Suchergebnisse

1) Introduction Moving from existing segmented care to integrated care is complex and disruptive. It is complex in the sense that the type of changes and the timeframe of these changes are not completely predictable. It is disruptive in the sense that the process of change modifies but also is influenced by the nature of interactions at the individual and organisational level. As a consequence, building competences to govern the necessary changes towards integrated care should include capacity to adapt to unexpected situations. Therefore, the tacit knowledge of the stakeholders ("knowledge-in-practice developed from direct experience; subconsciously understood and applied"1) should be at the centre. However, the usual research and training practices using such a knowledge (i.e. action research or case studies), are highly time-consuming. New approaches are therefore needed to elicit tacit knowledge. One of them is agent based modelling (ABM)2 through computer simulation. The aim of this paper is to make a "showcase" of an agent-based model that uses the emergence of tacit knowledge and enhances loco-regional adaptive governance for improving integrated chronic care. 2) Theory/Methods We used a complex adaptive system's lens to study the health systems integration process. We applied key components of ABM to assess how health systems adapts through the dynamics of heterogeneous and interconnected agents (agents are characterised by their level of autonomy, heterogeneity, and interactions with other agents). The agent-based model was developed through a process where concept maps, causal loop diagrams, object-oriented unified modelling language diagrams and computer simulation (using Netlogo©) were iteratively used. 3) Results The agent-based model was presented to health professionals with variable experience in healthcare to elicit their perceptions and tacit knowledge. It consisted of agents with certain characteristics and transition rules. Agents included providers, patients, networks' or health systems' managers. Agents can adopt or influence the adoption of integrated care through learning and because of being aware, motivated and capable of decision making. The environment includes institutional arrangements (e.g., financing, training, information systems and legislation) and leadership. Different scenarios were created and discussed. Key rules to strengthen adaptive governance were reflected on. 4) Discussion and conclusion This study is an initial step of an exercise to use ABM as a means to elicit of and enhance tacit knowledge to strengthen governance for integrated care. It is expected that the study will foster dialogue between actors of loco-regional projects to integrate health and social care for chronic diseases in Belgium (a new program initiated by federal authorities). 5) Suggestions for future research Future research is expected to continue developing methods that combine ABM with participative exploration approaches to make better use of tacit knowledge in strengthening loco-regional governance for the development of integrated care. 1. Kothari, A. et al. The use of tacit and explicit knowledge in public health: a qualitative study. Implement. Sci. 7, 20 (2012). 2. Anderson, J., Chaturvedi, A. & Cibulskis, M. Simulation tools for developing policies for complex systems: modeling the health and safety of refugee communities. Health Care Manag. Sci. 10, 331–339 (2007).

La Belgique s'est lancée depuis une décennie dans quelques projets d'ampleur pour améliorer les soins aux personnes nécessitant des soins complexes: les trajets de soins diabète et insuffisance rénale, la réforme du système de soins pour les personnes ayant besoin de soins en santé mentale, les alternatives de soins pour les personnes âgées fragiles, afin qu'elles puissent rester chez elles le plus longtemps possible et, enfin, les projets de soins intégrés. Ce dernier est le format le plus abouti. Au moment d'évaluer les projets, de multiples défis et leçons ont été tirées pouvant intéresser les chercheurs, politiques et professionnels de la santé et de l'aide. Ce sont des points qui seront présentés ici.

La Belgique s'est lancée depuis une décennie dans quelques projets d'ampleur pour améliorer les soins aux personnes nécessitant des soins complexes: les trajets de soins diabète et insuffisance rénale, la réforme du système de soins pour les personnes ayant besoin de soins en santé mentale, les alternatives de soins pour les personnes âgées fragiles, afin qu'elles puissent rester chez elles le plus longtemps possible et, enfin, les projets de soins intégrés. Ce dernier est le format le plus abouti. Au moment d'évaluer les projets, de multiples défis et leçons ont été tirées pouvant intéresser les chercheurs, politiques et professionnels de la santé et de l'aide. Ce sont des points qui seront présentés ici.

