Am J Epidemiol. 2020 Dec 1;189(12):1623-1627. doi: 10.1093/aje/kwaa139.
Child acute malnutrition (AM) is an important cause of child mortality. Accurately estimating its burden requires cumulative incidence data from longitudinal studies, which are rarely available in low-income settings. In the absence of such data, the AM burden is approximated using prevalence estimates from cross-sectional surveys and the incidence correction factor $K$, obtained from the few available cohorts that measured AM. We estimated $K$ factors for severe acute malnutrition (SAM) and moderate acute malnutrition (MAM) from AM incidence and prevalence using representative cross-sectional baseline and longitudinal data from 2 cluster-randomized controlled trials (Innovative Approaches for the Prevention of Childhood Malnutrition-PROMIS) conducted between 2014 and 2017 in Burkina Faso and Mali. We compared K estimates using complete (weight-for-length z score, mid-upper arm circumference (MUAC), and edema) and partial (MUAC, edema) definitions of SAM and MAM. $K$ estimates for SAM were 9.4 and 5.7 in Burkina Faso and in Mali, respectively; K estimates for MAM were 4.7 in Burkina Faso and 5.1 in Mali. The MUAC and edema-based definition of AM did not lead to different $K$ estimates. Our results suggest that $K$ can be reliably estimated when only MUAC and edema-based data are available. Additional studies, however, are required to confirm this finding in different settings.
儿童急性营养不良(AM)是儿童死亡的一个重要原因。准确估计其负担需要来自纵向研究的累积发病率数据,但在低收入环境中,此类数据很少。在缺乏此类数据的情况下,可使用来自横断面调查的患病率估计值和从少数有测量 AM 的队列中获得的发病率校正系数$K$来近似 AM 负担。我们使用 2014 年至 2017 年在布基纳法索和马里进行的 2 项集群随机对照试验(预防儿童营养不良创新方法-PROMIS)的代表性横断面基线和纵向数据,根据 AM 的发病率和患病率估计了严重急性营养不良(SAM)和中度急性营养不良(MAM)的$K$系数。我们比较了使用 SAM 和 MAM 的完全(体重长度 Z 评分、上臂中部周长(MUAC)和水肿)和部分(MUAC、水肿)定义的 K 估计值。布基纳法索和马里的 SAM 的 K 估计值分别为 9.4 和 5.7;布基纳法索的 MAM 的 K 估计值为 4.7,马里为 5.1。基于 MUAC 和水肿的 AM 定义不会导致不同的 K 估计值。我们的结果表明,当只有基于 MUAC 和水肿的数据时,可以可靠地估计 K。然而,需要进行更多研究以在不同环境中证实这一发现。