ABSTRACT
Recommendations for the management of malnutrition among infants aged less than 6 months (<6 m) are based on limited evidence. This study aimed to describe the characteristics, treatment outcomes and outcome-associated factors among malnourished infants <6 m admitted at Médecins Sans Frontières (MSF) inpatient and ambulatory therapeutic feeding centres (ITFC and ATFC) in North-East Nigeria, 2019-2022. We conducted a descriptive analysis of the cohorts and logistic regression to measure the association between two selected outcomes-inpatient mortality and defaulting from the ambulatory programme-and possible factors associated. In total, 940 infants <6 m were admitted at ITFC. Most of them presented severe acute malnutrition and comorbidities, with diarrhoea being the most frequent. On discharge, 13.3% (n = 125) of infants were cured, 72.9% (n = 684) stabilized (referred to ATFC), 6.5% (n = 61) left against medical advice and 4.2% (n = 39) died. The median length of hospital stay was 10 days [IQR 7-14]. A hospital stay shorter than 10 days was significantly associated with inpatient mortality (aOR = 12.51, 95% confidence interval [CI] = 3.72-42.11, p ≤ 0.01). Among 561 infants followed up at the ATFC, only 2.8% reported comorbidities. On discharge, 80.9% (n = 429) were cured, 16.2% (n = 86) defaulted and 1.1% (n = 6) died. Male sex (aOR = 1.94, 95% CI = 1.15-3.27, p = 0.01), internally displaced status (aOR = 1.70, 95% CI = 1.05-2.79, p = 0.03) and <-3 WLZ (aOR = 1.95, 95% CI = 1.05-3.63, p = 0.03) were significantly associated with programme defaulting. Stabilization and recovery rates among malnourished infants <6 m in the studied project align with acceptable standards in this humanitarian setting. Notable defaulting rates from outpatient care should be further explored.
ABSTRACT
[This corrects the article DOI: 10.1016/j.cdnut.2023.102053.].
ABSTRACT
Background: The Minimum Dietary Diversity for Women of Reproductive Age (MDD-W) indicator was validated as a proxy of micronutrient adequacy among nonpregnant women in low- and middle-income countries (LMICs). At that time, indeed, there was insufficient data to validate the indicator among pregnant women, who face higher micronutrient requirements. Objective: This study aimed to validate a minimum food group consumption threshold, out of the 10 food groups used to construct MDD-W, to be used as a population-level indicator of higher micronutrient adequacy among pregnant women aged 15-49 y in LMICs. Methods: We used secondary quantitative 24-h recall data from 6 surveys in 4 LMICs (Bangladesh, Burkina Faso, India, and Nepal, total n = 4909). We computed the 10-food group Women's Dietary Diversity Score (WDDS-10) and calculated the mean probability of adequacy (MPA) of 11 micronutrients. Linear regression models were fitted to assess the associations between WDDS-10 and MPA. Sensitivity, specificity, and proportion of individuals correctly classified were used to assess the performance of MDD-W in predicting an MPA of >0.60. Results: In the pooled sample, median values (interquartile range) of WDDS-10 and MPA were 3 (1) and 0.20 (0.34), respectively, whereas the proportion of pregnant women with an MPA of >0.60 was 9.6%. The WDDS-10 was significantly positively associated with MPA in each survey. Although the acceptable food group consumption threshold varied between 4 and 6 food groups across surveys, the threshold of 5 showed the highest performance in the pooled sample with good sensitivity (62%), very good specificity (81%), and percentage of correctly classified individuals (79%). Conclusions: The WDDS-10 is a good predictor of dietary micronutrient adequacy among pregnant women aged 15-49 y in LMICs. Moreover, the threshold of 5 or more food groups for the MDD-W indicator may be extended to all women of reproductive age, regardless of their physiologic status.
ABSTRACT
OBJECTIVE: To investigate the seasonal variations of women's dietary diversity (WDD) (items consumed and food supply) and its linkages with agriculture, market and wild resources. DESIGN: A cohort of 300 women was followed-up over a year to investigate WDD and food sources (production, purchase or foraging). Monthly qualitative 24 h recalls allowed computing WDD Scores from a standard 10-food groups (FG) classification (WDDS-10). Associations between farm/women's characteristics and WDDS-10 were investigated using multivariate mixed models including interaction terms factor*months. SETTING: Tuy province, Burkina Faso. PARTICIPANTS: 300 women of reproductive age. RESULTS: Both dietary diversity and food sources were seasonal. The mean WDDS-10 was relatively stable from August to January (ranging from 3·1 to 3·5 FG) when farm production predominated. The WDDS-10 gradually increased from February, concomitantly with an increase in food purchases (onions, tomatoes, mangoes) and reached its highest levels (>4 FG) from March to June, when food purchases were still relatively high and when more women consumed foraged fruits (shea plums and wild grapes). Women living on farms owning > 3 plough oxen and different animal species had significantly higher WDDS-10 than others (+0·28 and +0·35 FG, respectively). Women who practiced off-farm activities also had higher WDDS-10 than those who did not (+0·21 FG, P < 0·05). Other factors, for example, the number of foraged edible species, provided advantages in terms of dietary diversity only during certain seasons (October - January, P for interaction < 0·01). CONCLUSIONS: Diversifying women's diets throughout the year requires complementary interventions aimed at diversifying production, promoting foraging and increasing income-generating activities to enable food purchasing.
