 Diolch yn faut, ond rydyn ni'n mynd i'r ddarparu o'r wneud o'r ddweud yn ei ddweud. Roedd rydyn ni'n ffamilio am y cyd-ddeni, mae'r ddweud yn gŵr i chi'n gwneud yn ei ddweud yn y tŷch ar gyfer 45% o'r 5 o rhan o ddweud eich cyd-dweud. Mae'r cyd-dweud yn y ddweud yn 3 miliwn o ddweud anulwy. A'r llawd, mae'r ddweud yn ddweud yn ddweud i ddweud yn y ddweud o ddweud o'r ddweud. Yn gweld ymdAAf ac ni, rwy'n gweithio'r rhan â gwah에iswyr cydweithio, yn gwaheiswyr syddiadu yn ac yn digwydd, ac y gallai'n gwahegi gweithio'r hyffordd ffordd i gwaheiswyr cyntaf gyda am gyntaf yr oligfyrdd. Mae gwaheiswyr hyffordd syddiadu yn cynnig o gweithiol, i siŵr gwaith ym dal yn gwyllfa â'i gwaheydd â'i gwaheiswyr. four two years of age due to long term nutritional deficiencies often coupled with repeated infections. Importantly, Sit's effects on development, maybe irreversible. Acute malnutrition is also called wasting. And'd, as is defined, as low weight for height. It's a strong predictor of mortality in underfights. And is generally, due to an acute i'w ei woch o ddydig sydd yw mewn mwyach a'i mewn mwyach yn bod yn ystyried, unrhyw ffordd a bwyd wedi cael y gwaith y rhan o roi'r cyfrifiadau, cwrs o'r cyfrifiadau, cwrs o'r cyfrifiadau, enghraifft o ddod i'r armell ar gyfer mi o feddlachee, o gydag 6 pierfyn yn 50 o'n 5 pierfyn gynnig o flyngrifeth mae'n amlwysig rwy'n credu pwysig ziwelio. Y pwysig yw y modd yn y pwysig, oherwydd yr ysgol o'r hyff iechyd o gynnig o'r a'r rhan o'r rhan o'r pari a'r gael mewn methorol. Mae'n llwy fwy oes iddyn nhw a phobl yn ddod i'r rhan o'r cymryd. Mae'n ddiddordech yn cael ei ddiddordech o'r ddigoniad. Mae'r rhan o'r sgwr, gelo o modewyr, a gweinio o normal. Ac rydyn ni'n ddiddordech yn gydig o'r cymryd, fel ydych chi'n ddigoniad o'r ddigoniad a'r ddigoniad, oherwydd mae'n ddiddordech o'r ddigoniad o'r ddigoniad for different treatment feeding programmes and also different types of treatment. So if it's so widely used why did we bother trying to develop something different? What problems will we try to solve? Well in part we wanted to address some design flaws that have been reported through different reviews and things that you can pull thin straps too tight mae'r sgwrdd y gallai o'r sgwrdd sylwyr yn lleolol i ddweud y straff. Mae'r sgwrdd yn ei ddweud o'r llinion a'r ysgawdd. Mae'n mynd i gael y dyfodol ar y disgustiwn i 2013, ydych yn cymryd i'r amser hynny'n amser, ydych yn cymryd i'r cyflwyno rhai o'r ddweud o'r ddweud o'r ddweud yng nghymru. Ieithio, mae'n gwneud eich hunain yn y grwp oedd yn ychydig i'r enynt, a'r cyfnodd y gweithio i'r adegau hivau, ac mae'n ddweud i'r ddweud i'r ffigur ffyrddol. Felly, mae'n gweithio i'r grwp o'r ddweud i'r ddweud i'r ddweud, oherwydd o'r rhan o'r rhan o'r prirofiadau, oherwydd o'r rhan o'r rhan o'r ddweud i'r ddweud i'r ddweud. Mae'r grwp yn siaradu i chi chi o'r agynig yn yr agynigol i'ch byr iawn iawn, neu mae'r prindiau hynny i'r agynigol ac efallai plenwydl gan y gweldul, o gyfgrifiaid grwp ar gyfer y dweud rôl i chi arlŷu a'r agynigol, mae'r agynigol yn gwneud o'r awgwrs o ran fwy o banydd, a'r dweud o'u ffeydd mae'r ddasig wedi bydd hwnny o gyllidebeth o'r polygfau taneth, o gyntaf o gefnol yn dwynym. Cynydd chi'n weithio'r Unimwag yn wych â hyn? Byddwn i ni'n mynd o'r holl bwysigio ar gyfer gywethef a'r ystafell. Ond, yn y swyddiaeth ychydig iaith ei wneud o rai gilydd, a'u drefyn gweithio'r bwysigio ar gyfer y mewn cyfnod a'u ddweud y pryd yn fawr o'r bwysigio, gywethef enwedig a'u gilydd ymddangos flwysig. gyda'r llyfrir yma, y lluniaeth, ein lluniaeth yn cael ei bod chi wneud buddwyd ar ddiwedd o hwn o'ch gwrsau o'r gwahanol hanes ac yn cynnig o'r lluniaeth yn cael chi gyda o'r chwrsau. Rhywodol, ac rwyf yn cael ei gwrsau ar y cinsensueth cynghorif iawn o'r Llyfr i'r lluniaeth a gyrdwyr bod fe'n rhoi'r cyffredin. Be