Cochrane · systematic review · CD015311
Lay health workers in primary and community health care for maternal and child health: identification and treatment of wasting in children
Papadopoulou, E, Lim, YC, Chin, WY, et al. · Cochrane Database of Systematic Reviews · 2023 · Cochrane Library
Effective Practice and Organisation of CareAMSTAR 2: not assessed
SoF tableOnly the outcomes this review put in its Summary of Findings table are listed (the Cochrane Handbook caps them at about seven per comparison). Its other analyses are not shown here.
Questions
39
current version
GRADE rated
23
No studies
16
Included studies
NR
No studies 16 · 41%Ungraded 0 · 0%Very low 11 · 28.2%Low 5 · 12.8%Moderate 6 · 15.4%High 1 · 2.6%
Ungraded means an effect was reported without a GRADE rating; it is not a gap. No studies means the review found nothing to answer the question. The six categories are a display order, not a score.
Questions and results
Summary of findings – Randomised controlled trials
Population: children aged > 6 months and ≤ 5 years with wasting
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Anthropometric recovery: percentage of children who recover from moderate or severe wasting Defined as % children aged 6–59 months who recovered in treatment programmes for moderate or severe malnutrition (Wroe 2021) | no estimate extracted | 1 study · 90 participants | Low Downgraded: risk of bias, imprecision |
Anthropometric recovery: improvement from severe wasting Defined as MUAC ≥ 115 mm, clinically well, absence of oedema for 2 consecutive visits, and minimum stay of 8 weeks in the programme (Hussain 2021) | RR 0.93 [0.86, 0.99] | 1 study · 789 participants | Low Downgraded: risk of bias, imprecision |
Non‐response to treatment Defined as not meeting the criteria for recovery within 4 months Hussain 2021 | RR 1.44 [1.04, 2.01] | 1 study · 789 participants | Low Downgraded: risk of bias, imprecision |
Sustained recovery | no estimate extracted | NR | No studies |
Anthropometric outcomes: number of children with normal or underweight WHZ on discharge Defined as WHZ > −2 (Hussain 2021) | RR 0.94 [0.28, 3.18] | 1 study · 789 participants | Low Downgraded: imprecision |
Anthropometric outcomes: number of children with WHZ in moderate wasting range on discharge Defined as WHZ between −3 and −2 (Hussain 2021) | RR 1.09 [0.87, 1.36] | 1 study · 789 participants | Moderate Downgraded: imprecision |
Anthropometric outcomes: number of children with WHZ in severe wasting range on discharge Defined as WHZ < −3: Hussain 2021 | RR 1.23 [0.75, 2.04] | 1 study · 789 participants | Moderate Downgraded: imprecision |
Anthropometric outcomes: number of children with MUAC ≥ 115 mm on discharge (Hussain 2021) | RR 0.99 [0.93, 1.06] | 1 study · 789 participants | Moderate Downgraded: imprecision |
Anthropometric outcomes: weight gain per day (g/kg/day) Calculated as ((discharge weight − admission weight)/weight on admission)/days in treatment among recovered children (Hussain 2021) | no estimate extracted | 1 study · 571 participants | High |
Relapse Defined as MUAC < 115 mm within 2 months after recovery (Hussain 2021) | RR 1.03 [0.69, 1.54] | 1 study · 649 participants | Moderate Downgraded: imprecision |
Deterioration to severe wasting | no estimate extracted | NR | No studies |
Transfer to inpatient care Defined as referral for complications such as fever, pneumonia, anorexia or dehydration (Hussain 2021) | RR 3.71 [0.36, 38.23] | 1 study · 829 participants | Moderate Downgraded: imprecision |
Mortality among children with severe wasting | RR 0.46 [0.04, 5.98] | 1 study · 829 participants | Low Downgraded: imprecision |
Appropriate identification of children with wasting | no estimate extracted | NR | No studies |
Appropriate identification of children with oedema | no estimate extracted | NR | No studies |
Appropriate referral of children with moderate or severe wasting | no estimate extracted | NR | No studies |
Treatment coverage | no estimate extracted | NR | No studies |
Caregiver adherence to care plans | no estimate extracted | NR | No studies |
