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  • Title: A comparative study of the commonly used nutritional assessment tools for primary health care.
    Author: Asuzu MC.
    Journal: East Afr Med J; 1991 Nov; 68(11):913-22. PubMed ID: 1800086.
    Abstract:
    This is a community-based, cross-sectional study of the three commonly recommended nutritional assessment tools, namely, weight for age (as the Road to Health Chart), weight as a percentage of standard weight for height (as the Thinness Chart), and mid-upper arm circumference (as the Shakir strip). The study was done in the Igbo-ora Community of Oyo-State. Done on 204, one to four year old children, the study shows that all the methods show high levels of correlation with each other's classification of the children. Compared with the Thinness Chart and the physicians standardised clinical assessment, the epidemiological usefulness of the Shakir strip as one point screening tool for severely malnourished children can be improved by the use of 13.5cm rather than the 12.5cm previously recommended at the cut-off point for individuals patient intervention. This cut-off is therefore recommended for the use of the Shakir strip in this locality for the situations where its use is found appropriate. Compared with the other assessment methods, the borderline class interval of the Thinness chart as currently recommended appears too wide. Far too many children, apparently normal even by weight for age, were classified in the borderline category by that instrument. It is therefore recommended that the interval should also be narrowed down for a more adequate use of that instrument in this locality. A physician visited at least 204 1-4 year old children in their homes in Pako and Igbole villages of Igbo-ora town in Oyo State, Nigeria over a 2-month period to measure their weight, height, and mid-upper arm circumferences and to perform a clinical examination to compare the Thinness Chart (the weight as a percentage of standard weight for height) with the Shakir Strip (mid-upper arm circumference). He also intended to compare the classifications of both these assessments with the 1-point categorizations of the Road-to-Health Chart (weight for age). All 3 methods of assessing malnutrition were very highly associated (p.00001). Further, in a comparison of the Shakir Strip and the clinical assessment performed by the physician, the researcher found that the Shakir Strip using the 12.5 cm cut off only identified 3 of the 7 clinically malnourished children. If the cut off would have been 13.5 cm, it would have identified all 7. In comparison with the Thinness Chart, he found the 13.5 cm cut off increased the sensitivity of the Shakir Strip from 16.7-58.3%. he therefore recommended that 13.5 cm be the cut off for undernutrition in Nigeria. In addition, the researcher learned that the Thinness Chart rated too many children as borderline malnourished when, according to the other methods, they were nutritionally normal. Even though prospective studies of health outcome of these children are needed, he suggested reducing the range of the borderline categorization of the Thinness Chart for use in Nigeria. In conclusion, primary health care programs in Nigeria should adapt these changes to more effectively identify children at risk of malnutrition.
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