 42: Focus on coverage assessment The th
Page 43 and 44: Focus on coverage assessment This i
Page 45 and 46: Focus on coverage assessment Figure
Page 47 and 48: By Jan Komrska Field Article Increa
Page 49 and 50: UNHCR Technical Workshop on the Ope
Page 51 and 52: Experiences of the Nutrition in Eme
Page 53 and 54: News performance and ability of par
Page 55 and 56: Specific MRP objectives are: • to
Page 57 and 58: News UNHCR standardised nutrition s
Page 59 and 60: and that the general trend coming o
Page 61 and 62: Field Article ment areas of these t
Page 63 and 64: Evaluation There is a need for grea
Page 65 and 66: Evaluation review rest on three kin
Page 67 and 68:
Field Article Figure 1: Model of in
Page 69 and 70:
Field Article there were external f
Page 71 and 72:
Invite to submit material to Field
show all

Download a PDF of this issue - Field Exchange - Emergency ...

You also want an ePaper? Increase the reach of your titles

Delete template?

Save as template?