En Afrique subsaharienne, très peu d'études ont été réalisées sur les incapacités modérées à graves dans les domaines de la mobilité, de la communication et de la fonction mentale chez les personnes âgées vivant à domicile. Les études réalisées n'ont pas toujours décrit le contexte social qui permet de comprendre leurs résultats. Cette étude est réalisée au Burkina Faso pour combler les déficits d'informations scientifiques sur les incapacités danscesdomaines.Nousavonsconduituneétudedescriptivetransversalequis'estdéroulée à Bobo-Dioulasso auprès de la population des personnes de plus de 60 ans. Leur statut fonctionnel a été évalué avec le Système de Mesure de l'Autonomie Fonctionnelle (SMAF). L'analyse des données a été réalisée à l'aide de Stata. Un échantillon de 351 personnes âgées a été interviewé. Les incapacités fonctionnelles modérées à graves ou les besoins de surveillance ou d'aide étaient de 10% dans la mobilité, 28% dans la fonction mentale et 37% dans la communication. À l'intérieur de chaque domaine, ces proportions variaient selon les activités/items. Toutes les personnes en incapacités affirmaient disposer de ressources humaines quasi-stables pour les aider à gérer leurs incapacités. La famille constituait la principale ressource. La prise en compte du contexte social permet de mieux comprendre ces résultats. Les proportions d'incapacités trouvées dans cette étude sont supérieures à celles des études précédentes qui ont souvent mesuré les incapacités graves. Une bonne visibilité des incapacités modérées à graves devrait permettre la conception de bonnes politiques de soins et de supports aux personnes âgées.

En Afrique subsaharienne, très peu d'études ont été réalisées sur les incapacités modérées à graves dans les domaines de la mobilité, de la communication et de la fonction mentale chez les personnes âgées vivant à domicile. Les études réalisées n'ont pas toujours décrit le contexte social qui permet de comprendre leurs résultats. Cette étude est réalisée au Burkina Faso pour combler les déficits d'informations scientifiques sur les incapacités danscesdomaines.Nousavonsconduituneétudedescriptivetransversalequis'estdéroulée à Bobo-Dioulasso auprès de la population des personnes de plus de 60 ans. Leur statut fonctionnel a été évalué avec le Système de Mesure de l'Autonomie Fonctionnelle (SMAF). L'analyse des données a été réalisée à l'aide de Stata. Un échantillon de 351 personnes âgées a été interviewé. Les incapacités fonctionnelles modérées à graves ou les besoins de surveillance ou d'aide étaient de 10% dans la mobilité, 28% dans la fonction mentale et 37% dans la communication. À l'intérieur de chaque domaine, ces proportions variaient selon les activités/items. Toutes les personnes en incapacités affirmaient disposer de ressources humaines quasi-stables pour les aider à gérer leurs incapacités. La famille constituait la principale ressource. La prise en compte du contexte social permet de mieux comprendre ces résultats. Les proportions d'incapacités trouvées dans cette étude sont supérieures à celles des études précédentes qui ont souvent mesuré les incapacités graves. Une bonne visibilité des incapacités modérées à graves devrait permettre la conception de bonnes politiques de soins et de supports aux personnes âgées.

