INTRODUCTION: Reliable prospective estimates of annual severe acute malnutrition (SAM) caseloads for treatment are needed for policy decisions and planning of quality services in the context of competing public health priorities and limited resources. This paper compares the reliability of SAM caseloads of children 6-59 months of age in Niger estimated from prevalence at the start of the year and counted from incidence at the end of the year. METHODS: Secondary data from two health districts for 2012 and the country overall for 2013 were used to calculate annual caseload of SAM. Prevalence and coverage were extracted from survey reports, and incidence from weekly surveillance systems. RESULTS: The prospective caseload estimate derived from prevalence and duration of illness underestimated the true burden. Similar incidence was derived from two weekly surveillance systems, but differed from that obtained from the monthly system. Incidence conversion factors were two to five times higher than recommended. DISCUSSION: Obtaining reliable prospective caseloads was challenging because prevalence is unsuitable for estimating incidence of SAM. Different SAM indicators identified different SAM populations, and duration of illness, expected contact coverage and population figures were inaccurate. The quality of primary data measurement, recording and reporting affected incidence numbers from surveillance. Coverage estimated in population surveys was rarely available, and coverage obtained by comparing admissions with prospective caseload estimates was unrealistic or impractical. CONCLUSIONS: Caseload estimates derived from prevalence are unreliable and should be used with caution. Policy and service decisions that depend on these numbers may weaken performance of service delivery. Niger may improve SAM surveillance by simplifying and improving primary data collection and methods using innovative information technologies for single data entry at the first contact with the health system. Lessons may be relevant for countries with a high burden of SAM, including for targeted emergency responses
Black Robert E, Victora Cesar G, Walker Susan P, Bhutta Zulfiqar A, Christian Parul, de Onis Mercedes, Ezzati Majid, Grantham-McGregor Sally, Katz Joanne, Martorell Reynaldo, Uauy Ricardo, Maternal and child undernutrition and overweight in low-income and middle-income countries, 10.1016/s0140-6736(13)60937-x
(2009)
United Nations Children's Fund. NutriDash Global report New York: UNICEF; 2014.
Emergency Nutrition Network. Conference on government experiences of community-based management of acute malnutrition and scaling up nutrition: Conference report. 2012.
Deconinck H, De Man J, Macq J. Health systems strengthening for integrating and scaling up management of severe acute malnutrition. Report of a literature review. Brussels: Université catholique de Louvain; 2015.
Würthwein Ralph, Gbangou Adjima, Sauerborn Rainer, Schmidt Christoph M, Measuring the local burden of disease. A study of years of life lost in sub-Saharan Africa, 10.1093/ije/30.3.501
H Deconinck (2014)
(2013)
(2009)
(2012)
(2012)
(2012)
Isanaka S O'Neil Boundy E, Grais R, Myatt M, Briend A. Getting better numbers: Improving estimates of children with severe acute malnutrition with cohort and survey data [submitted for publication]. 2016.
(2013)
(2012)
(2012)
(2012)
SMART. Measuring Mortality, Nutritional Status, and Food Security in Crisis Situations: Standardized monitoring and assessment of relief and transitions (SMART) methodology. 2006.
M Garenne, Public Health Nutrition, 12, 1974 (2009)
(2015)
Isanaka S., Grais R. F., Briend A., Checchi F., Estimates of the Duration of Untreated Acute Malnutrition in Children From Niger, 10.1093/aje/kwq436
(2011)
M Myatt (2012)
M Myatt (2012)
(2010)
(2012)
(2013)
(2014)
Crowe Sonya, Seal Andrew, Grijalva-Eternod Carlos, Kerac Marko, Effect of nutrition survey ‘cleaning criteria’ on estimates of malnutrition prevalence and disease burden: secondary data analysis, 10.7717/peerj.380
Agyepong Irene, Corrah Tumani, Guo Yan, Hollingsworth Bruce, Klag Michael, Longfield Kim, de Fatima Marinho de Souza Maria, Piot Peter, Rao JVR Prasada, Røttingen John-Arne, Smith Peter, Sprenger Marc, Sutton Trevor, Curran Sarah, Ng Edmond SW, Making sense of health estimates, 10.1016/s0140-6736(15)60024-1
Grellety Emmanuel, Krause L Kendall, Shams Eldin Manal, Porten Klaudia, Isanaka Sheila, Comparison of weight-for-height and mid-upper arm circumference (MUAC) in a therapeutic feeding programme in South Sudan: is MUAC alone a sufficient criterion for admission of children at high risk of mortality?, 10.1017/s1368980015000737
Garenne Michel, Willie Douladel, Maire Bernard, Fontaine Olivier, Eeckels Roger, Briend André, Van den Broeck Jan, Incidence and duration of severe wasting in two African populations, 10.1017/s1368980009004972
Rogers Eleanor, Myatt Mark, Woodhead Sophie, Guerrero Saul, Alvarez Jose Luis, Coverage of Community-Based Management of Severe Acute Malnutrition Programmes in Twenty-One Countries, 2012-2013, 10.1371/journal.pone.0128666
The World Bank. The Wold Bank data base.
N Ribesse, Global Health Promotion (2015)
R Pawson (2004)
H Deconinck, Health Policy and Planning (2016)
T Adam, Health Policy and Planning, 27, iv1 (2012)
Bibliographic reference
Deconinck, Hedwig ; Pesonen, Anaïs ; Hallarou, Mahaman ; Gérard, Jean-Christophe ; Briend, André ; et. al. Challenges of Estimating the Annual Caseload of Severe Acute Malnutrition: The Case of Niger. In: PLoS One, Vol. 11, no.9, p. e0162534 [1-13] (2016)
