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Table 2 Total numbers, deaths, case-fatality rates and relative risk of death of children with SAM by diagnostic criteria, treatment program and age group

From: Severely malnourished children with a low weight-for-height have a higher mortality than those with a low mid-upper-arm-circumference: I. Empirical data demonstrates Simpson’s paradox

SAM type All patients In patients (IPF) Outpatients (OTP) SFC
Age group Total Dead CFR RR 95% CI RR 95% CI Total Dead CFR RR 95% CI RR 95% CI Total Dead CFR RR 95% CI RR 95% CI Total Dead CFR RR 95% CI
6–60 m # # %      # # %      # # %      # # %   
 M-muac 7191 56 0.78 Ref. 759 21 2.77 Ref. 780 9 1.15 Ref. 5652 26 0.46 Ref.
 M-whz 16,531 332 2.01 2.58 1.9–3.4 674 27 4.01 1.45 0.8–2.5 10,126 280 2.77 2.40 0.8–2.5 5731 25 0.44 0.95 0.5–1.6
 M-both 40,309 2000 4.96 6.37 4.9–8.3 5985 559 9.34 3.38 2.2–5.2 29,119 1381 4.74 4.11 2.2–5.2 5205 60 1.15 2.51 1.6–4.0
 Kwash 5882 337 5.73 7.36 5.6–9.7 Ref. 3735 262 7.01 2.54 1.6–3.9 Ref. 2147 75 3.49 3.03 1.6–3.9 Ref.
 K-muac 1669 118 7.07 9.08 6.6–12 1.23 1.0–1.5 1138 100 8.79 3.18 2.0–5.0 1.25 1.0–1.6 531 18 3.39 2.94 2.0–5.0 0.97 0.6–1.6
 K-whz 1088 169 15.53 19.95 15–27 2.71 2.3–3.2 465 77 16.56 5.98 3.7–9.6 2.36 1.9–3.0 623 92 14.77 12.80 3.7–9.6 4.23 3.2–5.6
 K-both 4217 576 13.66 17.54 13–23 2.38 2.1–2.7 2179 367 16.84 6.09 4–9.4 2.40 2.1–2.8 2038 209 10.26 8.89 4–9.4 2.94 2.3–3.8
Total 76,887 3588 4.67      14,935 1413 9.46      45,364 2064 4.55      16,588 111 0.67   
6 - < 18 m # # %      # # %      # # %      # # %   
 M-muac 4650 32 0.69 Ref. 246 8 3.25 Ref. 298 5 1.68 Ref. 4106 19 0.46 Ref.
 M-whz 5906 124 2.10 3.05 2.1–4.5 208 13 6.25 1.92 0.8–4.5 2901 94 3.24 1.93 0.8–4.7 2797 17 0.61 1.31 0.7–2.5
 M-both 21,095 1073 5.09 7.39 5.2–10 2703 307 11.37 3.50 1.8–7.0 14,416 721 5.00 2.98 1.2–7.1 3976 45 1.13 2.45 1.4–4.2
 Kwash 667 33 4.95 7.19 4.5–12 Ref.   290 17 5.86 1.80 0.8–4.1 Ref.   377 16 4.24 2.53 0.9–6.8 Ref.  
 K-muac 462 20 4.33 6.29 3.6–11 0.87 0.5–1.5 231 16 6.93 2.13 0.9–4.9 1.18 0.6–2.3 231 4 1.73 1.03 0.3–3.8 0.41 0.1–1.2
 K-whz 194 26 13.40 19.47 12–32 2.71 1.7–4.4 63 10 15.87 4.88 2.0–12 2.71 1.3–5.6 131 16 12.21 7.28 2.7–19 1.63 0.8–3.2
 K-both 1264 155 12.26 17.82 12–26 2.48 1.7–3.6 579 90 15.54 4.78 2.4–9.7 2.65 1.6–4.4 685 65 9.49 5.66 2.3–14 2.24 1.3–3.8
Total 34,238 1463 4.27      4320 461 10.68      19,039 921 4.84      10,879 81 0.74   
18 - < 36 m # # %      # # %      # # %      # # %   
 M-muac 1973 16 0.81 Ref. 242 8 3.31 Ref. 376 2 0.53 Ref. 1355 6 0.44 Ref.
