WHO Growth Standards and the Identification of Severe Acute Malnutrition in Infants and Children.pdf

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1、WHOchildgrowthstandardsandtheidentificationofsevereacutemalnutritionininfantsandchildrenAJointStatementbytheWorldHealthOrganizationandtheUnitedNationsChildren’sFundhisstatementpresentstherecommendedcut-offs,summarizestherationaleTfortheiradoptionandadvocatesfortheirharmonizedapplicationi

2、ntheidentificationof6–60montholdinfantsandchildrenforthemanagementofsevereacutemalnutrition(SAM).Italsoreviewstheimplicationsonpatientload,ondischargecriteriaandonprogrammeplanningandmonitoring.Usingweight-for-height:WHOandUNICEFUsingMUAC:WHOstandardsformid-upperrecommendtheuseofacut-off

3、forweight-for-armcircumference(MUAC)-for-ageshowthatinheightofbelow-3standarddeviations(SD)awellnourishedpopulationthereareveryfewoftheWHOstandardstoidentifyinfantsandchildrenaged6–60monthswithaMUAClesschildrenashavingSAM.Thecommonlyusedthan115mm.ChildrenwithaMUAClessthancut-offisthesame

4、cut-offforboththenew2006115mmhaveahighlyelevatedriskofdeathWHOchildgrowthstandards(WHOstandards)comparedtothosewhoareabove.ThusitisaswiththeearlierNationalCenterforHealthrecommendedtoincreasethecut-offpointfromStatistics(NCHSreference).Thereasonsforthe110to115mmtodefineSAMwithMUAC.choice

5、ofthiscut-offareasfollows:WhenusingtheWHOchildgrowthstandardsto1)Childrenbelowthiscut-offhaveahighlyidentifytheseverelymalnourishedamong6–60elevatedriskofdeathcomparedtothosemontholdchildren,thebelow-3SDcut-offforwhoareabove;weight-for-heightclassifiestwotofourtimesasmanychildrencompared

6、withtheNCHS2)Thesechildrenhaveahigherweightgainreference.TheprevalenceofSAM,i.e.numberswhenreceivingatherapeuticdietcomparedofchildrenwithSAM,basedonweight-for-tootherdiets,whichresultsinfasterheightbelow-3SDoftheWHOstandardsandrecovery;thosebasedonaMUACcut-offof115mm,are3)Inawell-nouris

7、hedpopulationthereareverysimilar.TheshiftfromNCHStoWHOchildvirtuallynochildrenbelow-3SD(<1%).growthstandardsortheadoptionofthenew4)Therearenoknownrisksornegativeeffectscut-offforMUACwillthereforesharplyincreaseassociatedwiththerapeuticfeedingofthesecaseloads.Thishasprogra