gyd-wyr, rwyf i'r panfyrddur wrthwyris oherwydd os ydyno eich cynnig o fyrdd, y rhaidiad o'r stw fan y Unimarch, ystafell ynglynig, mae'n uniseff mwywax straff. Ynmwybod i'r ddweud y pwysgau a'r ddweud. Beth sy'n mynd o'r ten ysgrifennu 10 cm a rydyn ni bydd ychydig eich clyw fydde. So mae'r rhaid i chi ddweud y cyfrans ei ddefnyddio y ffyrdd a'r brwyng. Dwi ddweud i'r ffyrdd, mae'r ffyrdd a'r brwyng. A mae'n ddweud i'r rôl eich cyfrannu o'r fyrdd, y gallwn llawer o ddifwud i gafodd. Y gallwn ni'n bod ni'n gweld i gynnwys iawn, mae gennych y twlwyr ystafell, mae'n gwybodaeth randdraeth, ond yn yn fibu. Diolch i fynd i'r holl maen nhw wedi bod yn fifio yn meddwl i'r benderfynuc llwythau oherwydd y gallwn i gyd yn meddwl i gweithio ymddir i'uДur rhaglion i flynydedd yn cael y dyfodol. Felly yw fod yna fydd hwn yn bwysig'r ysgol ulyll, yw fydd yn fwy o'r tyw. Mae'r parwmian i'r cyd-feyddio i'r cymaint, felly rydyn ni'n bwysig i chi i ddau, ac ar gyfer y byddai y gwahodd cyfnod yn meddwl. Felly mae'r randdau sy'n meddwl, sy'n ddiddordeb sy'n meddwl sy'n meddwl sy'n meddwl. Ond i'r cyfrifiadau, ma'n bwysig i chi'n meddwl, rydyn ni'n meddwl sy'n meddwl sy'n meddwl sy'n meddwl yn meddwl, sy'n meddwl ar gwybodaeth. Rydyn ni'n meddwl i'r cyfrifiadau, mae sy'n gweld o reliabillol, mae'n fy mwyno cyntaf o gallant gwirio gweithredu o'i creu zogrellgorau a phrygu'r gwirio. Mae'r amgylcheddai mae'r amgweld â'r dwyledig. Mae'r grannu o'r maen ni ei wneud yn cael eu gan Melissa o'r rhw Iron o rhan o'r rhywbeth o Yw'r rhwlaeth o'r rhwlaeth o ysbethru o'r rhwlaeth o'r rhwlaeth o Yw'r Rhwlaeth. Felly, we did this, we took 12 plastic tubes of known circumference, and coded them and then placed them in random order. And then we got 17 independent enumerators to measure them in both millimetres and in colour class using both straps. We got 204 measurements recorded for each strap, 408 in total. And this shows the first set of results. This is a modified bland altman plot, which measures the agreement between two values. Now, I'm not going to go through the methodology here, very happy to discuss it in the atrium over a glass of wine later, but in essence it looks at a comparison between the measured values to the true value of the tube. The most important thing to look at here is this red line, and actually it shows the average measurement error for each strap from zero or the real value of the tube. So you want this line to be as close to zero as possible. And as you can see here, the average error with the unimwack strap was minus 2.5 millimetres. The average error with the unicef strap was 1.25 millimetres. Now, you might think that a millimetre sounds pretty innocuous, but I hope to show you that actually even such a small amount can be very, very important. I'm going to skip over this slide for the sake of time. But just to show that this is how much 1 millimetre actually affects diagnostic accuracy when we look at colour class. So this table shows colour accuracy of both tools for unicef and unimwack. The left hand column shows the true colour class of each tube that we measured. And then across the top we see that which was measured by the enumerator. The middle diagonal line highlighted in blue shows where all the results would fall if the tool was 100% accurate and everything in a white cell is an incorrect measurement. As you can see in this table, 97% of all the unimwack measurements were correctly identified in terms of their colour class compared to only 84% with the gold standard unicef tool. And this is particularly interesting. If you look here, you can see that the unimwack incorrectly diagnosed, I'm going to use that word, diagnosed sort of what should have been a red tube, a red class tube as yellow. Whereas the unicef tool incorrectly diagnosed 17 red measurements as yellow. So what does that mean? That basically shows that the colour class errors are concentrated in the red classification, which is actually that of severe acute malnutrition. So if we go back to the way in which we traditionally talk about measurement errors, you can see that the measurement bias caused through the unicef mwack not accounting for strip thickness, basically that it means that the unimwack has a much higher sensitivity, so a sort of the rate of identifying true cases compared to the unicef strap. 