{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,29]],"date-time":"2025-10-29T19:37:35Z","timestamp":1761766655280},"reference-count":47,"publisher":"American Society of Tropical Medicine and Hygiene","issue":"2","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2020,2,5]]},"abstract":"<jats:p>Children with malnutrition compared with those without are at higher risk of infection, with more severe outcomes. How clinicians assess nutritional risk factors in febrile children in primary care varies. We conducted a post hoc subgroup analysis of febrile children with severe malnutrition enrolled in a randomized, controlled trial in primary care centers in Tanzania. The clinical outcome of children with severe malnutrition defined by anthropometric measures and clinical signs was compared between two electronic clinical diagnostic algorithms: ePOCT, which uses weight-for-age and mid-upper arm circumference to identify and manage severe malnutrition, and ALMANACH, which uses the clinical signs of edema of both feet and visible severe wasting. Those identified as having severe malnutrition by the algorithms in each arm were prescribed antibiotics and referred to the hospital. From December 2014 to February 2016, 106 febrile children were enrolled and randomized in the parent study, and met the criteria to be included in the present analysis. ePOCT identified 56\/57 children with severe malnutrition using anthropometric measures, whereas ALMANACH identified 2\/49 children with severe malnutrition using clinical signs. The proportion of clinical failure, defined as the development of severe symptoms by day 7 or persisting symptoms at day 7 (per-protocol), was 1.8% (1\/56) in the ePOCT arm versus 16.7% (8\/48) in the Algorithm for the MANagement of Childhood illnesses arm (risk difference \u221214.9%, 95% CI \u221226.0%, \u22123.8%; risk ratio 0.11, 95% CI 0.01, 0.83). Using anthropometric measures to identify and manage febrile children with severe malnutrition may have resulted in better clinical outcomes than by using clinical signs alone.<\/jats:p>","DOI":"10.4269\/ajtmh.19-0553","type":"journal-article","created":{"date-parts":[[2019,12,3]],"date-time":"2019-12-03T07:02:15Z","timestamp":1575356535000},"page":"427-435","source":"Crossref","is-referenced-by-count":7,"title":["Clinical Outcome of Febrile Tanzanian Children with Severe Malnutrition Using Anthropometry in Comparison to Clinical Signs"],"prefix":"10.4269","volume":"102","author":[{"given":"Rainer","family":"Tan","sequence":"first","affiliation":[{"name":"Center for Primary Care and Public Health (Unisant\u00e9), University of Lausanne, Lausanne, Switzerland;"},{"name":"Swiss Tropical and Public Health Institute (SwissTPH), University of Basel, Switzerland;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Frank","family":"Kagoro","sequence":"additional","affiliation":[{"name":"Ifakara Health Institute, Dar es Salaam, Tanzania;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gillian A.","family":"Levine","sequence":"additional","affiliation":[{"name":"Swiss Tropical and Public Health Institute (SwissTPH), University of Basel, Switzerland;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"John","family":"Masimba","sequence":"additional","affiliation":[{"name":"Ifakara Health Institute, Dar es Salaam, Tanzania;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Josephine","family":"Samaka","sequence":"additional","affiliation":[{"name":"Ifakara Health Institute, Dar es Salaam, Tanzania;"},{"name":"Amana Hospital, Dar es Salaam, Tanzania;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Willy","family":"Sangu","sequence":"additional","affiliation":[{"name":"Dar es Salaam City Council, Dar es Salaam, Tanzania;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Blaise","family":"Genton","sequence":"additional","affiliation":[{"name":"Center for Primary Care and Public Health (Unisant\u00e9), University of Lausanne, Lausanne, Switzerland;"},{"name":"Swiss Tropical and Public Health Institute (SwissTPH), University of Basel, Switzerland;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Val\u00e9rie","family":"D\u2019Acremont","sequence":"additional","affiliation":[{"name":"Center for Primary Care and Public Health (Unisant\u00e9), University of Lausanne, Lausanne, Switzerland;"},{"name":"Swiss Tropical and