Nutritional status of children living within institution-based care: a retrospective analysis with funnel plots and control charts for programme monitoring
Objectives The aim of this study is to fill a key information gap on the nutrition-related epidemiology of orphaned and vulnerable children living within institution-based care (IBC) across six countries.Design A retrospective analysis with Shewhart control charts and funnel plots to explore intersi...
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BMJ Publishing Group
2021-12-01
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| Series: | BMJ Open |
| Online Access: | https://bmjopen.bmj.com/content/11/12/e050371.full |
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| author | Marko Kerac Elizabeth Allen Cally J Tann Nora Ellen Groce Emily DeLacey Evan Hilberg Michael Quiring James Vilus Ethan Bergman Merzel Demasu-Ay Hang T Dam |
| author_facet | Marko Kerac Elizabeth Allen Cally J Tann Nora Ellen Groce Emily DeLacey Evan Hilberg Michael Quiring James Vilus Ethan Bergman Merzel Demasu-Ay Hang T Dam |
| author_sort | Marko Kerac |
| collection | DOAJ |
| description | Objectives The aim of this study is to fill a key information gap on the nutrition-related epidemiology of orphaned and vulnerable children living within institution-based care (IBC) across six countries.Design A retrospective analysis with Shewhart control charts and funnel plots to explore intersite and over time variations in nutritional status.Setting We conducted a retrospective analysis of records from Holt International’s Child Nutrition Programme from 35 sites in six countries; Mongolia, India, Ethiopia, Vietnam, China and the Philippines.Participants Deidentified health records from Holt International’s online nutrition screening database included records from 2926 children, 0–18 years old. Data were collected from 2013 to 2020 and included demographic and health information.Results At initial screening, 717 (28.7%) children were anaemic, 788 (34.1%) underweight, 1048 (37.3%) stunted, 212 (12.6%) wasted, 135 (12%) overweight or obese and 339 (31%) had small head circumference. Many had underlying conditions: low birth weight, 514 (57.5%); prematurity, 294 (42.2%) and disabilities, 739 (25.3%). Children with disabilities had higher prevalence of malnutrition compared with counterparts without disabilities at baseline and 1-year screenings. There was marked intersite variation. Funnel plots highlight sites with malnutrition prevalence outside expected limits for this specific population taking into consideration natural variation at baseline and at 1 year. Control charts show changes in site mean z-scores over time in relation to site control limits.Conclusions Malnutrition is prevalent among children living within IBC, notably different forms of undernutrition (stunting, underweight, wasting). Underlying risk factors are also common: prematurity, low birth weight and disability. Nutrition interventions should take into account the needs of this vulnerable population, especially for infants and those with disabilities. Using control charts to present data could be especially useful to programme managers as sites outside control limits could represent: problems to be investigated; good practices to be shared. |
| format | Article |
| id | doaj-art-31eaa438d9624077a6dba9cd0e172de4 |
| institution | OA Journals |
| issn | 2044-6055 |
| language | English |
| publishDate | 2021-12-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Open |
| spelling | doaj-art-31eaa438d9624077a6dba9cd0e172de42025-08-20T02:38:29ZengBMJ Publishing GroupBMJ Open2044-60552021-12-01111210.1136/bmjopen-2021-050371Nutritional status of children living within institution-based care: a retrospective analysis with funnel plots and control charts for programme monitoringMarko Kerac0Elizabeth Allen1Cally J Tann2Nora Ellen Groce3Emily DeLacey4Evan Hilberg5Michael Quiring6James Vilus7Ethan Bergman8Merzel Demasu-Ay9Hang T Dam10Centre for Maternal Adolescent Reproductive and Child Health, London School of Hygiene and Tropical Medicine, London, UKDepartment of Medical Statistics, London School of Hygiene and Tropical Medicine, London, UKCentre for Maternal Adolescent Reproductive and Child Health, London School of Hygiene and Tropical Medicine, London, UKInternational Disability Research Centre, University College London, London, UKNutrition & Health Department, Holt International, Eugene, Oregon, USANutrition & Health Department, Holt International, Eugene, Oregon, USANutrition & Health Department, Holt International, Eugene, Oregon, USAHolt Haiti Country Office, Holt International, Port-au-Prince, HaitiDepartment of Health Sciences, Central Washington University, Ellensburg, Washington, USANutrition Department, Kaisahang Buhay Foundation, Inc, Quezon City, PhilippinesNutrition & Health Department, Holt International, Eugene, Oregon, USAObjectives The aim of this study is to fill a key information gap on the nutrition-related epidemiology of orphaned and vulnerable children living within institution-based care (IBC) across six countries.Design A retrospective analysis with Shewhart control charts and funnel plots to explore intersite and over time variations in nutritional status.Setting We conducted a retrospective analysis of records from Holt International’s Child Nutrition Programme from 35 sites in six countries; Mongolia, India, Ethiopia, Vietnam, China and the Philippines.Participants Deidentified health records from Holt International’s online nutrition screening database included records from 2926 children, 0–18 years old. Data were collected from 2013 to 2020 and included demographic and health information.Results At initial screening, 717 (28.7%) children were anaemic, 788 (34.1%) underweight, 1048 (37.3%) stunted, 212 (12.6%) wasted, 135 (12%) overweight or obese and 339 (31%) had small head circumference. Many had underlying conditions: low birth weight, 514 (57.5%); prematurity, 294 (42.2%) and disabilities, 739 (25.3%). Children with disabilities had higher prevalence of malnutrition compared with counterparts without disabilities at baseline and 1-year screenings. There was marked intersite variation. Funnel plots highlight sites with malnutrition prevalence outside expected limits for this specific population taking into consideration natural variation at baseline and at 1 year. Control charts show changes in site mean z-scores over time in relation to site control limits.Conclusions Malnutrition is prevalent among children living within IBC, notably different forms of undernutrition (stunting, underweight, wasting). Underlying risk factors are also common: prematurity, low birth weight and disability. Nutrition interventions should take into account the needs of this vulnerable population, especially for infants and those with disabilities. Using control charts to present data could be especially useful to programme managers as sites outside control limits could represent: problems to be investigated; good practices to be shared.https://bmjopen.bmj.com/content/11/12/e050371.full |
| spellingShingle | Marko Kerac Elizabeth Allen Cally J Tann Nora Ellen Groce Emily DeLacey Evan Hilberg Michael Quiring James Vilus Ethan Bergman Merzel Demasu-Ay Hang T Dam Nutritional status of children living within institution-based care: a retrospective analysis with funnel plots and control charts for programme monitoring BMJ Open |
| title | Nutritional status of children living within institution-based care: a retrospective analysis with funnel plots and control charts for programme monitoring |
| title_full | Nutritional status of children living within institution-based care: a retrospective analysis with funnel plots and control charts for programme monitoring |
| title_fullStr | Nutritional status of children living within institution-based care: a retrospective analysis with funnel plots and control charts for programme monitoring |
| title_full_unstemmed | Nutritional status of children living within institution-based care: a retrospective analysis with funnel plots and control charts for programme monitoring |
| title_short | Nutritional status of children living within institution-based care: a retrospective analysis with funnel plots and control charts for programme monitoring |
| title_sort | nutritional status of children living within institution based care a retrospective analysis with funnel plots and control charts for programme monitoring |
| url | https://bmjopen.bmj.com/content/11/12/e050371.full |
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