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      The Forgotten Agenda of Wasting in Southeast Asia: Burden, Determinants and Overlap with Stunting: A Review of Nationally Representative Cross-Sectional Demographic and Health Surveys in Six Countries

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          Abstract

          Childhood wasting is among the most prevalent forms of undernutrition globally. The Southeast Asia region is home to many wasted children, but wasting is not recognized as a public health problem and its epidemiology is yet to be fully examined. This analysis aimed to determine the burden of wasting, its predictors, and the level of wasting and stunting concurrence. Datasets from Demographic and Health Surveys and Multiple Indicator Cluster Surveys in six countries in the region were analyzed. The pooled weighted prevalence for wasting and concurrent wasting and stunting among children 0–59 months in the six countries was 8.9%, 95% CI (8.0–9.9) and 1.6%, 95% CI (1.5–1.8), respectively. This prevalence is approximately 12-fold higher than the 0.7% prevalence of high-income countries; and translated into an absolute number of 1,088,747 children affected by wasting and 272,563 concurrent wasting and stunting. Wasting prevalence was 50 percent higher in the 0–23-month age group. Predictors for wasting included source of drinking water, wealth index, urban residence, child’s age and history of illness and mother’s body mass index. In conclusion, our analysis showed that wasting is a serious public health problem in the region that should be addressed urgently using both preventive and curative approaches.

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          Most cited references57

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          Maternal and child undernutrition and overweight in low-income and middle-income countries

          The Lancet, 382(9890), 427-451
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            Evidence-based interventions for improvement of maternal and child nutrition: what can be done and at what cost?

            The Lancet, 382(9890), 452-477
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              Management of severe acute malnutrition in children.

              Severe acute malnutrition (SAM) is defined as a weight-for-height measurement of 70% or less below the median, or three SD or more below the mean National Centre for Health Statistics reference values, the presence of bilateral pitting oedema of nutritional origin, or a mid-upper-arm circumference of less than 110 mm in children age 1-5 years. 13 million children under age 5 years have SAM, and the disorder is associated with 1 million to 2 million preventable child deaths each year. Despite this global importance, child-survival programmes have ignored SAM, and WHO does not recognise the term "acute malnutrition". Inpatient treatment is resource intensive and requires many skilled and motivated staff. Where SAM is common, the number of cases exceeds available inpatient capacity, which limits the effect of treatment; case-fatality rates are 20-30% and coverage is commonly under 10%. Programmes of community-based therapeutic care substantially reduce case-fatality rates and increase coverage rates. These programmes use new, ready-to-use, therapeutic foods and are designed to increase access to services, reduce opportunity costs, encourage early presentation and compliance, and thereby increase coverage and recovery rates. In community-based therapeutic care, all patients with SAM without complications are treated as outpatients. This approach promises to be a successful and cost-effective treatment strategy.
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                Author and article information

                Journal
                Nutrients
                Nutrients
                nutrients
                Nutrients
                MDPI
                2072-6643
                20 February 2020
                February 2020
                : 12
                : 2
                : 559
                Affiliations
                [1 ]United Nations Children’s Fund (UNICEF) East Asia Pacific Regional Office, Bangkok 10200, Thailand
                [2 ]Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine (LSHTM), London WC1E 7HT, UK; severine.frison@ 123456lshtm.ac.uk
                [3 ]Bergen Center for Ethics and Priority Setting (BCEPS), University of Bergen, 5009 Bergen, Norway; matteorava.moh@ 123456gmail.com
                [4 ]Centre de Recherche en Epidémiologie, Biostatistique et Recherche Clinique, Ecole de santé publique, Université Libre de Bruxelles, 1080 Brussels, Belgium; paluku.bahwere@ 123456ulb.ac.be
                Author notes
                [* ]Correspondence: mmutunga@ 123456unicef.org
                Article
                nutrients-12-00559
                10.3390/nu12020559
                7071426
                32093376
                fdf9562a-aa01-44d3-af39-cc00352f1316
                © 2020 by the authors.

                Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license ( http://creativecommons.org/licenses/by/4.0/).

                History
                : 09 January 2020
                : 03 February 2020
                Categories
                Article

                Nutrition & Dietetics
                wasting,severe wasting,wasting and stunting,prevalence,burden,southeast asia,dhs,mics,risk factors,under five

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