Change in quality of malnutrition surveys between 1986 and 2015

Background

Representative surveys collecting weight, height and MUAC are used to estimate the prevalence of acute malnutrition. The results are then used to assess the scale of malnutrition in a population and type of nutritional intervention required. There have been changes in methodology over recent decades; the objective of this study was to determine if these have resulted in higher quality surveys.

Methods

In order to examine the change in reliability of such surveys we have analysed the statistical distributions of the derived anthropometric parameters from 1843 surveys conducted by 19 agencies between 1986 and 2015.

Results

With the introduction of standardised guidelines and software by 2003 and their more general application from 2007 the mean standard deviation, kurtosis and skewness of the parameters used to assess nutritional status have each moved to now approximate the distribution of the WHO standards when the exclusion of outliers from analysis is based upon SMART flagging procedure. Where WHO flags, that only exclude data incompatible with life, are used the quality of anthropometric surveys has improved and the results now approach those seen with SMART flags and the WHO standards distribution. Agencies vary in their uptake and adherence to standard guidelines. Those agencies that fully implement the guidelines achieve the most consistently reliable results.

Conclusions

Standard methods should be universally used to produce reliable data and tests of data quality and SMART type flagging procedures should be applied and reported to ensure that the data are credible and therefore inform appropriate intervention. Use of SMART guidelines has coincided with reliable anthropometric data since 2007.

     

Characterization of metalloproteases and serine proteases of Toxoplasma gondii tachyzoites and their effect on epithelial cells

Parasitology Research - Toxoplasma gondii can infect all nucleated cells from warm-blooded organisms. After infection, Toxoplasma spreads throughout the body and migrates across biological...     

A Mixed-Methods Evaluation of a Community-Based Behavior Change Program to Improve Maternal Health Outcomes in the Upper West Region of Ghana

Background: The Community Benefits Health (CBH) program introduced a community-based behavior change intervention to address social norms and cultural practices influencing maternal health and breastfeeding behaviors in rural Ghana. The purpose of this study was to determine if CBH influenced maternal health outcomes by stimulating community-level support in woman’s social networks.

Methods: A mixed-methods study was conducted to evaluate changes in six antenatal/postpartum care, birth attendance, and breastfeeding behaviors in response to the CBH intervention and to assess how the program was implemented and to what extent conditions during implementation influenced the results.

Results: We found increases in five of the six outcomes in both the intervention and control areas. Qualitative findings indicated that this may have resulted from program spillover. We considered the dose of exposure to program activities and found that women were significantly more likely to practice maternal health behaviors with increased exposure to program activities while controlling for study area and time.

Conclusions: Overall, we determined that exposure to the CBH program significantly improved uptake of three of the six study outcomes, indicating that efforts aimed at increasing communication across women and their social networks may lead to improved health outcomes.     

The acceptability and effectiveness of a questionnaire for the identification of risk factors for HIV and hepatitis B and C: An observational study in general practice

Background: Many people in Europe remain undiagnosed for human immunodeficiency virus (HIV), hepatitis B virus (HBV), hepatitis C virus (HCV).

Objectives: To evaluate acceptability and effectiveness of a questionnaire designed to facilitate identification of risk factors for these viruses.

Methods: We performed an observational study, in a prospectively enrolled cohort of patients in Paris (France) seen in 2014. Eighteen GPs administered a questionnaire to the first 50 patients, collecting information about risk factors. GPs were randomized into two groups: A (self-administered questionnaire) and B (GP-administered questionnaire). We used the overall response rate to assess the acceptability of the questionnaire. We used the rate of newly identified risk factors and compared the number of tests performed one year before and immediately after the intervention to assess the effectiveness of the questionnaire.

Results: 842 patients were randomized: 349 (41.5%) in group A and 493 (58.5%) in group B. Acceptability was 88.5% (95%CI: 86.3–90.6); 93.1% (95%CI: 90.5–95.8) in-group A and 85.2% (95%CI: 82.1–88.3) in group B (P?=?0.0004). Prevalence of risk factors was 51.8% (95%CI: 48.2–54.4) and 58.3% were newly identified (95%CI: 52.9–63.7). The number of HIV tests performed during the four weeks after intervention increased by 27% compared to the same period one year before (P?=?0.22). It increased by 113% (P?=?0.005) and 135% (P?=?0.005) for HBV and HCV, respectively.

Conclusion: The questionnaire proved acceptable and effective in identifying risk factors for HIV, HBV and HCV in general practice.     

Oral anomalies in Nigerian children

A total of 2203 Nigerian school-age children (10-19 yr) were examined clinically for the presence of oral anomalies. The following prevalence figures were found: commissural lip pits (2.9%), ankyloglossia (0.2%), geographic tongue (0.3%), fissured tongue (0.8%), torus palatinus (4.5%), torus mandibularis (1.9%), snowcap type amelogenesis imperfecta (0.2%), localized enamel hypomaturation (11.7%), missing lateral incisors (0.7%), and peg lateral incisors (1.5%). None of the following conditions was found: cleft chin, cleft lip, double lip, medium rhomboid glossitis, bifid tongue, macroglossia, cleft palate or cleft lip and palate.