title: Lay-screeners and use of WHO growth standards increase case finding of hospitalized Malawian children with severe acute malnutrition.
abstract: OBJECTIVE
  Strategies to effectively identify and refer children with severe acute malnutrition (SAM) to Nutritional Rehabilitation units (NRU) can reduce morbidity and mortality.
  
  
  METHODS
  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.
  
  
  RESULTS
  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).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Medicine, Division of Allergy and Infectious Diseases, University of Washington, Seattle, WA 98195, USA UNC Project, Lilongwe, Malawi sylvial2@uw.edu.
authors.forename: Sylvia M
authors.initials: SM
authors.lastname: LaCourse
authors.affiliation: UNC Project, Lilongwe, Malawi.
authors.forename: Frances M
authors.initials: FM
authors.lastname: Chester
authors.affiliation: Department of Pediatrics, Baylor College of Medicine, Houston, TX 77030, USA.
authors.forename: Geoffrey
authors.initials: G
authors.lastname: Preidis
authors.affiliation: UNC Project, Lilongwe, Malawi University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC 27516, USA.
authors.forename: Leah M
authors.initials: LM
authors.lastname: McCrary
authors.affiliation: UNC Project, Lilongwe, Malawi.
authors.forename: Madalitso
authors.initials: M
authors.lastname: Maliwichi
authors.affiliation: UNC Project, Lilongwe, Malawi Department of Pediatrics, Division of Pulmonology, Johns Hopkins School of Medicine, Baltimore, MD 21287, USA.
authors.forename: Eric D
authors.initials: ED
authors.lastname: McCollum
authors.affiliation: UNC Project, Lilongwe, Malawi Department of Medicine, Division of Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA.
authors.forename: Mina C
authors.initials: MC
authors.lastname: Hosseinipour
mesh_terms: D000886:Anthropometry / Q000379:methods*; D001132:Arm / Q000033:anatomy & histology*; D002648:Child; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D007223:Infant; D008295:Malawi; D008297:Male; D044342:Malnutrition / Q000175:diagnosis* / Q000628:therapy; D008403:Mass Screening / Q000592:standards*; D009749:Nutrition Surveys; D009752:Nutritional Status; D017410:Practice Guidelines as Topic; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012016:Reference Values; D014944:World Health Organization
keywords: Malawi; National Center for Health Statistics (NCHS) growth reference; WHO growth standard; malnutrition screening; mid-upper arm circumference (MUAC); task-shifting