LaCourse Sylvia M, Chester Frances M, Preidis Geoffrey, McCrary Leah M, Maliwichi Madalitso, McCollum Eric D, Hosseinipour Mina C
Department of Medicine, Division of Allergy and Infectious Diseases, University of Washington, Seattle, WA 98195, USA UNC Project, Lilongwe, Malawi
UNC Project, Lilongwe, Malawi.
J Trop Pediatr. 2015 Feb;61(1):44-53. doi: 10.1093/tropej/fmu065. Epub 2014 Dec 3.
Strategies to effectively identify and refer children with severe acute malnutrition (SAM) to Nutritional Rehabilitation units (NRU) can reduce morbidity and mortality.
From December 2011 to May 2012, we conducted a prospective study task-shifting inpatient malnutrition screening of Malawian children 6-60 months to lay-screeners and evaluated World Health Organization (WHO) criteria vs. the National Center for Health Statistics (NCHS) guidelines for SAM.
Lay-screeners evaluated 3116 children, identifying 368 (11.8%) with SAM by WHO criteria, including 210 (6.7%) who met NCHS criteria initially missed by standard clinician NRU referrals. Overall case finding increased by 56.7%. Mid-upper arm circumference (MUAC) and bipedal edema captured 86% (181/210) NCHS/NRU-eligible children and 89% of those who died (17/19) meeting WHO criteria. Mortality of NCHS/NRU-eligible children was 10 times greater than those without SAM (odds ratio 10.5, 95% confidence interval 5.4-20.6).
Ward-based lay-screeners and WHO guidelines identified high-risk children with SAM missed by standard NRU referral. MUAC and edema detected the majority of NRU-eligible children.
有效识别患有重度急性营养不良（SAM）的儿童并将其转诊至营养康复单位（NRU）的策略可降低发病率和死亡率。
2011年12月至2012年5月，我们开展了一项前瞻性研究，将6至60个月马拉维儿童的住院营养不良筛查任务转移给非专业筛查人员，并评估了世界卫生组织（WHO）标准与美国国家卫生统计中心（NCHS）的SAM指南。
非专业筛查人员评估了3116名儿童，根据WHO标准识别出368名（11.8%）患有SAM的儿童，其中包括210名（6.7%）符合NCHS标准但最初被标准临床医生转诊至NRU时遗漏的儿童。总体病例发现率提高了56.7%。上臂中部周长（MUAC）和双足水肿筛查出86%（181/210）符合NCHS/NRU标准的儿童，以及89%符合WHO标准且死亡的儿童（17/19）。符合NCHS/NRU标准的儿童死亡率比无SAM的儿童高10倍（优势比10.5，95%置信区间5.4 - 20.6）。
基于病房的非专业筛查人员和WHO指南识别出了标准NRU转诊遗漏的患有SAM的高危儿童。MUAC和水肿筛查出了大多数符合NRU标准的儿童。
