Hedwig Deconinck

impact of household food insecurity on the nutritional status and the response to therapeutic feeding of people living with human immunodeficiency virus

Background The role of household food security (HFS) in the occurrence of wasting and the response to food-based intervention in people living with human immunodeficiency virus (PLHIV), especially adults, is still controversial and needs investigation. Methods Face-to-face interviews to collect data for Coping Strategies Index score and Dietary Diversity Score estimation were conducted during a noncontrolled and nonrandomized study assessing the effectiveness of ready-to-use therapeutic food in the treatment of wasting in adults with HIV. Coping Strategies Index score and Dietary Diversity Score were used to determine HFS, and the participants and tertiles of Coping Strategies Index score were used to categorize HFS. Results The study showed that most participants were from food insecure households at admission, only 2.7% (5/187) ate food from six different food groups the day before enrolment, and 93% (180/194) were applying forms of coping strategy. Acute malnutrition was rare among <5-year-old children from participants’ households, but the average (standard deviation) mid-upper arm circumference of other adults in the same households were 272.7 (42.1) mm, 254.8 (33.8) mm, and 249.8 (31.7) mm for those from the best, middle, and worst tertile of HFS, respectively (P = 0.021). Median weight gain was lower in participants from the worst HFS tertile than in those from the other two tertiles combined during therapeutic feeding phase (0.0 [−2.1 to 2.6] kg versus 1.9 [−1.7 to 6.0] kg; P = 0.052) and after ready-to-use therapeutic food discontinuation (−1.9 [−5.2 to 4.2] kg versus 1.8 [−1.4 to 4.7] kg; P = 0.098). Being on antiretroviral therapy influenced the response to treatment and nutritional status after discontinuation of ready-to-use therapeutic food supplementation. Conclusion Food insecurity is an important contributing factor to the development of wasting in PLHIV and its impact on therapeutic feeding response outlines the importance of food-based intervention in the management of wasting of PLHIV.

Information-Sharing to Improve Learning about Community-Based Management of Acute Malnutrition (CMAM) and its Impact

Background Severe acute malnutrition (SAM) affects 19 million children worldwide annually. The community-based management of acute malnutrition (CMAM) approach was first piloted in 2000. Endorsed by the United Nations in 2007, the approach has been introduced in over 60 countries. Current coverage and quality of services need further strengthening and key stakeholders have expressed the need for improved information-sharing. Objective To report on an information-sharing initiative that was established to support scale-up of quality services for CMAM by collecting existing technical guidance, evidence, and learning. Methods Routine website monitoring, country case studies, and surveys were used to assess the profiles of CMAM Forum users and the reach and use of information for improved health outcomes. Results The number of information products and services and their use have steadily increased. Country case studies have identified ways to adapt information better to the needs of those involved in managing acute malnutrition, particularly at the country level. An urgent need has been identified for more resources in additional languages, especially French and Arabic, and expanded production and use of audiovisual material and social media. Conclusions Improved information-sharing can have an impact on health outcomes, but further innovation and support are needed to improve access to, and use of, the information.

Challenges of Estimating the Annual Caseload of Severe Acute Malnutrition: The Case of Niger.

Introduction Reliable prospective estimates of annual severe acute malnutrition (SAM) caseloads for treatment are needed for policy decisions and planning of quality services in the context of competing public health priorities and limited resources. This paper compares the reliability of SAM caseloads of children 6–59 months of age in Niger estimated from prevalence at the start of the year and counted from incidence at the end of the year. Methods Secondary data from two health districts for 2012 and the country overall for 2013 were used to calculate annual caseload of SAM. Prevalence and coverage were extracted from survey reports, and incidence from weekly surveillance systems. Results The prospective caseload estimate derived from prevalence and duration of illness underestimated the true burden. Similar incidence was derived from two weekly surveillance systems, but differed from that obtained from the monthly system. Incidence conversion factors were two to five times higher than recommended. Discussion Obtaining reliable prospective caseloads was challenging because prevalence is unsuitable for estimating incidence of SAM. Different SAM indicators identified different SAM populations, and duration of illness, expected contact coverage and population figures were inaccurate. The quality of primary data measurement, recording and reporting affected incidence numbers from surveillance. Coverage estimated in population surveys was rarely available, and coverage obtained by comparing admissions with prospective caseload estimates was unrealistic or impractical. Conclusions Caseload estimates derived from prevalence are unreliable and should be used with caution. Policy and service decisions that depend on these numbers may weaken performance of service delivery. Niger may improve SAM surveillance by simplifying and improving primary data collection and methods using innovative information technologies for single data entry at the first contact with the health system. Lessons may be relevant for countries with a high burden of SAM, including for targeted emergency responses.

Agent-Based Modelling to Inform Health Intervention Strategies: The Case of Severe Acute Malnutrition in Children in High-Burden Low-Income Countries

Health interventions improve the management of severe acute malnutrition (SAM) in children under 5 in high-burden low-income countries. However, evaluation of their implementation faces a paucity of information and could benefit from a system perspective derived from the knowledge of implementers and experts. These challenges could be addressed using simulation modelling. We compared Markov and agent-based models of interventions for improving the management of SAM and assessed benefits and limitations in informing complex health intervention strategy designs. Based on a conceptual framework developed with existing evidence and expert advice, the agent-based model generated simulated data representing the complex evolution of the system. Multiple scenarios were investigated by varying parameters and mimicking rules of interventions. This study pointed out possible synergies between interventions enhancing early start of treatment and increasing recovery from SAM. When these interventions were adequately combined, outcomes of coverage, recovery and overall survival improved. Benefits of agent-based modelling were use of history, if-then rules to uncover mechanisms behind probabilities, and modifiable transition rates. Limitations related to model validation, choices of assumptions, and simplification. Agent-based modelling could be used to adapt intervention strategies to local contexts and support scale-up. As such, modelling could complement the methodological toolkit of health intervention strategy designs for improved policy decision.