Community health workers (CHWs) play an important role in the detection and referral of children with severe acute malnutrition (SAM) in many countries. However, distance to health facilities remains ...a significant obstacle for caregivers to attend treatment services, resulting in SAM treatment coverage rates below 40% in most areas of intervention. The inclusion of SAM treatment into the current curative tasks of CHWs has been proposed as an approach to increase coverage. A literature review of operational experiences was conducted to identify opportunities and challenges associated with this model. A total of 18 studies providing evidence on coverage, clinical outcomes, quality of care, and/or cost‐effectiveness were identified. The studies demonstrate that CHWs can identify and treat uncomplicated cases of SAM, achieving cure rates above the minimum standards and reducing default rates to less than 8%. Although the evidence is limited, these findings suggest that early detection and treatment in the community can increase coverage of SAM in a cost‐effective manner. Adequate training and close supervision were found to be essential to ensure high‐quality performance of CHWs. Motivation through financial compensation and other incentives, which improve their social recognition, was also found to be an important factor contributing to high‐quality performance. Another common challenge affecting performance is insufficient stock of key commodities (i.e., ready‐to‐use therapeutic food). The review of the evidence ultimately demonstrates that the successful delivery of SAM treatment via CHWs will require adaptations in nutrition and health policy and practice.
Objectives
The Middle Upper Arm Circumference (MUAC) bracelet is a widely used instrument in public health assessments and humanitarian assistance projects. The WHO guidelines present a universal ...cut‐off point of 115 mm to determine whether a child has severe acute malnutrition. The objective of this study is to analyze the existing differences in the MUAC for boys and girls aged between 6 and 59 months, from 22 countries distributed in three different continents, in contrast to the use of this single cut‐off point. In addition, the creation of MUAC growth charts is presented for reference use.
Materials and Methods
This study was carried out with a database developed by Action Against Hunger, composed, after the data pre‐processing phase, of 97 921 individuals without anthropometric failure from African, Asian, and American continents. MUAC measurements were compared between countries, dividing by sex and age groups. A k‐means method was used to create country clusters to allow comparisons and the variability was resumed using a Principal Component Analysis. For each cluster, growth curves were created and smoothed using the LOESS method.
Results
Our research has revealed the existence of differences in the MUAC between countries in both, males and females, although with different trends. The evidence was confirmed with the creation of two clusters using the k‐means method, which, when graphically represented by the Principal Component Analysis, showed that the MUAC was clearly different. There were also differences between males and females within each cluster, where growth curves did not overlap in any age group.
Conclusions
All statistical analysis indicate that there are differences in the MUAC values for children without anthropometric failure between countries, but also between sexes. With this research, a new reference is proposed that consider the existing variability between human populations to improve the precision in the determination of severe acute malnutrition in children.
Objectives
Around the aim of gaining knowledge on the secular trends in nutritional status of the Spanish population, we found a collection of historical records compiled by La Institución Libre de ...Enseñanza and their alumni association along 47 years. These data had been collected from boys and girls attending summer camps, with a policy of improving health of children with unfavorable socioeconomic conditions. The objective is to extract all possible information about growth changes, and eventually any interpretation related to status of the originating families.
Materials and methods
Primary data were collected from both unpublished manuscripts containing the original records and publications of the organizing institutions. They had been gathered from 86 summer camps in Spain from 1887 to 1934. In these camps, detailed anthropometric data were collected from every attendee, including body height and weight. The sample population amounts to 1,791 boys and 1,281 girls, between 7 and 16 years of age.
Results
Body height and weight, pooled by camp year, age and sex, displayed variable secular increases. A similar observation appears for the body mass index (BMI). As a complement, a comparison was done to contemporary published references from both Spanish and international studies.
Discussion
Height, weight, and BMI from the camps may be judged as retardation of growth and malnutrition by modern standards but it is not the case when coetaneous references are considered: no overall significant differences were found with respect to several publications from Spanish and European populations.
