http://www.julescrittenden.com/2008/01/18/lancet-botches-another-one/
According to Medecins Sans Frontieres, which judges a malnutrition study
in Lancet to be deeply, dangerously flawed in its methodology and
conclusions. MSF:
London/New York, January 16, 2008 – A series on maternal and child
undernutrition in the current issue of the medical journal The Lancet,
correctly puts the spotlight on nutrition as “a desperately neglected
aspect of maternal, newborn, and child health.” However, because of
weaknesses in analysis and outmoded recommendations the series is
undermining efforts to promote urgently needed change.
Doctors Without Borders/Médecins Sans Frontières (MSF) teams are
confronted daily with the devastating impact of childhood malnutrition,
having treated more than 150,000 children in 99 programs in 2006. The
organization’s medical staff sees first-hand how malnutrition weakens
children’s resistance and increases the risk of dying from pneumonia,
diarrhea, malaria, measles, and AIDS. They have also documented the
dramatic impact of nutrient-dense, ready-to-use food (RUF) in treating
childhood malnutrition.
A few of the weaknesses in the Lancet series:
By not including, for example, deaths from nutritional oedema, the
highly lethal form of severe acute malnutrition which predominates in
large parts of central and southern Africa, The Lancet series
dramatically underestimates the number of deaths attributable to severe
acute malnutrition;
A failure to actively endorse the new WHO, UNICEF, and WFP supported
approach of community/home-based management of severe acute malnutrition
with RUF;
A focus on hospital-based care in an era when ministries of health,
UN agencies, and NGOs are actively moving to a proven strategy of
community/home-based care with RUF. Only complicated cases are now
treated in hospital;
The authors justify withholding strong support for community-based
care on a lack of “randomized trials.” However, they go on to stress the
usefulness of hospital-based care based on the results of nine studies,
none of which are randomized.
MSF has been treating acute malnutrition with ready-to-use food since
2000 in African and Asian countries, including Afghanistan, Angola,
Burundi, Ethiopia, Niger and Sudan. Outpatient/home-based strategies have
permitted MSF to treat far more children than would have been possible in
the past, when hospital-based treatment was the standard of care. Results
have been most closely monitored in MSF’s program in Maradi, Niger, where
hundreds of thousands of patients have been treated since 2001. In 2007,
over 22,000 severely malnourished children were treated with a cure rate
of 84 percent and a mortality rate of less than three percent.
Large-scale outpatient treatment of severe acute malnutrition is
being successfully implemented by ministries of health, with support from
implementing partners, in Malawi, Ethiopia, and Niger. However, despite
strong UN recommendations to implement RUF treatment strategies, only
about three percent of children with severe acute malnutrition have
access to therapeutic RUF today. 1
By failing to strongly endorse and promote community treatment with
RUF, the The Lancet authors are undermining the support for this
lifesaving intervention.
Perhaps the conservative approach is based on the fact that new, more
effective strategies with ready-to-use food will be more expensive, and
will require international funding to purchase products (often locally).
But considering the exceptional results achieved to date with RUF by MSF
and others, and the potential to save lives, donors should fund and
support recipient countries to rapidly scale-up this intervention.
Implementation of this strategy will mean the difference between life and
death for at-risk children under three.
I know zip about this issue and have no opinion. Readers will be familiar
with controversy surrounding Lancet’s historical issues with bias and bad
metholodogy, however.
--
Fred Stone
aa# 1369
I believe that all government is evil, and that trying to improve it is
largely a waste of time.
H. L. Mencken
.
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