INTRODUCTION The Belgian government Integreo program (www.integreo.be) aims at a nationwide whole-system change in health and social care towards more Integrated Care (IC), by means of geographically defined integrated care projects (ICPs). Starting in early 2018, the twelve ICPs are implementing their action plan to change the organization of their regional network, covering up to 150.000 inhabitants, towards more IC. They receive limited financing: one FTE coordinator. As the final goal of the national plan is to anchor successful changes and scale-up best practices, FAITH.be (Federated consortium for Appraisal of Integrated care Teams in Health in Belgium) developed a mixed methods realist evaluation framework which aims at responding to the questions if, how, for whom and why the implementation of the ICP is successful or not so far, and learn lessons to help the ICPs to adjust their governance to support successful implementation of a whole-system change in their region. We will present preliminary insights of the implementation analysis, describing the main difficulties ICPs struggle with and how they address them. THEORY/METHODS We use participative action and realist methods following RAMESES II standards (http://www.ramesesproject.org/). Data collection tools are chosen in consultation with stakeholders: coordinators, partners of and policy makers. Intermediate results are fed back and discussed with the stakeholders. Two methods are combined: qualitative enquiry for all ICPs and case study methods for three selected ICPs. Normalization Process Theory (NPT) (1) is chosen to guide the analysis. RESULTS First observations show that ICPs struggle with divergence in vision about priorities and timelines between ICPs, Governmental agencies at both federal and regional level. After postponement of crucial policy decisions and delivery of promised ICT-tools, ICPs are forced to adapt their action plan, which impedes their coherence. Moreover, due to the limited financing, ICPs are expected to pre-finance their actions towards IC, which impedes the involvement of key stakeholders, such as GPs' and social care workers' organisations and raises tensions between care providers, e.g. working in a fee-for service system versus those working in bundled payment systems. Hence, this hinders collective action and participation. DISCUSSION These preliminary results will be further discussed and extended with the stakeholders. By the time of the conference, we will present the main issues for each social mechanism as described by NPT and explain why, how and for whom these difficulties occur and describe observed strategies to cope with them. CONCLUSIONS First results show how the divergence of visions between policy makers and stakeholders in ICPs, hinder ICPs to implement innovative actions towards IC. LESSONS LEARNED Even though co-creation is considered an important pillar of the Integreo Plan, the lack of convergence of visions between policy agencies and ICPs hinders the implementation of innovative actions towards IC. LIMITATIONS The results only reflect the views of ICPs, not the policy makers. SUGGESTIONS FOR FUTURE RESEARCH The results of the implementation analysis will be linked to the outcome and cost analysis of the ICPs (see: https://interfaithbel.blog/methodological-information/). 1. Murray E, Treweek S, Pope C, MacFarlane A, Ballini L, Dowrick C, et al. Normalisation process theory: a framework for developing, evaluating and implementing complex interventions. BMC medicine. 2010;8:63.

INTRODUCTION The Belgian government Integreo program (www.integreo.be) aims at a nationwide whole-system change in health and social care towards more Integrated Care (IC), by means of geographically defined integrated care projects (ICPs). Starting in early 2018, the twelve ICPs are implementing their action plan to change the organization of their regional network, covering up to 150.000 inhabitants, towards more IC. They receive limited financing: one FTE coordinator. As the final goal of the national plan is to anchor successful changes and scale-up best practices, FAITH.be (Federated consortium for Appraisal of Integrated care Teams in Health in Belgium) developed a mixed methods realist evaluation framework which aims at responding to the questions if, how, for whom and why the implementation of the ICP is successful or not so far, and learn lessons to help the ICPs to adjust their governance to support successful implementation of a whole-system change in their region. We will present preliminary insights of the implementation analysis, describing the main difficulties ICPs struggle with and how they address them. THEORY/METHODS We use participative action and realist methods following RAMESES II standards (http://www.ramesesproject.org/). Data collection tools are chosen in consultation with stakeholders: coordinators, partners of and policy makers. Intermediate results are fed back and discussed with the stakeholders. Two methods are combined: qualitative enquiry for all ICPs and case study methods for three selected ICPs. Normalization Process Theory (NPT) (1) is chosen to guide the analysis. RESULTS First observations show that ICPs struggle with divergence in vision about priorities and timelines between ICPs, Governmental agencies at both federal and regional level. After postponement of crucial policy decisions and delivery of promised ICT-tools, ICPs are forced to adapt their action plan, which impedes their coherence. Moreover, due to the limited financing, ICPs are expected to pre-finance their actions towards IC, which impedes the involvement of key stakeholders, such as GPs' and social care workers' organisations and raises tensions between care providers, e.g. working in a fee-for service system versus those working in bundled payment systems. Hence, this hinders collective action and participation. DISCUSSION These preliminary results will be further discussed and extended with the stakeholders. By the time of the conference, we will present the main issues for each social mechanism as described by NPT and explain why, how and for whom these difficulties occur and describe observed strategies to cope with them. CONCLUSIONS First results show how the divergence of visions between policy makers and stakeholders in ICPs, hinder ICPs to implement innovative actions towards IC. LESSONS LEARNED Even though co-creation is considered an important pillar of the Integreo Plan, the lack of convergence of visions between policy agencies and ICPs hinders the implementation of innovative actions towards IC. LIMITATIONS The results only reflect the views of ICPs, not the policy makers. SUGGESTIONS FOR FUTURE RESEARCH The results of the implementation analysis will be linked to the outcome and cost analysis of the ICPs (see: https://interfaithbel.blog/methodological-information/). 1. Murray E, Treweek S, Pope C, MacFarlane A, Ballini L, Dowrick C, et al. Normalisation process theory: a framework for developing, evaluating and implementing complex interventions. BMC medicine. 2010;8:63.