In 2015, the Ministry of Health in Mali included the treatment of severe acute malnutrition (SAM) into the package of activities of the integrated Community Case Management (iCCM). This paper aims to ...analyze the impact of including community health workers (CHWs) as treatment providers outside the Health Facilities (HFs) on the coverage of SAM treatment when scaling up the intervention in the three largest districts of the Kayes Region in Mali. A baseline coverage assessment was conducted in August 2017 in the three districts before the CHWs started treating SAM. The end-line assessment was conducted one year later, in August 2018. Coverage was assessed by the standardized methodology called Semi-Quantitative Evaluation of Access and Coverage (SQUEAC). The primary outcome was treatment coverage and other variables evaluated were the geographical distribution of the HFs, CHW's sites and overlapping between both health providers, the estimation of children with geographical access to health care and the estimation of children screened for acute malnutrition in their communities. Treatment coverage increased in Kayes (28.7-57.1%) and Bafoulabé (20.4-61.1%) but did not in Kita (28.4-28.5%). The decentralization of treatment has not had the same impact on coverage in all districts, with significant differences. The geospatial analyses showed that Kita had a high proportion of overlap between HFs and/or CHWs 48.7% (39.2-58.2), a high proportion of children without geographical access to health care 70.4% (70.1-70.6), and a high proportion of children not screened for SAM in their communities 52.2% (51.9-52.5). Working with CHWs in SAM increases treatment coverage, but other critical aspects need to be considered by policymakers if this intervention model is intended to be scaled up at the country level. To improve families' access to nutritional health care, before establishing decentralized treatment in a whole region it must be considered the geographical location of CHWs. This previous assessment will avoid overlap among health providers and ensure the coverage of all unserved areas according to their population densities need.
Introduction
Waist circumference (WC) constitutes an indirect measurement of central obesity in children and adolescents.
Objective
To provide percentiles of WC for Hispanic‐American children and ...adolescents, and compare them with other international references.
Materials and methods
The sample comprised 13 289 healthy children between 6 and 18 years coming from public schools of middle and low socioeconomic levels in different parts of Argentina, Cuba, Spain, Mexico, and Venezuela. The LMS method to calculate WC percentiles was applied. Sex and age differences were assessed using Student's t test and ANOVA (SPSS v.21.0). Comparisons were established with references from the United States, Colombia, India, China, Australia, Kuwait, Germany, Tunisia, Greece, and Portugal.
Results
WC increases with age in both sexes. Boys show higher WC in P3, P50, and P97. Comparison of 50th and 90th percentiles among populations from diverse sociocultural and geographical contexts shows high variability, not all justified by the measurement method.
Discussion and conclusions
Specific WC percentiles for sex and age, and P90 cut‐off points are provided; these values are potentially useful to assess central obesity in Hispanic‐American adolescent children.
Abstract Objectives The aim of this study was to explore, based on sex and age, knowledge regarding weight, height, and the perception of body shape in Spanish adults who attend dietary consultation. ...We also wanted to determine the participants' desired body shapes and what they considered their best health status. Methods The sample consisted of 8100 women and 1220 men from Spain. They were between the ages of 18 and 75 y. Weight (kg) and height (cm) were measured and body mass index (BMI) was calculated. Participants were nutritionally classified following the cutoffs proposed by the World Health Organization. Each individual was asked about his or her weight and height and self-reported BMI was calculated. They also answered a test of body image perception through drawings of human silhouettes that corresponded to an exact BMI. With this, perceived BMI, desired BMI, and BMI considered healthy were estimated. Parametric statistic tests for contrast of mean and percentages were applied. Results Self-reported and perceived BMI underestimate the BMI obtained through anthropometry. Differences between measured and self-reported BMI are lower in women and increase with age in both sexes. The same result was obtained when comparing measured BMI with perceived BMI through silhouette test. On average, desired BMI and healthy BMI were in the limits of normal weight for all ages and both sexes. However, the difference between them was also lower in women. Conclusion Age and sex influence the perception of excess weight and body image. This could condition the demand of dietary treatment to improve the nutritional status.
Outpatient treatment of acute malnutrition is usually centralized in health centers and separated into different programs according to case severity. This complicates case detection, care delivery, ...and supply chain management, making it difficult for families to access treatment. This study assessed the impact of treating severe and moderate cases in the same program using a simplified protocol and decentralizing treatment outside health centers through community health workers (CHWs).
A three-armed cluster randomized controlled trial under a non-inferiority hypothesis was conducted in the Gao region of Mali involving 2,038 children between 6 and 59 months of age with non-complicated acute malnutrition. The control arm consisted of 549 children receiving standard treatment in health centers from nursing staff. The first intervention arm consisted of 800 children treated using the standard protocol with CHWs added as treatment providers. The second intervention arm consisted of 689 children treated by nurses and CHWs under the ComPAS simplified protocol, considering mid-upper arm circumference as the sole anthropometric criterion for admission and discharge and providing a fixed dose of therapeutic food for severe and moderate cases. Coverage was assessed through cross-sectional surveys using the sampling evaluation of access and coverage (SLEAC) methodology for a wide area involving several service delivery units.
