Skip to main content
Top
Published in: Archives of Public Health 1/2017

Open Access 01-12-2017 | Methodology

Improving estimates of the burden of severe acute malnutrition and predictions of caseload for programs treating severe acute malnutrition: experiences from Nigeria

Authors: Assaye Bulti, André Briend, Nancy M. Dale, Arjan De Wagt, Faraja Chiwile, Stanley Chitekwe, Chris Isokpunwu, Mark Myatt

Published in: Archives of Public Health | Issue 1/2017

Login to get access

Abstract

Background

The burden of severe acute malnutrition (SAM) is estimated using unadjusted prevalence estimates. SAM is an acute condition and many children with SAM will either recover or die within a few weeks. Estimating SAM burden using unadjusted prevalence estimates results in significant underestimation. This has a negative impact on allocation of resources for the prevention and treatment of SAM. A simple method for adjusting prevalence estimates intended to improve the accuracy of burden estimates and caseload predictions has been proposed. This method employs an incidence correction factor. Application of this method using the globally recommended incidence correction factor has led to programs underestimating burden and caseload in some settings.

Methods

A method for estimating a locally appropriate incidence correction factor from prevalence, population size, program caseload, and program coverage was developed and tested using data from the Nigerian national SAM treatment program.

Results

Applying the developed method resulted in errors in caseload prediction of about 10%. This is a considerable improvement upon the current method, which resulted in a 79.5% underestimate. Methods for improving the precision of estimates are proposed.

