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Objective: When planning severe acute malnutrition (SAM) treatment services, estimates of the number of children requiring treatment are needed. Prevalence surveys, used with population estimates, can directly estimate the number of prevalent cases but not the number of subsequent incident cases. Health managers often use a prevalence-to-incidence conversion factor (J) derived from two African cohort studies to estimate incidence and add the expected number of incident cases to prevalent cases to estimate expected SAM caseload for a given period. The present study aimed to estimate J empirically in different contexts.Design: Observational study, with J estimated by correlating expected numbers of children to be treated, based on prevalence surveys, population estimates and assumed coverage, with the observed numbers of SAM patients treated.Setting: Survey and programme data from six African and Asian countries.Subjects: Twenty-four data sets including prevalence surveys and programme admissions data for 5 months following the survey.Results: A statistically significant relationship between the number of SAM cases admitted to SAM treatment services and the estimated burden of SAM from prevalence surveys was found. Estimate for the slope (intercept forced to be zero) was 2·17 (95 % CI 1·33, 3·79). Estimates for the prevalence-to-incidence conversion factor J varied from 2·81 to 11·21, assuming programme coverage of 100 % and 38 %, respectively.Conclusions: Estimation of expected caseload from prevalence may require revision of the currently used prevalence-to-incidence conversion factor J of 1·6. Appropriate values for J may vary between different locations. [ABSTRACT FROM AUTHOR]

Objective: The World Health Organization recommends discharging children admitted to nutrition programs treating severe acute malnutrition, with a low mid-upper arm circumference (MUAC <115 mm) when weight gain is >15%. When this recommendation is followed, the most severely malnourished children receive a shorter treatment compared to children that are less severely malnourished. This study assesses whether using MUAC >125 mm as discharge criteria eliminates this effect. Methods and Findings: Data from 753 children cured from a Médecins Sans Frontières outpatient nutrition program in Gedaref, North Sudan were analyzed. MUAC >125 mm was used as discharge criteria. Length of stay and percent weight gain of children were compared in relation to nutritional status on admission. Children with low MUAC on admission had a longer duration of treatment (p = 0.000) and also a higher percent weight gain (p = 0.000) than children with higher MUAC. Similar results with weight-for-height z-scores categories were shown with both duration of treatment (p = 0.000) and percent weight gain (p = 0.000). Conclusion: This study shows that using MUAC as the discharge criteria eliminates the effect of shorter treatment in most severely malnourished children compared to least severely malnourished, as is observed with percent weight gain. The findings directly address the main concern that has been identified with the current WHO recommendation of using percent weight gain. MUAC could be used as discharge criteria, instead of percent weight gain, as having a longer duration of treatment and a higher percent weight gain for the most malnourished is highly desirable. [ABSTRACT FROM AUTHOR]

Information about several papers discussed at the informal consultation meeting of several international health organizations regarding the community-based management of child malnutrition. Since severe malnutrition is one of the cause of death in children, health organizations continue to develop health programs that would solve malnutrition problems. The meeting did not make any recommendations on preventing malnutrition.