Public Health Institute (SwissTPH), University of Basel, Switzerland;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kristina","family":"Keitel","sequence":"additional","affiliation":[{"name":"Swiss Tropical and Public Health Institute (SwissTPH), University of Basel, Switzerland;"},{"name":"Department of Pediatric Emergency Medicine, University Hospital Bern, Bern, Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"2795","reference":[{"year":"2018","series-title":"Levels and Trends in Child Malnutrition: Key Findings of the 2018 Edition of the Joint Child Malnutrition Estimates","author":"United Nations Children\u2019s Fund (UNICEF), WHO, World Bank Group","key":"b1"},{"key":"b2","series-title":"Clin Microbiol Rev","first-page":"919","article-title":"Impact of childhood malnutrition on host defense and infection","volume":"30","author":"Ibrahim","year":"2017"},{"key":"b3","series-title":"AIDS Res Hum Retroviruses","first-page":"46","article-title":"Malnutrition in HIV-infected children is an indicator of severe disease with an impaired response to antiretroviral therapy","volume":"34","author":"Muenchhoff","year":"2018"},{"key":"b4","series-title":"Bull World Health Organ","first-page":"593","article-title":"Antibiotics in severely malnourished children: systematic review of efficacy, safety and pharmacokinetics","volume":"89","author":"Lazzerini","year":"2011"},{"key":"b5","series-title":"Pediatric Health Med Ther","first-page":"121","article-title":"The prevalence of urinary tract infection in children with severe acute malnutrition: a narrative review","volume":"7","author":"Uwaezuoke","year":"2016"},{"key":"b6","series-title":"PLoS One","first-page":"e68699","article-title":"Infections in children admitted with complicated severe acute malnutrition in Niger","volume":"8","author":"Page","year":"2013"},{"key":"b7","series-title":"Lancet Glob Health","first-page":"e57","article-title":"Mortality and its risk factors in Malawian children admitted to hospital with clinical pneumonia, 2001\u201312: a retrospective observational study","volume":"4","author":"Lazzerini","year":"2016"},{"key":"b8","series-title":"PLoS Med","first-page":"e1001256","article-title":"Risk factors for death among children less than 5 years old hospitalized with diarrhea in rural Western Kenya, 2005\u20132007: a cohort study","volume":"9","author":"O\u2019Reilly","year":"2012"},{"key":"b9","series-title":"Acta Paediatr","first-page":"e275","article-title":"Predictors of death in under-five children with diarrhoea admitted to a critical care ward in an urban hospital in Bangladesh","volume":"100","author":"Chisti","year":"2011"},{"key":"b10","series-title":"Int J Tuberc Lung Dis","first-page":"1074","article-title":"Malnutrition associated with unfavorable outcome and death among South African MDR-TB and HIV co-infected children","volume":"18","author":"Hicks","year":"2014"},{"key":"b11","series-title":"J Pediatr","first-page":"484","article-title":"Pneumonia and malnutrition are highly predictive of mortality among African children hospitalized with human immunodeficiency virus infection or exposure in the era of antiretroviral therapy","volume":"159","author":"Preidis","year":"2011"},{"key":"b12","series-title":"Lancet","first-page":"427","article-title":"Maternal and child undernutrition and overweight in low-income and middle-income countries","volume":"382","author":"Black","year":"2013"},{"year":"2008","series-title":"Integrated Management of Childhood Illness for High HIV Settings","author":"WHO","key":"b13"},{"year":"2009","series-title":"WHO Child Growth Standards and the Identification of Severe Acute Malnutrition in Infants and Children: A Joint Statement by the World Health Organization and the United Nations Children\u2019s Fund","author":"WHO","key":"b14"},{"year":"2014","series-title":"Integrated Management of Childhood Illness: Chart Booklet","author":"WHO","key":"b15"},{"key":"b16","series-title":"J Health Popul Nutr","first-page":"210","article-title":"Training in complementary feeding counselling of healthcare workers and its influence on maternal behaviours and child growth: a cluster-randomized controlled trial in Lahore, Pakistan","volume":"26","author":"Zaman","year":"2008"},{"key":"b17","series-title":"PLoS One","first-page":"e5937","article-title":"An evaluation of the