96% compared to 75% for severe acute malnutrition, 98% to 85% across both malnutrition classes. The specificity, the ability to rule out, was similar across both straps. And I haven't included precision data here for the interests of time, but basically when we looked at the data within the 95% limits of agreement under the Bland Altman method, the precision was same for both straps. So, in conclusion, the unimwack strap is more accurate in measuring true circumference than the unicef strap, particularly so in small circumferences. And the unimwack strap has a higher sensitivity for diagnosing SAM and general acute malnutrition than the unicef strap. There were of course limitations to our very short standardisation exercise. We used plastic tubes and not human compressible skin. We didn't test the measurement side of the adult unimwack. And it was certainly true that this three slit design, designed for sort of stability, required more of an initial explanation than the slightly more intuitive unicef mwack, which only has one slit. Whilst we were putting together sort of our results, we actually were contacted by several other organisations, asking us as to whether they could take a look at the strap. And we gave it to people basically saying, sort of reiterating this was not an official MSF tool, this was merely a project in development. And also that they could use it providing they gave us feedback. Action against hunger used it in a test against other straps in the community looking at how mothers used it to monitor malnutrition in their kids. And they wrote back to us saying this, mothers performed better with the unimwack than other types of device tested. Mothers understood it and can do it even better than we thought. So the key implication of these findings is essentially that the use of a mwack tool with low sensitivity could lead to misdiagnosis and service denial for the most vulnerable patients. And inaccurate measurements can lead to inconsistent collection of data and misreporting of prevalence. There are some key questions. Essentially the mwack cut-offs that we have at the moment, can we still use them? And it would seem that it's probably true since most of these cut-offs have been developed using a wide variety of straps. Can we actually see the same inaccuracies in measurement in the field and does this actually lead to service denial for children and adults? And then following from the mother's understanding and can do it study, mwack, mwack, is are these mwacks, the unimwack, actually suitable for community use? So our next steps are to conduct a mixed method study in the MSF field to explore whether or not this measurement bias is actually reproducible in the compressible skin of children. We will also gather qualitative feedback to explore how easily healthcare workers and mothers are able to use the tool and actually whether it's acceptable to both groups. So for whether healthcare workers can accept mothers inputting into their management and look really at the options of community usage. Thank you. I was just going to say I didn't miss the thank you side but just thank you to Becky, Rabie and Chrissy LeBeau who did most of the work, to Philip De Crow who thought of the idea. And a particular thanks to Mark Myat for his support in the study design and analysis.