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acute malnutrition in double burden contexts

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SUSANA RAFFALLI

consultant

Normal user

7 May 2016, 12:29

Is there any ongoing discussion on which indexes could we use to assess acute malnutrition in contexts with high level of double burden of malnutrition? .Any alternative to wasting as an indicator among malnourished obese? This is becoming an issue in emergencies in urban settings in Latin America. Many thanks

Carlos Grijalva-Eternod

UCL Institute for Global Health

Normal user

8 May 2016, 22:25

Hi Susana,

There was a more or less recent review of the different way that you can assess the double burden of malnutrition. See the following link: http://www.ncbi.nlm.nih.gov/pubmed/22816196

Regarding the assessment of wasting in the context of double burden, there are at present only two indicators, namely weight-for-height z-score and mid-upper circumference for children aged 6-59 months

How this double burden of malnutrition could affect the prevalence of wasting as measured by each of these indicators is at present unknown.

I hope the above helps

Kennedy Musumba

SMART Program Manager

Normal user

9 May 2016, 14:05

Hi Susana,

SMART nutrition surveys can be used to assess the double burden of malnutrition with the inclusion of overweight tables in ENA software based on WHZ.

Andrew Seal

UCL and NIE Regional Training Initiative

Frequent user

9 May 2016, 14:40

Hi Kennedy
I would be very interested to hear your experience on doing this, and why you used overweight tables rather than just looking at the proportion above +2 or +3 WHZ?
One of the potential challenges is, as you know, that if you have a bi-modal distribution of WHZ, then the cleaning criteria recommended by SMART may not allow you to see it.
What have you found when you look at your data?
Thanks
Andrew

Carlos Grijalva-Eternod

UCL Institute for Global Health

Normal user

9 May 2016, 15:10

I think the challenge of using the SMART criteria for outlier selection on WHZ values (observed mean plus/minus 3 z-scores) will exist regardles of whether the distribution of bi-modal or uni-modal.
The most likely manifestation of an increase in the prevalence children with a WHZ>2 with an elevated prevalence of children with a WHZ<-2 is a widening of the distribution tails and an increase of the observed standard deviation. In this situation using the SMART criteria would remove "true" cases at both ends.

Andrew Seal

UCL and NIE Regional Training Initiative

Frequent user

9 May 2016, 15:22

For me, its a really hard thing to try and predict and may be different in different populations. Either way, (uni or bi-modal) the current SMART criteria for cleaning are likely to be problematic for detecting both types of malnutrition in these populations.

If any one out there has experience of what their (pre exclusions) survey data looks like from populations with a strong double burden it would be very interesting to hear?

Kennedy Musumba

SMART Program Manager

Normal user

10 May 2016, 19:54

Hi All,

I think it will be order to have people share their experiences and views on obtaining a bi-modal distribution of WHZ in analysis of double burden malnutrition !

Job

nutritionist-msf

Normal user

11 May 2016, 17:05

hi ,
Assessment of nutritional dual -burden has been basically relied on use of two indicators: W/H and MUAC.The prevalence like here in Kenya among the urban slums is always low and attributed to household Food Insecurity,Lack of formal education hence ignorance,culture, etc.But for sure the cases are low compared to other malnutrition incidences. Thanks

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