Related Experiment Videos
A new classification of acute protein-energy malnutrition
1Regional Institute of Community Mental Health Care, The Netherlands. gernaat@worldonline.nl
Insights
A new method for classifying protein-energy malnutrition (PEM) in children shows promise. This approach, focusing on wasting and edema, appears more accurate than current methods for hospitalized children in developing nations.
Area of Science:
- Pediatrics
- Nutrition Science
- Global Health
Background:
- Current protein-energy malnutrition (PEM) classification systems in developing countries have limitations.
- Existing methods often struggle with unknown ages and accurate identification of wasted children.
Purpose of the Study:
- To compare a new PEM classification scheme (based on wasting and edema) with clinical diagnosis and Wellcome criteria.
- To evaluate the diagnostic accuracy of different PEM classification methods in hospitalized children under five.
Main Methods:
- A study involving 538 hospitalized children under five with PEM in Nchelenge, Zambia.
- Comparison of a proposed scheme using weight-for-height z-scores and edema against clinical assessment and Wellcome criteria.
Main Results:
- The proposed scheme demonstrated potential for improved accuracy in diagnosing PEM.
- Clinical and Wellcome criteria showed significant rates of false-positive and false-negative diagnoses for both wasting and edema.
- The Wellcome classification did not improve clinical diagnostic accuracy for PEM.
Conclusions:
- The proposed classification scheme for PEM warrants further investigation.
- Current methods, including the Wellcome criteria, have limitations in accurately diagnosing PEM in young children.
- Accurate PEM classification is crucial for effective treatment and management in resource-limited settings.
Abstract:
Current schemes to classify protein-energy malnutrition (PEM) in hospitalized children below 5 years of age in developing countries are of limited usefulness, because age is often not known and wasted children are insufficiently discriminated. In this study, a newly proposed scheme, based on the presence of wasting (weight-for-height < or = -2 z scores) and oedema, was compared with clinical and the original Wellcome criteria to classify PEM in 538 under-fives hospitalized for PEM in a rural hospital in Nchelenge, Zambia. Wasting in the absence of oedema was clinically false-positively diagnosed in 34.0 per cent, whereas the Wellcome classification gave rise to 28.6 per cent false-positive and 39.9 per cent false-negative diagnosis. In the presence of oedema, clinical diagnosis of wasting was 44.7 per cent false-positive and 41.4 per cent false-negative, while the Wellcome scheme had a false-negative rate of 54.3 per cent. We conclude that the Wellcome classification did not add to the clinical diagnostic accuracy of PEM as opposed to the proposed scheme, which merits further study. In an Appendix the use and calculation of z scores of weight-for-height is further explained.