Introduction Little is known about the outcomes of subjects with a history of severe acute malnutrition(SAM). We therefore sought to explore the long-term effects of SAM during childhood on human capital in adulthood in terms of education, cognition, self-esteem and health-relateddisabilities in daily living. Methodology We traced 524 adults (median age of 22) in the eastern Democratic Republic of the Congo,who were treated for SAM during childhood at Lwiro hospital between 1988 and 2007(median age 41 months). We compared them with 407 community controls of comparable age and sex. Our outcomes of interest were education, cognitive function [assessed using the Mini Mental State Examination (MMSE) for literate participants, or its modified version created by Ertan et al. (MMSE-I) for uneducated participants], self-esteem (measured using the Rosenberg Self-Esteem Scale) and health-related social and functional disabilities measured using the World Health Organization Disability Assessment Schedule (WHODAS). For comparison, we used the Chi-squared test along with the Student's t-test for the proportions and means respectively. Results Compared with the community controls, malnutrition survivors had a lower probability of attaining a high level of education (p < 0.001), of reporting a high academic performance (p= 0.014) or of having high self-esteem (p = 0.003). In addition, ma lnutrition survivors had anoverall mean score in the cognitive test that was lower compared with the community controls [25.6 compared with 27.8, p = 0.001 (MMSE) and 22.8 compared with 26.3, p < 0.001 (MMSE-I)] and a lower proportion of subjects with a normal result in this test (78.0% compared with 90.1%, p < 0.001). Lastly, in terms of health-related disabilities, unlike the community controls, malnutrition survivors had less social disability (p = 0.034), but no difference was observed as regards activities of daily living (p = 0.322). Conclusion SAM during childhood exposes survivors to low human capital as regards education, cognition and behaviour in adulthood. Policy-deciders seeking to promote economic growth and to address various psychological and medico-social disorders must take into consideration the fact that appropriate investment in child health as regards SAM is an essential means to achieve this.

Introduction Little is known about the outcomes of subjects with a history of severe acute malnutrition(SAM). We therefore sought to explore the long-term effects of SAM during childhood on human capital in adulthood in terms of education, cognition, self-esteem and health-relateddisabilities in daily living. Methodology We traced 524 adults (median age of 22) in the eastern Democratic Republic of the Congo,who were treated for SAM during childhood at Lwiro hospital between 1988 and 2007(median age 41 months). We compared them with 407 community controls of comparable age and sex. Our outcomes of interest were education, cognitive function [assessed using the Mini Mental State Examination (MMSE) for literate participants, or its modified version created by Ertan et al. (MMSE-I) for uneducated participants], self-esteem (measured using the Rosenberg Self-Esteem Scale) and health-related social and functional disabilities measured using the World Health Organization Disability Assessment Schedule (WHODAS). For comparison, we used the Chi-squared test along with the Student's t-test for the proportions and means respectively. Results Compared with the community controls, malnutrition survivors had a lower probability of attaining a high level of education (p < 0.001), of reporting a high academic performance (p= 0.014) or of having high self-esteem (p = 0.003). In addition, ma lnutrition survivors had anoverall mean score in the cognitive test that was lower compared with the community controls [25.6 compared with 27.8, p = 0.001 (MMSE) and 22.8 compared with 26.3, p < 0.001 (MMSE-I)] and a lower proportion of subjects with a normal result in this test (78.0% compared with 90.1%, p < 0.001). Lastly, in terms of health-related disabilities, unlike the community controls, malnutrition survivors had less social disability (p = 0.034), but no difference was observed as regards activities of daily living (p = 0.322). Conclusion SAM during childhood exposes survivors to low human capital as regards education, cognition and behaviour in adulthood. Policy-deciders seeking to promote economic growth and to address various psychological and medico-social disorders must take into consideration the fact that appropriate investment in child health as regards SAM is an essential means to achieve this.

