Anthropometric criteria for best-identifying children at high risk of mortality: a pooled analysis of twelve cohorts
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Anthropometric criteria for best-identifying children at high risk of mortality: a pooled analysis of twelve cohorts. / Khara, Tanya; Myatt, Mark; Sadler, Kate; Bahwere, Paluku; Berkley, James A; Black, Robert E; Boyd, Erin; Garenne, Michel; Isanaka, Sheila; Lelijveld, Natasha; McDonald, Christine; Mertens, Andrew; Mwangome, Martha; O'Brien, Kieran; Stobaugh, Heather; Taneja, Sunita; West, Keith P; Briend, André.
In: Public Health Nutrition, Vol. 26, No. 4, 2023, p. 803-819.Research output: Contribution to journal › Review › Research › peer-review
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TY - JOUR
T1 - Anthropometric criteria for best-identifying children at high risk of mortality: a pooled analysis of twelve cohorts
AU - Khara, Tanya
AU - Myatt, Mark
AU - Sadler, Kate
AU - Bahwere, Paluku
AU - Berkley, James A
AU - Black, Robert E
AU - Boyd, Erin
AU - Garenne, Michel
AU - Isanaka, Sheila
AU - Lelijveld, Natasha
AU - McDonald, Christine
AU - Mertens, Andrew
AU - Mwangome, Martha
AU - O'Brien, Kieran
AU - Stobaugh, Heather
AU - Taneja, Sunita
AU - West, Keith P
AU - Briend, André
N1 - CURIS 2023 NEXS 061
PY - 2023
Y1 - 2023
N2 - Objective: To understand which anthropometric diagnostic criteria best discriminate higher from lower risk of death in children and explore programme implications.Design: A multiple cohort individual data meta-analysis of mortality risk (within 6 months of measurement) by anthropometric case definitions. Sensitivity, specificity, informedness and inclusivity in predicting mortality, face validity and compatibility with current standards and practice were assessed and operational consequences modelled.Setting: Community-based cohort studies in twelve low-income countries between 1977 and 2013 in settings where treatment of wasting was not widespread.Participants: Children aged 6 to 59 months.Results: Of the 12 anthropometric case definitions examined, four (weight-for-age Z-score (WAZ) <-2), (mid-upper arm circumference (MUAC) <125 mm), (MUAC <115 mm or WAZ <-3) and (WAZ <-3) had the highest informedness in predicting mortality. A combined case definition (MUAC <115 mm or WAZ <-3) was better at predicting deaths associated with weight-for-height Z-score <-3 and concurrent wasting and stunting (WaSt) than the single WAZ <-3 case definition. After the assessment of all criteria, the combined case definition performed best. The simulated workload for programmes admitting based on MUAC <115 mm or WAZ <-3, when adjusted with a proxy for required intensity and/or duration of treatment, was 1·87 times larger than programmes admitting on MUAC <115 mm alone.Conclusions: A combined case definition detects nearly all deaths associated with severe anthropometric deficits suggesting that therapeutic feeding programmes may achieve higher impact (prevent mortality and improve coverage) by using it. There remain operational questions to examine further before wide-scale adoption can be recommended.
AB - Objective: To understand which anthropometric diagnostic criteria best discriminate higher from lower risk of death in children and explore programme implications.Design: A multiple cohort individual data meta-analysis of mortality risk (within 6 months of measurement) by anthropometric case definitions. Sensitivity, specificity, informedness and inclusivity in predicting mortality, face validity and compatibility with current standards and practice were assessed and operational consequences modelled.Setting: Community-based cohort studies in twelve low-income countries between 1977 and 2013 in settings where treatment of wasting was not widespread.Participants: Children aged 6 to 59 months.Results: Of the 12 anthropometric case definitions examined, four (weight-for-age Z-score (WAZ) <-2), (mid-upper arm circumference (MUAC) <125 mm), (MUAC <115 mm or WAZ <-3) and (WAZ <-3) had the highest informedness in predicting mortality. A combined case definition (MUAC <115 mm or WAZ <-3) was better at predicting deaths associated with weight-for-height Z-score <-3 and concurrent wasting and stunting (WaSt) than the single WAZ <-3 case definition. After the assessment of all criteria, the combined case definition performed best. The simulated workload for programmes admitting based on MUAC <115 mm or WAZ <-3, when adjusted with a proxy for required intensity and/or duration of treatment, was 1·87 times larger than programmes admitting on MUAC <115 mm alone.Conclusions: A combined case definition detects nearly all deaths associated with severe anthropometric deficits suggesting that therapeutic feeding programmes may achieve higher impact (prevent mortality and improve coverage) by using it. There remain operational questions to examine further before wide-scale adoption can be recommended.
KW - Faculty of Science
KW - Wasting
KW - Stunting
KW - Underweight
KW - Mid-upper arm circumference
KW - Anthropometry
KW - Mortality
KW - Therapeutic feeding
KW - Child survival
U2 - 10.1017/S136898002300023X
DO - 10.1017/S136898002300023X
M3 - Review
C2 - 36734049
VL - 26
SP - 803
EP - 819
JO - Public Health Nutrition
JF - Public Health Nutrition
SN - 1368-9800
IS - 4
ER -
ID: 334956595