quality of IMCI assessments among IMCI trained health workers in South Africa","volume":"4","author":"Horwood","year":"2009"},{"key":"b18","series-title":"Lancet Glob Health","first-page":"e285","article-title":"Preparedness of Tanzanian health facilities for outpatient primary care of hypertension and diabetes: a cross-sectional survey","volume":"2","author":"Peck","year":"2014"},{"key":"b19","series-title":"PLoS One","first-page":"e0211274","article-title":"Determining predictors of sepsis at triage among children under 5 years of age in resource-limited settings: a modified Delphi process","volume":"14","author":"Fung","year":"2019"},{"key":"b20","series-title":"Food Nutr Bull","first-page":"S7","article-title":"A review of methods to detect cases of severely malnourished children in the community for their admission into community-based therapeutic care programs","volume":"27","author":"Myatt","year":"2006"},{"key":"b21","series-title":"Public Health Nutr","first-page":"2513","article-title":"Mid-upper arm circumference v. weight-for-height Z-score for predicting mortality in hospitalized children under 5 years of age","volume":"19","author":"Sachdeva","year":"2016"},{"key":"b22","series-title":"JAMA","first-page":"591","article-title":"Assessment of severe malnutrition among hospitalized children in rural Kenya: comparison of weight for height and mid upper arm circumference","volume":"294","author":"Berkley","year":"2005"},{"key":"b23","series-title":"Arch Dis Child","first-page":"181","article-title":"Detection of severe protein-energy malnutrition by nurses in The Gambia","volume":"89","author":"Hamer","year":"2004"},{"key":"b24","series-title":"Bull World Health Organ","first-page":"900","article-title":"Diagnostic performance of visible severe wasting for identifying severe acute malnutrition in children admitted to hospital in Kenya","volume":"89","author":"Mogeni","year":"2011"},{"key":"b25","series-title":"PLoS Med","first-page":"e1002411","article-title":"A novel electronic algorithm using host biomarker point-of-care tests for the management of febrile illnesses in Tanzanian children (e-POCT): a randomized, controlled non-inferiority trial","volume":"14","author":"Keitel","year":"2017"},{"year":"2009","series-title":"WHO Child Growth Standards: Growth Velocity Based on Weight, Length and Head Circumference: Methods and Development","author":"WHO","key":"b26"},{"key":"b27","series-title":"PLoS One","first-page":"e0127674","article-title":"Managing the sick child in the era of declining malaria transmission: development of ALMANACH, an electronic algorithm for appropriate use of antimicrobials","volume":"10","author":"Rambaud-Althaus","year":"2015"},{"key":"b28","series-title":"Acta Paediatr Suppl","first-page":"56","article-title":"Assessment of differences in linear growth among populations in the WHO Multicentre Growth Reference Study","volume":"450","author":"WHO Multicentre Growth Reference Study Group","year":"2006"},{"year":"2011","series-title":"Haemoglobin Concentrations for the Diagnosis of Anaemia and Assessment of Severity","author":"WHO","key":"b29"},{"key":"b30","series-title":"J Trop Pediatr","first-page":"203","article-title":"Vitamin D levels in malnourished children under 5 years in a tertiary care center at Muhimbili National Hospital, Dar es Salaam, Tanzania-a cross-sectional study","volume":"63","author":"Walli","year":"2017"},{"key":"b31","series-title":"Tanzan Health Res Bull","first-page":"189","article-title":"Infections associated with severe malnutrition among hospitalised children in east Africa","volume":"8","author":"Sunguya","year":"2006"},{"key":"b32","series-title":"Am J Trop Med Hyg","first-page":"249","article-title":"Performance of health workers using an electronic algorithm for the management of childhood illness in Tanzania: a pilot implementation study","volume":"96","author":"Rambaud-Althaus","year":"2017"},{"key":"b33","series-title":"N Engl J Med","first-page":"425","article-title":"Antibiotics as part of the management of severe acute malnutrition","volume":"368","author":"Trehan","year":"2013"},{"key":"b34","series-title":"Lancet Glob Health","first-page":"e464","article-title":"Daily co-trimoxazole prophylaxis to prevent mortality in children with complicated severe acute malnutrition: a multicentre, double-blind, randomised