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The effect of nutrition and inflammation on osteocalcin and other hormonesin growing rats was studied. Rats were artificially subjected to starvation and inflammation and compared to well fed control groups. Serum osteocalcin was noted to decrease 72 hours after the start of starvation and was restored by food intake. These suggested that starvation affected osteocalcin levels, independent of dihydroxycholecalciferol levels. Starvation also enhanced insulin control of osteocalcin synthesis. Inflammation does not affect osteocalcin although the consequent lower food intake lowered its levels.

Abstract Background Nutrition and mortality surveys are the main tools whereby evidence on the health status of populations affected by disasters and armed conflict is quantified and monitored over time. Several reviews have consistently revealed a lack of rigor in many surveys. We describe an algorithm for analyzing nutritional and mortality survey reports to identify a comprehensive range of errors that may result in sampling, response, or measurement biases and score quality. We apply the algorithm to surveys conducted in Darfur, Sudan. Methods We developed an algorithm based on internationally agreed upon methods and best practices. Penalties are attributed for a list of errors, and an overall score is built from the summation of penalties accrued by the survey as a whole. To test the algorithm reproducibility, it was independently applied by three raters on 30 randomly selected survey reports. The algorithm was further applied to more than 100 surveys conducted in Darfur, Sudan. Results The Intra Class Correlation coefficient was 0.79 for mortality surveys and 0.78 for nutrition surveys. The overall median quality score and range of about 100 surveys conducted in Darfur were 0.60 (0.12-0.93) and 0.675 (0.23-0.86) for mortality and nutrition surveys, respectively. They varied between the organizations conducting the surveys, with no major trend over time. Conclusion Our study suggests that it is possible to systematically assess quality of surveys and reveals considerable problems with the quality of nutritional and particularly mortality surveys conducted in the Darfur crisis.

Abstract Background Malnutrition prevalence and mortality rates are increasingly used as essential indicators to assess the severity of a crisis, to follow trends, and to guide decision-making, including allocation of funds. Although consensus has slowly developed on the methodology to accurately measure these indicators, errors in the application of the survey methodology and analysis have persisted. The aim of this study was to identify common methodological weaknesses in nutrition and mortality surveys and to provide practical recommendations for improvement. Methods Nutrition (N = 368) and crude mortality rate (CMR; N = 158) surveys conducted by 33 non-governmental organisations and United Nations agencies in 17 countries from October 1993 to April 2004 were analysed for sampling validity, precision, quality of measurement and calculation according to several criteria. Results One hundred and thirty (35.3%) nutrition surveys and 5 (3.2%) CMR surveys met the criteria for quality. Quality of surveys varied significantly depending on the agency. The proportion of nutrition surveys that met criteria for quality rose significantly from 1993 to 2004; there was no improvement for mortality surveys during this period. Conclusion Significant errors and imprecision in the methodology and reporting of nutrition and mortality surveys were identified. While there was an improvement in the quality of nutrition surveys over the years, the quality of mortality surveys remained poor. Recent initiatives aimed at standardising nutrition and mortality survey quality should be strengthened. There are still a number of methodological issues in nutrition and mortality surveys in humanitarian emergencies that need further study.

ObjectivePrevalence of acute malnutrition is classically estimated by the proportion of children meeting a case definition in a representative population sample. In 1995 the WHO proposed the PROBIT method, based on converting parameters of a normally distributed variable to cumulative probability, as an alternative method requiring a smaller sample size. The present study compares classical and PROBIT methods for estimating the prevalence of global, moderate and severe acute malnutrition (GAM, MAM and SAM) defined by weight-for-height Z-score (WHZ) or mid-upper arm circumference (MUAC).DesignBias and precision of classical and PROBIT methods were compared by simulating a total of 1·26 million surveys generated from 560 nutrition surveys.SettingData used for simulation were derived from nutritional surveys of children aged 6–59 months carried out in thirty-one countries around the world.SubjectsData of 459 036 children aged 6–59 months from representative samples were used to generate simulated populations.ResultsThe PROBIT method provided an estimate of GAM, MAM and SAM using WHZ or MUAC proportional to the true prevalence with a small systematic overestimation. The PROBIT method was more precise than the classical method for estimating the prevalence for GAM, MAM and SAM by WHZ or MUAC for small sample sizes (i.e. n<150 for SAM and GAM; n<300 for MAM), but lost this advantage when sample sizes increased.ConclusionsThe classical method is preferred for estimating acute malnutrition prevalence from large sample surveys. The PROBIT method may be useful in sentinel-site surveillance systems with small sample sizes. [ABSTRACT FROM AUTHOR]

Valid and timely information about various domains of public health underpins the effectiveness of humanitarian public health interventions in crises. However, obstacles including insecurity, insufficient resources and skills for data collection and analysis, and absence of validated methods combine to hamper the quantity and quality of public health information available to humanitarian responders. This paper, the second in a Series of four papers, reviews available methods to collect public health data pertaining to different domains of health and health services in crisis settings, including population size and composition, exposure to armed attacks, sexual and gender-based violence, food security and feeding practices, nutritional status, physical and mental health outcomes, public health service availability, coverage and effectiveness, and mortality. The paper also quantifies the availability of a minimal essential set of information in large armed conflict and natural disaster crises since 2010: we show that information was available and timely only in a small minority of cases. On the basis of this observation, we propose an agenda for methodological research and steps required to improve on the current use of available methods. This proposition includes setting up a dedicated interagency service for public health information and epidemiology in crises. [ABSTRACT FROM AUTHOR]