Consideration of the Nutrition Components of the Sick Child Initiative (1995) / Chapter Skim
Currently Skimming:
Appendix B: Guidance on Development of the SCI Diagnostic Screens and Specific Comments on the Proposed Approaches to Diagnose and Treat Malnutrition
Appendix B: Guidance on Development of the SCI Diagnostic Screens and Specific Comments on the Proposed Approaches to Diagnose and Treat Malnutrition
Pages 23-40
The Chapter Skim interface presents what we've algorithmically identified as the most significant single chunk of text within every page in the chapter.
Select key terms on the right to highlight them within pages of the chapter.
From page 23... ...
In this section, comments are offered on: the need for analyses that measure the quality of the nutrition screens; a more appropriate method for comparing diagnostic screening tools according to these qualities; and the need to consider different outcomes to test the validity of these screens.
|
From page 24... ...
Both of these avenues of comparison are directly related to the positive predictive value, however, and therefore will change across populations even when the sensitivity-specificity characteristics are constant. For this reason, the more appropriate way to compare diagnostic screening tools is the Receiver Operating Characteristics (ROC)
|
From page 25... ...
Rankings are then compared across settings to assess their reliability. In summary, it is the committee's opinion that the development of the nutrition screens requires that data from more health workers be used to develop ROC curves to compare the screens in different settings, and that Z score transformations be used when plotting these curves.
|
From page 26... ...
SPECIFIC COMMENTS ON THE PROPOSED DIAGNOSIS AND TREATMENT OF MALNUTRITION IN THE NUTRITION ALGORITHMS The SCI's management of childhood diseases, including undernutrition, can be divided conceptually into three major areas: · The diagnosis and treatment of the sick child with severe malnutrition or severe anemia. · The diagnosis and treatment of the sick child with moderate malnutrition or moderate anemia.
|
From page 27... ...
Bern, CDC, Atlanta, personal communication, 1995~. In Siaya, Kenya, health workers assessed pallor at various anatomic sites and demonstrated that palmer pallor was 90 percent sensitive and 63 percent specific for the detection of moderate
|
From page 28... ...
THE SICK CHILD WITH MODERATE MALNUTRITION OR MODERATE ANEMIA Diagnosis Although severe malnutrition is a major concern because it can be immediately life-threatening, the majority of mortality associated with malnutrition occurs among children with moderate malnutrition because of its higher prevalence (Pelletier et al., 1993~. Thus, it is most important to correctly identify
|
From page 29... ...
Consideration should be given to developing a growth chart with a reference curve based on varying cutoffs depending on the age of the child. If the appropriateness of different cutoffs is not carefully considered and tested, this could lead to inappropriate and inefficient use of resources, given that the IMCI recommends feeding assessment, advice, and follow-up for every child whose weight falls below a given threshold.
|
From page 30... ...
Foamy Patches on the Whites of the Eyes to Diagnose Moderate Vitamin A Def ciency While this indicator is appropriate for diagnosing vitamin A deficiency, the committee suggests adding "won't open eyes" and a question about nightblindness history to the classification of nutritional status. The committee also recommends that children who "won't open their eyes" or "whose eyes are pussy" be included under measles, requiring referral, in addition to clouding of the cornea.
|
From page 31... ...
The part of the nutrition algorithm concerned with assessment of the feeding of older children contains three sections: usual breastfeeding practices, usual consumption of other foods and fluids, and any modifications of these feeding practices during the current illness. The questions on breastteeding refer to the frequency of daytime breastfeeding and any occurrence of nighttime breastfeeding.
|
From page 32... ...
Comments on Infant Feeding Assessment It will be necessary to develop appropriate age-specific feeding recommendations (considering issues of food availability, cultural beliefs, and prevailing nutritional problems) for each country or subregion within the country before successful implementation of the nutritional treatment algorithm will be possible at new locales.
|
From page 33... ...
It is not certain, however, whether all mothers will be able to report their frequency of nursing. Because the feeding recommendations specify that the child should be fed as often as he or she wants, it would be desirable to obtain information on the signals used to initiate a feed (mother's preference or child's demand)
|
From page 34... ...
A number of studies suggest, however, that the growth velocity of children of this age in developing countries approximates that of children in more affluent nations (Allen, 1993~. Therefore, specific feeding recommendations may no longer be necessary for children of this age range in developing countries when local data suggest adequate growth and nutritional status.
|
From page 35... ...
The committee was uncertain about the specific age at which children could consume customary family foods in place of specially prepared infant foods. This may vary in individual countries, depending on the types of family foods available and prevailing cultural beliefs.
|
From page 36... ...
In addition, however, a considerable body of research and programmatic experience suggests that when mothers are made to feel that their viewpoint is respected and considered valuable by health workers, they are more likely to follow the advice being given and to return for future visits to the health facility. One component of the nutrition algorithm is to advise the mother/caretaker of infants or children diagnosed as having moderate malnutrition or feeding problems to return with the child in 14 days.
|
From page 37... ...
There are several potential sources of such information. One is systematic evaluation of the past experience of first-level health facilities with follow-up visits for sick children.
|
From page 38... ...
The addition of oil, however, needs to be done with caution, as described under our comments on appropriate complementary foods for infants. NUTRITIONAL MANAGEMENT OF THE SICK CHILD WHO IS NOT MALNOURISHED In most cases, few, if any, modifications of currently recommended feeding practices for infants and young preschool children are required during illness.
|
From page 39... ...
Measles The nutritional recommendation for severe, complicated measles; complicated measles; and uncomplicated measles is to treat with vitamin A This recommendation is based on a recent meta-analysis of community vitamin A supplementation trials, which shows that vitamin A reduced mortality and severe complications after the onset of measles (Beaton et al., 19924.
|
From page 40... ...
40 SICK CHILD INITIA TI HE recommendation to supplement with vitamin A is justifiable if there is a high prevalence of vitamin A deficiency or of measles fatality in the community, which must be decided prior to implementation of the SCI. Mothers of children with severe measles and uncomplicated measles are asked to return to the clinic with the child in 5 days if the child still has a fever; if there is no fever at 5 days, they are asked to return to the clinic in 14 days for a full assessment- including possible malnutrition and for advice on how to feed her child based on the Food Box.
|
Key Terms
This material may be derived from roughly machine-read images, and so is provided only to facilitate research.
More
information on Chapter Skim is available.