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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
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Nutrition Journal

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