Conclusions

It is possible to considerably improve predictions of caseload by applying a simple model to data that are readily available to program managers. This implies that more accurate estimates of burden may also be made using the same methods and data.
Appendix
Available only for authorised users
Literature
1.
go back to reference Anon, WHO child growth standards and the identification of severe acute malnutrition in infants: A joint statement by the World Health Organisation and the United Nations Children’s Fund, WHO, Geneva, 2009. Anon, WHO child growth standards and the identification of severe acute malnutrition in infants: A joint statement by the World Health Organisation and the United Nations Children’s Fund, WHO, Geneva, 2009.
2.
go back to reference Anon, Level and Trend in Acute Malnutrition, UNICEF / WHO / World Bank Group Joint Child Malnutrition Estimates: Key findings of the 2016 edition, Data and Analytics Section of the Division of Data, Research and Policy, UNICEF New York; the Department of Nutrition for Health and Development, WHO Geneva; and the Development Data Group of the World Bank, Washington DC, September 2016. Anon, Level and Trend in Acute Malnutrition, UNICEF / WHO / World Bank Group Joint Child Malnutrition Estimates: Key findings of the 2016 edition, Data and Analytics Section of the Division of Data, Research and Policy, UNICEF New York; the Department of Nutrition for Health and Development, WHO Geneva; and the Development Data Group of the World Bank, Washington DC, September 2016.
3.
go back to reference Myatt M, Khara T, Collins S. A review of methods to detect cases of severely malnourished children in the community for their admission into community-based therapeutic care programs. Food Nutr Bull. 2006;27(3):S7–S23.CrossRefPubMed Myatt M, Khara T, Collins S. A review of methods to detect cases of severely malnourished children in the community for their admission into community-based therapeutic care programs. Food Nutr Bull. 2006;27(3):S7–S23.CrossRefPubMed
4.
go back to reference Briend A, Collins S, Golden M, Manary M, Myatt M, Maternal and child nutrition, Lancet, November 2013:382(9904):1549. Briend A, Collins S, Golden M, Manary M, Myatt M, Maternal and child nutrition, Lancet, November 2013:382(9904):1549.
5.
go back to reference Hure A, Oldmeadow C, Attia J. Invited commentary: improving estimates of severe acute malnutrition requires more data. Am J Epidemiol. 2016;184(12):870–2.CrossRefPubMed Hure A, Oldmeadow C, Attia J. Invited commentary: improving estimates of severe acute malnutrition requires more data. Am J Epidemiol. 2016;184(12):870–2.CrossRefPubMed
6.
go back to reference Isanaka S, Grais RF, Briend A, Checchi F. Estimates of the duration of untreated acute malnutrition in children from Niger. Am J Epidemiol. 2011;173(8):932–40.CrossRefPubMed Isanaka S, Grais RF, Briend A, Checchi F. Estimates of the duration of untreated acute malnutrition in children from Niger. Am J Epidemiol. 2011;173(8):932–40.CrossRefPubMed
7.
go back to reference Glaser AN, High yield™ biostatistics (3rd Ed.), Lippincott Williams & Wilkins, Baltimore, Md., USA, 2005. Glaser AN, High yield™ biostatistics (3rd Ed.), Lippincott Williams & Wilkins, Baltimore, Md., USA, 2005.
8.
go back to reference Myatt M. How do we estimate case load for SAM and / or MAM in children 6–59 months in a given time period? Llawryglyn: Brixton Health; 2012. Myatt M. How do we estimate case load for SAM and / or MAM in children 6–59 months in a given time period? Llawryglyn: Brixton Health; 2012.
9.
go back to reference MacMahon B, Pugh TF. Epidemiology principles and methods. Boston, USA: Little Brown & Company; 1970. MacMahon B, Pugh TF. Epidemiology principles and methods. Boston, USA: Little Brown & Company; 1970.
10.
go back to reference Golden M, Brennan M, Brennan R, Kaiser Rm, Colleen M, Nathan R, Robinson C, Woodruff B, Sean J, Erhardt J, Measuring Mortality, Nutritional Status, and Food Security in Crisis Situations: SMART METHODOLOGY (Version 1), CIDA / USAID / UNICEF, April 2006. Golden M, Brennan M, Brennan R, Kaiser Rm, Colleen M, Nathan R, Robinson C, Woodruff B, Sean J, Erhardt J, Measuring Mortality, Nutritional Status, and Food Security in Crisis Situations: SMART METHODOLOGY (Version 1), CIDA / USAID / UNICEF, April 2006.
11.
