MUAC as the sole discharge criterion from community-based management of severe acute malnutrition in Burkina Faso
MUAC as the sole discharge criterion from community-based management of severe acute malnutrition in Burkina Faso
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DOI：
10.1111/mcn.12688
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发表时间：
2019-04-01
影响因子：
3.4
通讯作者：
Grais, Rebecca F.
中科院分区：
文献类型：
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作者：
Isanaka, Sheila;Hanson, Kerstin E.;Grais, Rebecca F.
已建立了使用中上臂围（MUAC）测量来筛选和确定治疗性喂养计划的准入资格，但将MUAC用作出院标准的证据和计划经验有限。我们目前的结果，从一个大规模的营养计划，使用MUAC入院和出院，并比较程序的结果和治疗反应时，确定出院的资格，按比例体重增加与出院的MUAC。研究人群包括2007年9月至2011年12月期间在布基纳法索北方接受无国界医生组织支持的卫生部治疗性喂养计划的所有儿童（n = 50，841）。使用两种出院标准，总体恢复率较高，死亡、无应答和转入住院治疗的风险较低，体重、MUAC、身高体重Z评分和身高的每日增量较高。当出院时仅由MUAC进行时，恢复增加，而所有不良计划结局和住院时间减少，入院时MUAC增加。基于MUAC的规划，其中MUAC被整合到程序筛选，入院和出院，是几种新的方法，可用于目标资源最危险的营养不良儿童和提高程序的效率和一致性之一。该分析提供了关于使用基于MUAC的放电标准的额外编程经验，但可能需要更多的工作来告知跨设置的最佳放电阈值。
The use of mid upper arm circumference (MUAC) measurement to screen and determine eligibility for admission to therapeutic feeding programs has been established, but evidence and programmatic experience to inform guidance on the use of MUAC as a discharge criterion is limited. We present results from a large-scale nutritional program using MUAC for admission and discharge and compare program outcomes and response to treatment when determining eligibility for discharge by proportional weight gain versus discharge by MUAC. The study population included all children admitted to the Ministry of Health therapeutic feeding program supported by Medecins Sans Frontieres in northern Burkina Faso from September 2007 to December 2011 (n = 50,841). Recovery was high overall using both discharge criteria, with low risks of death, nonresponse, and transfer to inpatient care and high daily gains in weight, MUAC, weight-for-height Z score, and height. When discharge was made by MUAC only, recovery increased, while all adverse program outcomes and length of stay decreased, with increasing MUAC on admission. MUAC-based programming, where MUAC is integrated into program screening, admission, and discharge, is one of several new approaches that can be used to target resources to the most at-risk malnourished children and improve program efficiency and coherency. This analysis provides additional programmatic experience on the use of MUAC-based discharge criterion, but more work may be needed to inform optimal discharge thresholds across settings.