placebo-controlled trial","volume":"4","author":"Berkley","year":"2016"},{"key":"b35","series-title":"N Engl J Med","first-page":"444","article-title":"Routine amoxicillin for uncomplicated severe acute malnutrition in children","volume":"374","author":"Isanaka","year":"2016"},{"key":"b36","series-title":"PLoS One","first-page":"e53184","article-title":"Do children with uncomplicated severe acute malnutrition need antibiotics? A systematic review and meta-analysis","volume":"8","author":"Alcoba","year":"2013"},{"key":"b37","series-title":"Clin Infect Dis","first-page":"677","article-title":"Massive increase, spread, and exchange of extended spectrum \u03b2-lactamase\u2013encoding genes among intestinal Enterobacteriaceae in hospitalized children with severe acute malnutrition in Niger","volume":"53","author":"Woerther","year":"2011"},{"key":"b38","series-title":"PLoS One","first-page":"e0143729","article-title":"Epidemiology and burden of bloodstream infections caused by extended-spectrum beta-lactamase producing Enterobacteriaceae in a pediatric hospital in Senegal","volume":"11","author":"Ndir","year":"2016"},{"key":"b39","series-title":"Am J Clin Nutr","first-page":"896","article-title":"The effect of multiple anthropometric deficits on child mortality: meta-analysis of individual data in 10 prospective studies from developing countries","volume":"97","author":"McDonald","year":"2013"},{"key":"b40","series-title":"Public Health Nutr","first-page":"862","article-title":"Improving screening for malnourished children at high risk of death: a study of children aged 6\u201359 months in rural Senegal","volume":"22","author":"Myatt","year":"2019"},{"year":"2013","series-title":"Updates on the Management of Severe Acute Malnutrition in Infants and Children","author":"WHO","key":"b41"},{"key":"b42","series-title":"Health Technol Assess","first-page":"1","article-title":"The effectiveness of interventions to treat severe acute malnutrition in young children: a systematic review","volume":"16","author":"Picot","year":"2012"},{"key":"b43","series-title":"Food Nutr Bull","first-page":"S49","article-title":"Key issues in the success of community-based management of severe malnutrition","volume":"27","author":"Collins","year":"2006"},{"key":"b44","series-title":"BMC Health Serv Res","first-page":"118","article-title":"Reliability of length measurements collected by community nurses and health volunteers in rural growth monitoring and promotion services","volume":"18","author":"Laar","year":"2018"},{"key":"b45","series-title":"Trop Med Int Health","first-page":"622","article-title":"Reliability and accuracy of anthropometry performed by community health workers among infants under 6 months in rural Kenya","volume":"17","author":"Mwangome","year":"2012"},{"key":"b46","series-title":"BMJ","first-page":"e4224","article-title":"Derivation and validation of age and temperature specific reference values and centile charts to predict lower respiratory tract infection in children with fever: prospective observational study","volume":"345","author":"Nijman","year":"2012"},{"key":"b47","series-title":"Archives of Disease in Childhood","first-page":"361","article-title":"Deriving temperature and age appropriate heart rate centiles for children with acute infections","volume":"94","author":"Thompson","year":"2009"}],"container-title":["The American Journal of Tropical Medicine and Hygiene"],"original-title":[],"link":[{"URL":"https:\/\/www.ajtmh.org\/view\/journals\/tpmd\/102\/2\/article-p427.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.ajtmh.org\/downloadpdf\/journals\/tpmd\/102\/2\/article-p427.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/www.ajtmh.org\/downloadpdf\/journals\/tpmd\/102\/2\/article-p427.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,7,31]],"date-time":"2024-07-31T22:01:39Z","timestamp":1722463299000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ajtmh.org\/view\/journals\/tpmd\/102\/2\/article-p427.xml"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,2,5]]},"references-count":47,"journal-issue":{"issue":"2"},"URL":"https:\/\/doi.org\/10.4269\/ajtmh.19-0553","relation":{},"ISSN":["0002-9637","1476-1645"],"issn-type":[{"type":"print","value":"0002-9637"},{"type":"electronic","value":"1476-1645"}],"subject":[],"published":{"date-parts":[[2020,2,5]]}}}