go back to reference Clopper CJ, Pearson ES. The use of confidence or fiducial limits illustrated in the case of the binomial. Biometrika. 1934;26:404–13.CrossRef Clopper CJ, Pearson ES. The use of confidence or fiducial limits illustrated in the case of the binomial. Biometrika. 1934;26:404–13.CrossRef
13.
go back to reference Garenne M, Willie D, Maire B, Fontaine O, Eeckels R, Briend A, Van den Broeck J. Incidence and duration of severe wasting in two African populations. Public Health Nutr. 2009;12(11):1974–82.CrossRefPubMed Garenne M, Willie D, Maire B, Fontaine O, Eeckels R, Briend A, Van den Broeck J. Incidence and duration of severe wasting in two African populations. Public Health Nutr. 2009;12(11):1974–82.CrossRefPubMed
14.
go back to reference Deconinck H, Pesonen A, Hallarou M, Gérar JC, Briend A, Donnen P, Macq J. Challenges of estimating the annual caseload of severe acute malnutrition: the case of Niger. PLoS One. 2016;11(9):1–13.CrossRef Deconinck H, Pesonen A, Hallarou M, Gérar JC, Briend A, Donnen P, Macq J. Challenges of estimating the annual caseload of severe acute malnutrition: the case of Niger. PLoS One. 2016;11(9):1–13.CrossRef
15.
go back to reference Isanaka S, Boundy EO, Grais RF, Myatt M, Briend A. Improving Estimates of Numbers of Children With Severe Acute Malnutrition Using Cohort and Survey Data, AJE. 2016;184(12)1–9. Isanaka S, Boundy EO, Grais RF, Myatt M, Briend A. Improving Estimates of Numbers of Children With Severe Acute Malnutrition Using Cohort and Survey Data, AJE. 2016;184(12)1–9.
16.
go back to reference Dale NM, Myatt M, Prudhon C, Briend A. Using cross-sectional surveys to estimate the number of severely malnourished children needing to be enrolled in specific treatment programmes. Public Health Nutr. 2017;24:1–5. Dale NM, Myatt M, Prudhon C, Briend A. Using cross-sectional surveys to estimate the number of severely malnourished children needing to be enrolled in specific treatment programmes. Public Health Nutr. 2017;24:1–5.
17.
go back to reference Aho KA, Bowyer RT. Confidence intervals for a product of proportions: application to importance values. Ecosphere. 2015;6(11):1–7.CrossRef Aho KA, Bowyer RT. Confidence intervals for a product of proportions: application to importance values. Ecosphere. 2015;6(11):1–7.CrossRef
18.
go back to reference Kish L. Survey sampling. New York: Wiley; 1965. Kish L. Survey sampling. New York: Wiley; 1965.
19.
go back to reference Raiffa H, Schlaifer R. Applied statistical decision theory. Cambridge: Division of Research, Graduate School of Business Administration, Harvard University; 1961. Raiffa H, Schlaifer R. Applied statistical decision theory. Cambridge: Division of Research, Graduate School of Business Administration, Harvard University; 1961.
20.
go back to reference Anon, Nigeria National Nutrition and health survey 2014, Nigeria National Bureau of Statistics, Abuja, Nigeria, 2014. Anon, Nigeria National Nutrition and health survey 2014, Nigeria National Bureau of Statistics, Abuja, Nigeria, 2014.
21.
go back to reference Anon, Nigeria National Nutrition and health survey 2015, Nigeria National Bureau of statistics, Abuja, Nigeria, 2015. Anon, Nigeria National Nutrition and health survey 2015, Nigeria National Bureau of statistics, Abuja, Nigeria, 2015.
22.
go back to reference Myatt M, Feleke T, Sadler K, Collins S. A field trial of a survey method for estimating the coverage of selective feeding programmes. Bull World Health Organ. 2006;83(1):20–6. Myatt M, Feleke T, Sadler K, Collins S. A field trial of a survey method for estimating the coverage of selective feeding programmes. Bull World Health Organ. 2006;83(1):20–6.
23.
go back to reference Aaron GJ, Sodani PR, Sankar R, Fairhurst J, Siling K, Guevarra E, Norris A, Myatt M. Household coverage of fortified staple food Commodities in Rajasthan, India. PLoS One. 2016;11(10):1–19. Aaron GJ, Sodani PR, Sankar R, Fairhurst J, Siling K, Guevarra E, Norris A, Myatt M. Household coverage of fortified staple food Commodities in Rajasthan, India. PLoS One. 2016;11(10):1–19.
24.
go back to reference Aaron GJ, Strutt N, Boateng NA, Guevarra E, Siling K, Norris A, Ghosh S, Nyamikeh M, Attiogbe A, Burns R, Foriwa E, Toride Y, Kitamura A, Tano-Debrah K, Sarpong D, Myatt M. Assessing program coverage of two approaches to distributing a complementary feeding supplement to infants and young children in Ghana. PLoS One. 2016;11(10):1–19. Aaron GJ, Strutt N, Boateng NA, Guevarra E, Siling K, Norris A, Ghosh S, Nyamikeh M, Attiogbe A, Burns R, Foriwa E, Toride Y, Kitamura A, Tano-Debrah K, Sarpong D, Myatt M. Assessing program coverage of two approaches to distributing a complementary feeding supplement to infants and young children in Ghana. PLoS One. 2016;11(10):1–19.