 M-whz 8044 171 2.13 2.62 1.6–4.4 242 7 2.89 0.88 0.3–2.4 6143 158 2.57 4.84 1.2–19 1659 6 0.36 0.82 0.3–2.5
 M-both 16,506 774 4.69 5.78 3.5–9.5 2110 169 8.01 2.42 1.2–4.9 13,289 594 4.47 8.40 2.1–34 1107 11 0.99 2.24 0.8–6.0
 Kwash 2510 138 5.50 6.78 4.1–11 Ref.   1393 99 7.11 2.15 1.1–4.4 Ref.   1117 39 3.49 6.56 1.6–27 Ref.  
 K-muac 655 43 6.56 8.10 4.6–14 1.19 0.8–1.7 444 35 7.88 2.38 1.1–5.1 1.11 0.8–1.6 211 8 3.79 7.13 1.5–33 1.09 0.5–2.3
 K-whz 574 83 14.46 17.83 11–30 2.63 2.0–3.4 173 32 18.50 5.60 2.6–12 2.60 1.8–3.7 401 51 12.72 23.91 5.9–97 3.64 2.4–5.4
 K-both 2139 275 12.86 15.85 9.6–26 2.34 1.9–2.8 976 160 16.39 4.96 2.5–9.9 2.31 1.8–2.9 1163 115 9.89 18.59 4.6–75 2.83 2.0–4.0
Total 32,401 1500 4.63      5580 510 9.14      22,700 967 4.26      4121 23 0.56   
36–60 m # # %      # # %      # # %      # # %   
 M-muac 568 8 1.41 Ref. 271 5 1.85 Ref. 106 2 1.89 Ref. 191 1 0.52 Ref.
 M-whz 2581 37 1.43 1.02 0.5–2.2 224 7 3.13 1.69 0.5–5.3 1082 28 2.59 1.37 0.3–5.7 1275 2 0.16 0.30 0.0–3.3
 M-both 2708 153 5.65 4.01 2.0–8.1 1172 83 7.08 3.84 1.6–9.4 1414 66 4.67 2.47 0.6–10 122 4 3.28 6.26 0.7–55
 Kwash 2705 166 6.14 4.36 2.2–8.8 Ref. 2052 146 7.12 3.86 1.6–9.3 Ref. 653 20 3.06 1.62 0.4–6.8 Ref.
 K-muac 552 55 9.96 7.07 3.4–15 1.62 1.2–2.2 463 49 10.58 5.74 2.3–14 1.49 1.2–2.0 89 6 6.74 3.57 0.7–17 2.20 0.9–5.3
 K-whz 320 60 18.75 13.31 6.4–27 3.06 2.3–4.0 229 35 15.28 8.28 3.3–21 2.15 1.5–3.0 91 25 27.47 14.56 3.5–60 8.97 5.2–15
 K-both 814 146 17.94 12.73 6.3–26 2.92 2.4–3.6 624 117 18.75 10.16 4.2–25 2.64 2.1–3.3 190 29 15.26 8.09 2.0–33 4.98 2.9–8.6
Total 10,248 625 6.10      5035 442 8.78      3625 176 4.86      1588 7 0.44   
  1. IPF In-patient Facility (Hospital. Therapeutic Feeding Center); OTP Out-patient treatment program (Home treatment); SFC Supplementary Feeding Center; M-muac MUAC < 115 mm with WHZ ≥ −3Z and no oedema (marasmus by MUAC only); M-whz WHZ < −3Z with MUAC ≥115 mm and no oedema (marasmus by WHZ only); M-Both MUAC < 115 mm & WHZ < −3Z and no oedema (marasmus by both diagnostic criteria); Kwash nutritional oedema/Kwashiorkor without meeting either MUAC or WHZ criteria; K-muac oedema & MUAC < 115 mm with WHZ ≥ −3Z (marasmic kwashiorkor by MUAC only); K-whz oedema & WHZ < −3Z with MUAC ≥115 mm (marasmic kwashiorkor by WHZ only); K-Both oedema & MUAC < 115 mm & WHZ < −3Z (marasmic kwashiorkor by both diagnostic criteria); CFR Case Fatality Rate %; RR Relative Risk of death; 95% CI 95% Confidence interval. Significance tests are given in Table 3