The recovery rates were 76.3% in the control group, 81.8% in the group that included CHWs with the standard protocol, and 92.9% in the group that applied the simplified protocol, confirming non-inferiority and revealing a significant risk difference among the groups. No significant differences were found in the time to recovery (6 weeks) or in anthropometric gain, whereas the therapeutic food expenditure was significantly lower with the simplified combined program in severe cases (43 sachets fewer than the control). In moderate cases, an average of 35 sachets of therapeutic food were used. With the simplified protocol, the CHWs had 6% discharge errors compared with 19% with the standard protocol. The treatment coverage increased significantly with the simplified combined program (SAM +42.5%, MAM +13.8%).
Implementing a simplified combined treatment program and adding CHWs as treatment providers can improve coverage while maintaining non-inferior effectiveness, reducing the expenditure on nutritional intrants, and ensuring the continuum of care for the most vulnerable children.
Objective
The Tarahumara ethnic group is composed of indigenous people from the Sierra Madre Occidental of Mexico. Conditions of isolation and poverty compel them to migrate to the city in search of ...better opportunities. This work aims to explore the influence of migration on the growth and nutritional status of Tarahumara schoolchildren.
Methods
One hundred Tarahumara students were analyzed (50 rural with a mean age of 9.78 ± 1.25 years; 50 urban aged 10.0 ± 1.04 years), comparing anthropometric indicators and body composition (T‐Student, U‐Mann–Whitney Tests).
Results
Twenty percent of rural girls and 35% of rural boys showed stunted growth compared to only 9% of the urban girls (no stunted growth among urban boys). Migrants showed greater body size, skinfold thickness, and fat percentage. Weight excess, understood as an increase in the prevalence of overweight and obesity, was detected in 17.8% of urban boys and 13.6% of urban girls compared to 10.0% of boys and 3.3% of girls of the rural series.
Conclusion
Migration reduces stunting and increases adiposity.
Several precedents support an association between single nucleotide genetic polymorphisms (SNPs), the obese phenotype, and eating behavior in the infant-juvenile population. This study aims to study ...this aspect in depth, analyzing the eating behavior of a sample of schoolchildren from Madrid in regard to their genetic predisposition to obesity. A total of 258 schoolchildren, aged 6 to 16 years, were evaluated through the Children’s Eating Behaviour Questionnaire (CEBQ) and the genotyping of 32 SNPs. Associations were observed between the total genetic risk score and eating behaviors related to emotional eating and food responsiveness. Individually, different SNPs were associated with eating behaviors, primarily those related to pro-eating behaviors or increased risk of developing obesity. However, diverse results are obtained, depending on the SNP. These results highlighted the strongest associations between the rs1801725 SNP risk allele (CASR) and increased enjoyment of food by 1846-fold. Likewise, the satiety response was associated with SNP rs11676272 (ADCY3) 2.39 and SNP rs7566605 (INSIG2), increasing this response by 2.39 and 1.63 times, respectively. Emotional anti-ingesting behaviors were inversely associated with SNP rs1421085 (FTO) and SNP rs987237 (TFAP2B). In contrast, SNP rs55915917 (CRHR1) increased the risk of these behaviors. SNPs rs4788099 (SH2B1), rs6857 (NECTIN2), and rs180172 (ADCY3) were associated with slow feeding. In conclusion, associations were found between most of the analyzed SNPs and the CEBQ items. This suggests that feeding behavior exists as a mediator between genotype and obesity phenotype, beginning in childhood.
Of the 45.4 million children under five affected by acute malnutrition in the world, the majority (31.8 million) are affected by moderate acute malnutrition (MAM). Its treatment is particularly ...complex in emergency settings such as the Diffa region in Niger. This study aims to evaluate the effectiveness and coverage of a simplified treatment protocol with Community Health Workers (CHWs) as treatment providers.
This study is a non-randomized controlled trial. The control group (
= 181) received the standard protocol currently used in country, delivered by nursing staff only in health centres and health posts, while the intervention group (
= 483) received the simplified protocol which included nursing at health centres and CHWs at health post as treatment providers.
The recovery rate was higher in the simplified protocol group (99.6% vs. 79.56%,
< 0.001) recording lower time to recover and higher anthropometric gain. Treatment coverage in the intervention group increased from 28.8% to 84.9% and reduced in the control group (25.3% to 13.6%). No differences were found in the recovery rate of children treated by CHWs and nursing staff.
The outcomes using the simplified protocol exceeded humanitarian requirements and demonstrated improvements compared to the standard protocol showing that the simplified protocol could be safely provided by CHWs in an emergency context. Further research in other contexts is needed to scale up this intervention.
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