Prognostic Accuracy of WHO Growth Standards to Predict Mortality in a Large-Scale Nutritional Program in Niger 英文参考文献.docVIP

o PL SMEDICINE PrognosticAccuracyofWHOGrowthStandards toPredictMortalityinaLarge-Scale NutritionalPrograminNiger Nathanael Lapidus1,Francisco J.Luquero1,2,Vale′rie Gaboulaud1,Susan Shepherd3,Rebecca F.Grais1* 1Epicentre,Paris,France,2EuropeanProgrammeforInterventionEpidemiologyTraining(EPIET),EuropeanCentreforDiseasePreventionandControl(ECDC),Stockholm, Sweden,3Me′decinsSansFrontie`res,Paris,France Funding:Thisresearchwasfunded byMe′decinsSansFrontie`resandthe UnitedNationsSystemStanding CommitteeonNutrition(SCN).The fundershadnoroleinthestudy design,datacollectionandanalysis, decisiontopublish,orpreparation ofthemanuscript. ABSTRACT Background Importantdifferencesexistinthediagnosisofmalnutritionwhencomparingthe2006World HealthOrganization(WHO)ChildGrowthStandardsandthe1977NationalCenterforHealth Statistics (NCHS) reference. However, their relationship with mortality has not been studied. Here,weassessedtheaccuracyoftheWHOstandardsandtheNCHSreferenceinpredicting deathinapopulationofmalnourishedchildreninalargenutritionalprograminNiger. CompetingInterests:Theauthors havedeclaredthatnocompeting interestsexist. AcademicEditor:AndrewSeal, InstituteofChildHealth,United Kingdom MethodsandFindings We analyzed data from 64,484 children aged 6–59 mo admitted with malnutrition (,80% weight-for-height percentage of the median [WH]% [NCHS] and/or mid-upper arm circum- ference [MUAC] ,110 mm and/or presence of edema) in 2006 into the Me′decins Sans Frontie`res (MSF)nutritionalprograminMaradi,Niger.Sensitivityandspecificityofweight-for- heightintermsofZscore(WHZ)andWH%forbothWHOstandardsandNCHSreferencewere calculatedusingmortalityasthegoldstandard.SensitivityandspecificityofMUACwerealso calculated.Thereceiveroperatingcharacteristic(ROC)curvewastracedforthesecutoffsandits area under curve (AUC) estimated. In predicting mortality, WHZ (NCHS) and WH% (NCHS) showed AUC values of 0.63 (95% confidence interval [CI] 0.60–0.66) and 0.71 (CI 0.68–0.74), respectively. WHZ (WHO) and W