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Impact of the shift from NCHS growth reference to WHO(2006) growth standards in a therapeutic feeding programme in

A Minetti1, M Shams Eldin, I Defourny

  • 1Epicentre, 75011 Paris, France. andrea.minetti@epicentre.msf.org

Tropical Medicine & International Health : TM & IH
|September 24, 2009
PubMed

Insights

The World Health Organization (WHO) 2006 growth standards identified more malnourished children earlier, leading to improved treatment outcomes in a therapeutic feeding program. This shift facilitated outpatient care and reduced severe malnutrition cases.

Area of Science:

  • Public Health
  • Pediatrics
  • Nutrition Science

Background:

  • Therapeutic feeding programs are crucial for managing severe acute malnutrition in children.
  • The World Health Organization (WHO) introduced new growth standards in 2006 to improve the identification and management of childhood malnutrition.
  • Shifting to updated growth standards can impact program reach and effectiveness.

Purpose of the Study:

  • To evaluate the implementation and impact of the WHO (2006) growth standards within a therapeutic feeding program.
  • To compare child characteristics, care pathways, and treatment outcomes before and after adopting the new standards.

Main Methods:

  • Analysis of program monitoring data from 21,769 children (6-59 months) admitted to a therapeutic feeding program in 2007.
  • Comparison of admission criteria: NCHS standards (oedema, MUAC, WFH <-70%) versus WHO (2006) standards (WFH <-3 z-score).
  • Assessment of differences in child demographics, malnutrition severity, care setting (inpatient vs. outpatient), and treatment outcomes.

Main Results:

  • Children admitted under WHO (2006) standards were younger, had a higher proportion of males, and were less severely malnourished (mean WFH -3.6 z-score vs. -4.6 z-score).
  • Adoption of WHO (2006) standards led to significantly lower hospitalization rates (28.4% vs. 77%) and intensive care needs (12.8% vs. 36.5%).
  • Outpatient treatment increased substantially (71.6% vs. 23%), with improved outcomes: higher cure rates (89% vs. 71.7%) and lower death (2.7% vs. 6.4%) and default rates (6.7% vs. 12.3%).

Conclusions:

  • The WHO (2006) growth standards effectively identify a greater number of malnourished children at an earlier disease stage.
  • Early identification facilitates successful treatment, enabling more children to be managed on an outpatient basis.
  • Implementation of WHO (2006) standards enhanced treatment success rates in the therapeutic feeding program.
Abstract

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