Default from care Defined as absence on 2 consecutive visits (Hussain 2021) | RR 1.48 [0.65, 3.4] | 1 study · 829 participants | Moderate Downgraded: imprecision |
Adverse effects and other harms | no estimate extracted | NR | No studies |
Summary of findings – Non‐randomised controlled trials
Population: children aged > 6 months and < 5 years with wasting
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Anthropometric recovery Defined as: WHZ ≥ −1.5 or MUAC > 125 mm for 2 consecutive visits and absence of nutritional oedema for 14 days (Alvarez Moran 2018b); absence of oedema and WHZ ≥ −1.5 or MUAC > 125 mm (Charle‐Cuellar 2021c; no oedema and we... | RR 1.06 [1, 1.11] | 5 studies · 6688 participants | Very low Downgraded: risk of bias, inconsistency |
Non‐response to treatment Defined as: not achieving weight‐for‐height > 85% of ideal or relapse requiring inpatient treatment (Linneman 2007)a; persistent oedema at 21 days or no weight gain in 2 consecutive visits (Ogobara Dougnon 2021)d; not mee... | RR 1.29 [0.93, 1.78] | 3 studies · 3807 participants | Very low Downgraded: risk of bias, imprecision |
Sustained recovery | no estimate extracted | NR | No studies |
Anthropometric outcomes: total MUAC gain Defined as MUAC at discharge − MUAC on admission among children with no oedema and discharged as cured (Charle‐Cuellar 2021)c | no estimate extracted | 1 study · 532 participants | Very low Downgraded: risk of bias, imprecision |
Anthropometric outcomes: MUAC gain per day Defined as (discharge MUAC − admission MUAC)/days in treatment among children with no oedema and discharged as cured (Charle‐Cuellar 2021)c | no estimate extracted | 1 study · 531 participants | Very low Downgraded: risk of bias, imprecision |
Anthropometric outcomes: total weight gain (g/kg) Defined as (weight at discharge − weight on admission)/weight on admission among children with no oedema and discharged as cured (Charle‐Cuellar 2021)c | no estimate extracted | 1 study · 517 participants | Very low Downgraded: risk of bias, imprecision |
Anthropometric outcomes: mean weight gain per day (g/kg/d) Defined as ((discharge weight − admission weight)/admission weight)/days in treatment (Wilunda 2021)e | no estimate extracted | 1 study · 343 participants | Very low Downgraded: risk of bias |
Anthropometric outcomes: median weight gain per day (g/kg/d) Defined as ((discharge weight − admission weight)/weight on admission)/days on treatment among children with no oedema and discharged as cured (Charle‐Cuellar 2021)c | no estimate extracted | 1 study · 517 participants | Very low Downgraded: risk of bias, imprecision |
Relapse | no estimate extracted | NR | No studies |
Deterioration to severe wasting | no estimate extracted | NR | No studies |
Transfer to inpatient care Defined as referral for: presence of danger signs and failed appetite test on first day of treatment (Alvarez Moran 2018)b; appearance of severe signs of illness, persistent oedema, absence of weight gain in non‐oedemato... | RR 1.42 [1.04, 1.95] | 4 studies · 4739 participants | Very low Downgraded: risk of bias |
Mortality among children with wasting | RR 0.89 [0.56, 1.44] | 5 studies · 6688 participants | Very low Downgraded: risk of bias, imprecision |
Appropriate identification of children with wasting | no estimate extracted | NR | No studies |
Appropriate identification of children with oedema | no estimate extracted | NR | No studies |
Appropriate referral of children with moderate or severe wasting | no estimate extracted | NR | No studies |
Treatment coverage Defined as proportion of children with SAM who receive treatment (number of children treated from baseline to endline; Wilunda 2021)e | RR 1.94 [1.62, 2.32] | 1 study · 445 participants | Very low Downgraded: risk of bias |
Caregiver adherence to care plans | no estimate extracted | NR | No studies |
Default from care Defined as: absence on 2 | RR 0.57 [0.4, 0.82] | 5 studies · 6688 participants | Very low Downgraded: risk of bias, inconsistency |
Adverse effects and other harms | no estimate extracted | NR | No studies |