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Incidence and duration of severe wasting in two African populations

  • Michel Garenne (a1), Douladel Willie (a2), Bernard Maire (a3), Olivier Fontaine (a4), Roger Eeckels (a5), André Briend (a4) and Jan Van den Broeck (a2)...
Abstract
AbstractObjective

The present study aimed to compare two situations of endemic malnutrition among <5-year-old African children and to estimate the incidence, the duration and the case fatality of severe wasting episodes.

Design

Secondary analysis of longitudinal studies, conducted several years ago, which allowed incidence and duration to be calculated from transition rates. The first site was Niakhar in Senegal, an area under demographic surveillance, where we followed a cohort of children in 1983–5. The second site was Bwamanda in the Democratic Republic of Congo, where we followed a cohort of children in 1989–92. Both studies enrolled about 5000 children, who were followed by routine visits and systematic anthropometric assessment, every 6 months in the first case and every 3 months in the second case.

Results

Niakhar had less stunting, more wasting and higher death rates than Bwamanda. Differences in cause-specific mortality included more diarrhoeal diseases, more marasmus, but less malaria and severe anaemia in Niakhar. Severe wasting had a higher incidence, a higher prevalence and a more marked age profile in Niakhar. However, despite the differences, the estimated mean durations of episodes of severe wasting, calculated by multi-state life table, were similar in the two studies (7·5 months). Noteworthy were the differences in the prevalence and incidence of severe wasting depending on the anthropometric indicator (weight-for-height Z-score ≤–3.0 or mid upper-arm circumference <110 mm) and the reference system (National Center for Health Statistics 1977, Centers for Disease Control and Prevention 2000 or Multicentre Growth Reference Study 2006).

Conclusions

Severe wasting appeared as one of the leading cause of death among under-fives: it had a high incidence (about 2 % per child-semester), long duration of episodes and high case fatality rates (6 to 12 %).

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Corresponding author
*Corresponding author: Email mgarenne@pasteur.fr
Linked references
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3. A Briend , C Prudhon , ZW Prinzo , BM Daelmans & JB Mason (2006) Putting the management of severe malnutrition back on the international health agenda. Food Nutr Bull 27, 3 Suppl., S3S6.

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11. A Briend , C Dykewiz , K Graven , RN Mazumder , B Wojtyniak & M Bennish (1986) Usefulness of nutritional indices and classifications in predicting death of malnourished children. Br Med J 293, 373375.

12. A Briend & S Zimicki (1986) Validation of arm circumference as an indicator of risk of death in one to four year old children. Nutr Res 6, 249261.

19. RE Black , LH Allen , ZA Bhutta , LE Caulfield , M de Onis , M Ezzati , C Mathers & J Rivera ; Maternal and Child Undernutrition Study Group (2008) Maternal and child undernutrition: global and regional exposures and health consequences. Lancet 371, 243260.

22. J Van den Broeck , R Eeckels & J Vuylsteke (1993) Influence of nutritional status on child mortality in rural Zaire. Lancet 341, 14911495.

28. P Brambilla , MF Rolland-Cachera , C Testolin , A Briend , A Salvatoni , G Testolin & G Chiumello (2000) Lean mass of children in various nutritional states. Ann N Y Acad Sci 904, 433436.

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Public Health Nutrition
  • ISSN: 1368-9800
  • EISSN: 1475-2727
  • URL: /core/journals/public-health-nutrition
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