25.
go back to reference Anon, 2006 Population and housing census of the Federal Republic of Nigeria, Nigeria National Population Commission, Abuja, Nigeria, 2009. Anon, 2006 Population and housing census of the Federal Republic of Nigeria, Nigeria National Population Commission, Abuja, Nigeria, 2009.
26.
go back to reference Banda C, Shaba B, Balegamire S, Sogoba M, Guevarra E, Fieschi L, Simplified Lot Quality Assurance Sampling Evaluation of Access and Coverage (SLEAC) Survey of Community Management of Acute Malnutrition program, Northern States of Nigeria, VALID International, Oxford, UK, 2014. Banda C, Shaba B, Balegamire S, Sogoba M, Guevarra E, Fieschi L, Simplified Lot Quality Assurance Sampling Evaluation of Access and Coverage (SLEAC) Survey of Community Management of Acute Malnutrition program, Northern States of Nigeria, VALID International, Oxford, UK, 2014.
27.
go back to reference Guevarra E, Guerrero S, Myatt M. Using SLEAC as a wide-area survey method. Field Exchange. 2012;42:39–44. Guevarra E, Guerrero S, Myatt M. Using SLEAC as a wide-area survey method. Field Exchange. 2012;42:39–44.
28.
go back to reference R Code Team, R: a language and environment for statistical computing, R Foundation for Statistical Computing, Vienna, Austria, 2017. R Code Team, R: a language and environment for statistical computing, R Foundation for Statistical Computing, Vienna, Austria, 2017.
29.
go back to reference Efron B. Tibshirani, an introduction to the bootstrap. London: Chapman & Hall; 1993.CrossRef Efron B. Tibshirani, an introduction to the bootstrap. London: Chapman & Hall; 1993.CrossRef
30.
go back to reference Carpenter J, Bithell J. Bootstrap confidence intervals: when, which, what? A practical guide for medical statisticians. Stat Med. 2000 May 15;19(9):1141–64.CrossRefPubMed Carpenter J, Bithell J. Bootstrap confidence intervals: when, which, what? A practical guide for medical statisticians. Stat Med. 2000 May 15;19(9):1141–64.CrossRefPubMed
31.
go back to reference World Health Organization. WHO technical report series 854. Physical status: the use and interpretation of anthropometry. Report of a WHO expert committee. Geneva: World Health Organization; 1995. World Health Organization. WHO technical report series 854. Physical status: the use and interpretation of anthropometry. Report of a WHO expert committee. Geneva: World Health Organization; 1995.
32.
go back to reference Dale NM, Myatt M, Prudhon C, Briend A. Assessment of the PROBIT approach for estimating the prevalence of global, moderate and severe acute malnutrition from population surveys. Public Health Nutr. 2013 May;16(5):858–63.CrossRefPubMed Dale NM, Myatt M, Prudhon C, Briend A. Assessment of the PROBIT approach for estimating the prevalence of global, moderate and severe acute malnutrition from population surveys. Public Health Nutr. 2013 May;16(5):858–63.CrossRefPubMed
33.
go back to reference Blanton CJ, Bilukha OO. The PROBIT approach in estimating the prevalence of wasting: revisiting bias and precision. Emerg Themes Epidemiol. 2013;10(1):8.CrossRefPubMedPubMedCentral Blanton CJ, Bilukha OO. The PROBIT approach in estimating the prevalence of wasting: revisiting bias and precision. Emerg Themes Epidemiol. 2013;10(1):8.CrossRefPubMedPubMedCentral
34.
go back to reference Altmann M, Fermanian C, Jiao B, Altare C, Loada M, Myatt M. Nutrition surveillance using a small open cohort: experience from Burkina Faso. Emerg Themes Epidemiol. 2016;13(1):745.CrossRef Altmann M, Fermanian C, Jiao B, Altare C, Loada M, Myatt M. Nutrition surveillance using a small open cohort: experience from Burkina Faso. Emerg Themes Epidemiol. 2016;13(1):745.CrossRef
Metadata
Title
Improving estimates of the burden of severe acute malnutrition and predictions of caseload for programs treating severe acute malnutrition: experiences from Nigeria
Authors
Assaye Bulti
André Briend
Nancy M. Dale
Arjan De Wagt
Faraja Chiwile
Stanley Chitekwe
Chris Isokpunwu
Mark Myatt
Publication date
01-12-2017
Publisher
BioMed Central
Published in
Archives of Public Health / Issue 1/2017
Electronic ISSN: 2049-3258
DOI
https://doi.org/10.1186/s13690-017-0234-4

Other articles of this Issue 1/2017

Archives of Public Health 1/2017 Go to the issue