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The risk approach to intervention in severe malnutrition in rural Bangladesh
F J Henry1, A Briend, V Fauveau
1International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh.
Insights
Targeted interventions for childhood marasmus are inefficient. Risk factors like multiple young siblings and formula feeding increase risk, but targeting these households misses many affected children.
Area of Science:
- Public Health
- Pediatrics
- Nutrition
Background:
- Clinical marasmus is a severe form of malnutrition in children.
- Identifying high-risk households is crucial for effective intervention strategies.
Purpose of the Study:
- To identify risk indicators for clinical marasmus in children.
- To evaluate the efficiency of targeted interventions based on these indicators.
Main Methods:
- A case-control study was conducted in Matlab, Bangladesh, involving 164 pairs of children aged 1-4 years.
- Cases had mid-upper arm circumference < 110 mm; controls had circumference > 120 mm.
- Conditional logistic regression analysis was used to identify risk factors.
Main Results:
- Children in families with multiple siblings under 5 years (OR=2.80) and those consuming formula foods (OR=18.81) showed increased marasmus risk.
- Higher maternal education was associated with a reduced risk of marasmus.
- Targeting interventions based on identified risk factors may be inefficient due to missing cases.
Conclusions:
- The risk-based approach for targeted marasmus interventions is unlikely to be efficient.
- Interventions need to balance resource allocation with the need to identify all at-risk children.
Abstract:
To determine whether clinical marasmus occurs in small groups of children from easily recognizable high-risk households, the authors conducted a case-control study to identify risk indicators that may be used in targeted interventions. Cases were children whose mid-upper arm circumference measured less than 110 mm, and controls were children matched for age and sex with arm circumferences greater than 120 mm. Between June 1988 and June 1989, 164 such pairs of children aged 1-4 years were studied in Matlab, Bangladesh. Conditional logistic regression analysis showed an increased risk of marasmus among children from families with other children under 5 years of age (odds ratio = 2.80, 95% confidence interval 1.56-5.02) and children who consumed formula foods (odds ratio = 18.81, 95% confidence interval 4.15-85). Higher maternal education was associated with reduced risk of marasmus. Further examination of these risk indicators suggests that the resources saved through targeting fewer households will be negated by missing many children with marasmus. The authors conclude that the application of targeted interventions against marasmus, using the risk approach, is unlikely to be efficient.