Background: The eastern Democratic Republic of Congo (DRC) has experienced decades-long armed conflicts which have had a negative impact on population's health. Most research in public health explores measures that focus on a specific health problem rather than overall population health status. The aim of this study was to assess the health status of the population and its predictors in conflict settings of South Kivu province, using the World Health Organization Disability Assessment Schedule (WHODAS). Methods: Between May and June 2019, we conducted a community-based cross-sectional survey among 1440 adults in six health zones (HZ), classified according to their level of armed conflict intensity and chronicity in four types (accessible and stable, remote and stable, intermediate and unstable). The data were collected by a questionnaire including socio-demographic data and the WHODAS 2.0 tool with 12 items. The main variable of the study was the WHODAS summary score measuring individual's health status and synthesize in six domains of disability (household, cognitive, mobility, self-care, social and society). Univariate analysis, correlation and comparison tests as well as hierarchical multiple linear regression were performed. Results: The median WHODAS score in the accessible and stable (AS), remote and stable (RS), intermediate (I) and unstable (U) HZ was 6.3 (0–28.6); 25 (6.3–41.7); 22.9 (12.5–33.3) and 39.6 (22.9–54.2), respectively. Four of the six WHODAS domain scores (household, cognitive, mobility and society) were the most altered in the UHZs. The RSHZ and IHZ had statistically comparable global WHODAS scores. The stable HZs (accessible and remote) had statistically lower scores than the UHZ on all items. In regression analysis, the factors significantly associated with an overall poor health status (or higher WHODAS score) were advanced age, being woman, being membership of an association; being divorced, separated or widower and living in an unstable HZ. Conclusions: Armed conflicts have a ...

Introduction: Continuity of care is essential when trying to avoid untimely institutionalization of the frail elderly. Either continuously or occasionally, multiple care providers are involved in the integrated care for a community-dwelling frail older person. In this coming and going of care providers over time, the informal caregiver usually remains the constant factor. In 2009 the Belgian Federal Government launched a call for innovative projects that aim at maintaining the community-dwelling frail elderly at home for as long as possible. That call resulted in 66 projects that offer a variety of innovative interventions. Aims: The aim of this study is to describe to what extent these projects involve the informal caregivers in the organization of care for the frail elderly. Methods: Data are collected through the projects initial application files, yearly questionnaires, interviews and focus groups. We performed a descriptive analysis of the data and compared subgroups of projects based on the type of interventions. Results: First results show that in most projects involvement of the informal caregiver in the care process is not well established. A minority of projects describe how they plan to implement caregiver involvement in their application files. Caregiver involvement mainly occurs sporadically, when important decisions about an individual client have to be made. Conclusion: The projects lack a structured approach to implement informal caregiver involvement in the care process of frail elderly.

Introduction: Continuity of care is essential when trying to avoid untimely institutionalization of the frail elderly. Either continuously or occasionally, multiple care providers are involved in the integrated care for a community-dwelling frail older person. In this coming and going of care providers over time, the informal caregiver usually remains the constant factor. In 2009 the Belgian Federal Government launched a call for innovative projects that aim at maintaining the community-dwelling frail elderly at home for as long as possible. That call resulted in 66 projects that offer a variety of innovative interventions. Aims: The aim of this study is to describe to what extent these projects involve the informal caregivers in the organization of care for the frail elderly. Methods: Data are collected through the projects initial application files, yearly questionnaires, interviews and focus groups. We performed a descriptive analysis of the data and compared subgroups of projects based on the type of interventions. Results: First results show that in most projects involvement of the informal caregiver in the care process is not well established. A minority of projects describe how they plan to implement caregiver involvement in their application files. Caregiver involvement mainly occurs sporadically, when important decisions about an individual client have to be made. Conclusion: The projects lack a structured approach to implement informal caregiver involvement in the care process of frail elderly.

Abstract
Background
The eastern Democratic Republic of Congo (DRC) has experienced decades-long armed conflicts which have had a negative impact on population's health. Most research in public health explores measures that focus on a specific health problem rather than overall population health status. The aim of this study was to assess the health status of the population and its predictors in conflict settings of South Kivu province, using the World Health Organization Disability Assessment Schedule (WHODAS).

Methods
Between May and June 2019, we conducted a community-based cross-sectional survey among 1440 adults in six health zones (HZ), classified according to their level of armed conflict intensity and chronicity in four types (accessible and stable, remote and stable, intermediate and unstable). The data were collected by a questionnaire including socio-demographic data and the WHODAS 2.0 tool with 12 items. The main variable of the study was the WHODAS summary score measuring individual's health status and synthesize in six domains of disability (household, cognitive, mobility, self-care, social and society). Univariate analysis, correlation and comparison tests as well as hierarchical multiple linear regression were performed.

