Mid-upper arm circumference only protocol in Pakistan: missed opportunities for children suffering from severe acute malnutrition? A mixed-methods observational study.

OBJECTIVE: We investigated the missed treatment opportunities affecting programmes using mid-upper arm circumference (MUAC) as the sole anthropometric criterion for identification and monitoring of children suffering from severe acute malnutrition (SAM). DESIGN: Alongside MUAC, we assessed weight-for-height Z-score (WHZ) in children screened and treated according to the national MUAC only protocol in Pakistan. Besides, we collected parents' perceptions regarding the treatment received by their children through qualitative interviews. SETTING: Data were collected from October to December 2021 in Tando Allah Yar District, Sindh. SUBJECTS: All children screened in the health facilities (n 8818) and all those discharged as recovered (n 686), throughout the district, contributed to the study. All children screened in the community in the catchment areas of five selected health facilities also contributed (n 8459). Parents of forty-one children randomly selected from these same facilities participated in the interviews. RESULTS: Overall, 80·3 % of the SAM cases identified during community screening and 64·1 % of those identified in the health facilities presented a 'WHZ-only' diagnosis. These figures reached 93·9 % and 84·5 %, respectively, in children aged over 24 months. Among children treated for SAM and discharged as recovered, 25·3 % were still severely wasted according to WHZ. While parents positively appraised the treatment received by their children, they also recommended to extend eligibility to other malnourished children in their neighbourhood. CONCLUSION: In this context, using MUAC as the sole anthropometric criterion for treatment decisions (referral, admission and discharge) resulted in a large number of missed opportunities for children in need of timely and adequate care.

Health care utilisation in Cox's Bazar district, Bangladesh, during the first year of the COVID-19 pandemic: A mixed-methods study among host communities.

To respond to the COVID-19 pandemic, countries introduced public health and social measures that had indirect societal, economic consequences. Concerns during epidemics include continuity of routine health services. We investigate how healthcare utilisation and healthcare seeking behaviour changed during the first year of the COVID-19 pandemic among host communities in Cox's Bazar, Bangladesh. This mixed-methods study combines quantitative analyses of routine health data and population-based findings about healthcare seeking behaviours. Trends in consultations changed according to facility level (higher-level facilities included Upazila Health Complexes and District Hospitals; lower-level facilities included Community Clinics and Union Health and Family Welfare Centers). At the pandemic's beginning, drops were seen at higher-level health facilities for outpatient department (OPD) consultations, respiratory infections, and antenatal care. Minor reductions or increases were seen at lower-level facilities for the same services. Half of the subdistricts reported a cumulative increase in OPD and respiratory tract infection consultations. Most subdistricts reported a cumulative decrease in antenatal care. Child vaccinations dropped in all subdistricts, half of which did not catch-up, resulting in a cumulative decrease of delivered doses. Fear of contracting COVID-19 and financial constraints were the main reasons for decreased access. Drivers of healthcare seeking behaviours should be better understood to guide preparedness and service delivery modalities at primary and secondary levels.

Changes in Selected Physiological Parameters Following a Training Block of Specific Circuit Training Among National Top-level Basketball Players.

The study aims at measuring the effects of six weeks of specific circuit training (SCT) according to the 15-15 modality, on selected physiological parameters in national top-level basketball players. It was an intervention study, undertaken with 44 senior players randomly assigned to two groups depending on the program: intervention (IG: n = 22; SCT) and control (CG: n = 22; usual content of the defending champion team's), submitted to a six-week training block. The heart rate recovery at 1 (HRR1) and then 2 (HRR2) minutes, the double product (DP) and V̇O2max were assessed prior to and at the end of the training period. As appropriate, the Student t-test on paired or independent samples, was used to compare measures and groups. At the end of the training period, the HRR1 decreased by 14.2% (p = 0.01) and 14.1% (p = 0.03) respectively in IG and CG. The mean HRR2 was higher in IG than in GC (63 ± 8 bpm versus 57 ± 6 bpm, p = 0.003) at the end of the training period. The variation of DP in IG was not significant (p = 0. 42) while it increased by 7.2% (p = 0.0005) in CG. The V̇O2max increased by 6.5% (p < 0. 001) in IG but not in CG (p = 0.50). The specific circuit training block in the 15-15 modality improved heart rate recovery at one minute and V̇O2max, but had no effect on the double product in the basketball players studied.

Changes in Renal Parameters during a Training Camp among Handball Players in the Sub-Saharan Environment.

The aim of the study was to describe the changes in kidney parameters induced by 10 days of tapering (TP) during a training camp (TC), where the players were preparing for a group competition, in 15 female handball team members of a Division 1 Amateur of Benin, in the sub-Saharan environment. Measures were taken in all the players before and after the intensive training (IT) and tapering (TP) phases in an intervention study. The estimated glomerular filtration rate (eGFR) with the CKD-EPI 4-level race formula, the fractional excretions of sodium (FeNa) and potassium (FeK), the urine potassium-to-sodium ratio (Na/K urine), and the hemoglobin rate [Hb] were determined for all participants. At the end of IT, eGFR and FeNa increased, respectively, by 22.39% (P < 0.01) and 143.85% (P < 0.01), but the variation of FeK is not significant (P > 0.05). The number of abnormally low eGFR values (<90 mL/min/1.73 m2) was reduced from 11 to 5 (P < 0.05). At the end of TP, the eGFR and urine Na-to-K ratio remained on average constant (P > 0.05) but FeNa decreased by 96.32% (P < 0.001) and FeK increased by 144.41% (P < 0.001). The [Hb] rate increased by 9.80% (P < 0.001), and players had inadequate hydration practice. The results suggested that in addition to its already known effects, TP preserves the positive effects of IT on glomerular function in athletes preparing for a competition that presents a major challenge.