Impact of the shift from NCHS growth reference to WHO(2006) growth standards in a therapeutic feeding programme in Niger.
OBJECTIVE
To describe the implementation of the WHO(2006) growth standards in a therapeutic feeding programme.


METHODS
Using programme monitoring data from 21,769 children 6-59 months admitted to the Médecins Sans Frontières therapeutic feeding programme during 2007, we compared characteristics at admission, type of care and outcomes for children admitted before and after the shift to the WHO(2006) standards. Admission criteria were bipedal oedema, MUAC <110 mm, or weight-for-height (WFH) of <-70% of the median (NCHS) before mid-May 2007, and WFH <-3 z score (WHO(2006)) after mid-May 2007.


RESULTS
Children admitted with the WHO(2006) standards were more likely to be younger, with a higher proportion of males, and less malnourished (mean WFH -3.6 z score vs. mean WFH -4.6 z score). They were less likely to require hospitalization or intensive care (28.4%vs. 77%; 12.8%vs. 36.5%) and more likely to be treated exclusively on an outpatient basis (71.6%vs. 23%). Finally, they experienced better outcomes (cure rate: 89%vs. 71.7%, death rate: 2.7%vs. 6.4%, default rate: 6.7%vs. 12.3%).


CONCLUSIONS
In this programme, the WHO(2006) standards identify a larger number of malnourished children at an earlier stage of disease facilitating their treatment success.
Minetti
A
A
Epicentre, 75011 Paris, France. andrea.minetti@epicentre.msf.org
Shams Eldin
M
M
Defourny
I
I
Harczi
G
G
D000886:Anthropometry / Q000379:methods; D002657:Child Development; D002675:Child, Preschool; D004487:Edema / Q000517:prevention & control / Q000628:therapy*; D005260:Female; D006128:Growth; D006130:Growth Disorders / Q000517:prevention & control / Q000628:therapy*; D006801:Humans; D007223:Infant; D008297:Male; D044342:Malnutrition / Q000628:therapy*; D009309:National Center for Health Statistics, U.S.; D009548:Niger; D009749:Nutrition Surveys; D011379:Prognosis; D012015:Reference Standards; D012066:Relief Work; D014481:United States; D014944:World Health Organization