Results
The median WHODAS score in the accessible and stable (AS), remote and stable (RS), intermediate (I) and unstable (U) HZ was 6.3 (0–28.6); 25 (6.3–41.7); 22.9 (12.5–33.3) and 39.6 (22.9–54.2), respectively. Four of the six WHODAS domain scores (household, cognitive, mobility and society) were the most altered in the UHZs. The RSHZ and IHZ had statistically comparable global WHODAS scores. The stable HZs (accessible and remote) had statistically lower scores than the UHZ on all items. In regression analysis, the factors significantly associated with an overall poor health status (or higher WHODAS score) were advanced age, being woman, being membership of an association; being divorced, separated or widower and living in an unstable HZ.

Conclusions
Armed conflicts have a significantly negative impact on people's perceived health, particularly in crisis health zones. In this area, we must accentuate actions aiming to strengthen people's psychosocial well-being.

BACKGROUND: The eastern Democratic Republic of Congo (DRC) has experienced decades-long armed conflicts which have had a negative impact on population's health. Most research in public health explores measures that focus on a specific health problem rather than overall population health status. The aim of this study was to assess the health status of the population and its predictors in conflict settings of South Kivu province, using the World Health Organization Disability Assessment Schedule (WHODAS). METHODS: Between May and June 2019, we conducted a community-based cross-sectional survey among 1440 adults in six health zones (HZ), classified according to their level of armed conflict intensity and chronicity in four types (accessible and stable, remote and stable, intermediate and unstable). The data were collected by a questionnaire including socio-demographic data and the WHODAS 2.0 tool with 12 items. The main variable of the study was the WHODAS summary score measuring individual's health status and synthesize in six domains of disability (household, cognitive, mobility, self-care, social and society). Univariate analysis, correlation and comparison tests as well as hierarchical multiple linear regression were performed. RESULTS: The median WHODAS score in the accessible and stable (AS), remote and stable (RS), intermediate (I) and unstable (U) HZ was 6.3 (0–28.6); 25 (6.3–41.7); 22.9 (12.5–33.3) and 39.6 (22.9–54.2), respectively. Four of the six WHODAS domain scores (household, cognitive, mobility and society) were the most altered in the UHZs. The RSHZ and IHZ had statistically comparable global WHODAS scores. The stable HZs (accessible and remote) had statistically lower scores than the UHZ on all items. In regression analysis, the factors significantly associated with an overall poor health status (or higher WHODAS score) were advanced age, being woman, being membership of an association; being divorced, separated or widower and living in an unstable HZ. CONCLUSIONS: Armed conflicts have a ...

BACKGROUND: Few studies have evaluated the body composition (BC) of adults who suffered from severe acute malnutrition (SAM) during childhood, a population at risk of long-term noncommunicable diseases. OBJECTIVE: We performed an observational cohort study to evaluate BC in a group of young adults aged 11–30 y after nutritional rehabilitation for SAM, in the Democratic Republic of the Congo (DRC). METHODS: We evaluated 151 adults in eastern DRC who were treated for SAM during childhood between 1988 and 2007. They were compared with 120 aged- and sex-matched control adults living in the same community who had not been exposed to malnutrition as children. The main variables of interest were the different compartments of adult BC (fat-free mass [FFM], fat mass [FM], and 2 indices of height-normalized BC: FFM index [FFMI] and FM index [FMI]) measured by deuterium dilution. RESULTS: The mean age in both groups was 23 y, and females represented 49% and 56% of the exposed and nonexposed groups, respectively. SAM-exposed males had lower mean ± SD weight (53.6 ± 6.4 compared with 56.4 ± 7.9 kg, P = 0.029) and lower height (159.9 ± 6.6 compared with 163.6 ± 6.7 cm, P = 0.003) compared to unexposed males. SAM-exposed subjects had less FFM (–1.56 kg [–2.93, –0.20]; P = 0.024) but this observation was more marked in males (45.4 ± 5.4 compared with 48.2 ± 6.9 kg, P = 0.01) than in females. No differences in FM were noted between SAM-exposed and unexposed subjects. Adjusting for height, FFMI and FMI showed no difference between SAM-exposed and unexposed in either sex. CONCLUSION: SAM during childhood is associated with reduced FFM in adulthood which is probably due to a shorter height.