Diarrhoeal children with concurrent severe wasting and stunting compared to severe wasting or severe stunting.

To determine the predictors of mortality within 30days of hospital admission in a diarrhoeal disease hospital in Bangladesh. Cohort study of hospitalised children aged 0-59months with severe acute malnutrition (SAM) and severe pneumonia in Dhaka Hospital, icddr,b, Bangladesh from April 2015 to March 2017. Those discharged were followed up, and survival status at 30days from admission was determined. Children who died were compared with the survivors in terms of clinical and laboratory biomarkers. Multivariable logistic regression analysis was used for calculating adjusted odds ratio for death within 30days of hospital admission. We enrolled 191 children. Mortality within 30days of admission was 6% (14/191). After adjusting for potential confounders (hypoxia, CRP and haematocrit) in logistic regression analysis, independent factors associated with death were female sex (aOR=5.80, 95% CI: 1.34-25.19), LAZ <-4 (aOR=6.51, 95% CI: 1.49-28.44) and Polymorphonuclear Leucocytes (PMNL) (>6.0×109 /L) (aOR=1.06, 95% CI: 1.01-1.11). Using sex, Z-score for length for age (LAZ), and PMNL percentage, we used random forest and linear regression models to achieve a cross-validated AUC of 0.83 (95% CI: 0.82, 0.84) for prediction of 30-day mortality. The results of our data suggest that female sex, severe malnutrition (<-4 LAZ) and higher PMNL percentage were prone to be associated with 30-day mortality in children with severe pneumonia. Association of these factors may be used in clinical decision support for prompt identification and appropriate management for prevention of mortality in this population.

High Prevalence of Severe Acute Malnutrition in Children with Sickle Cell Anemia over 5 Years of Age in Northern Nigeria

Although several studies have shown that undernutrition is frequent in children with cerebral palsy (CP), studies determining predictors of undernutrition and its impact on health-related quality of life (HRQoL) are scarce. This study aimed to assess the prevalence, severity, and predictors of malnutrition in children with CP and its impact on quality of life. This prospective study was performed between August 2019 and December 2021 in children with a clinical diagnosis of CP aged 2-18years. We also intended to determine the socio-demographic and clinical predictors of undernutrition in these children and its impact on HRQoL, measured by the cerebral palsy quality of life (CPQoL)-Primary Caregiver reported version. Out of 569 (5.4 ± 2.8years of age, 74% boys) children with CP, 71%, 44%, and 72% children were underweight, wasted, and stunted respectively, whereas 22%, 11%, and 21% were severely underweight, wasted and stunted respectively. Lower socioeconomic status, higher Gross Motor Function Classification System, and Manual Ability Classification System level were found to be significantly associated with the severity of stunting and underweight (p < 0.05), but not with wasting. CPQoL score in children with CP aged > 4years was lower in patients with severe wasting, stunting, and underweight, as compared to their rest of the counterparts when adjusted for socio-demographic and other clinical variables (p < 0.05). Conclusion: Chronic undernutrition is more common than severe acute malnutrition in children with CP. The severity of undernutrition is an important predictor of impaired HRQoL in children with CP. What is Known: • Several studies have shown that undernutrition is frequent in children with cerebral palsy; however, studies determining predictors of undernutrition and its impact on health-related quality of life are scarce. What is New: • Our study identifies that lower socioeconomic status, higher Gross Motor Function Classification System, and Manual Ability Classification System level are significantly associated with the severity of stunting and being underweight. • Chronic undernutrition is more common than severe acute malnutrition in children with cerebral palsy. Its severity is an important predictor of impaired health-related quality of life in children with cerebral palsy.

Is measuring malnutrition in children enough?

BackgroundMalnutrition in children is widely prevalent around the world. It has been observed that malnourished children with multiple anthropometric deficits have higher mortality. However, adequate studies are not available on...

Introduction: Malnutrition is one of the leading causes of morbidity and mortality in children under the age of five in developing countries. Ethiopia being one of these countries, malnutrition is an important public health problem. However, little information is available on the severity of malnutrition and treatment responses in under five children especially in hospital settings. Objective: To determine the severity of malnutrition and treatment responses of severe acute malnutrition in children under the age of five and to identify its associated factors. Methodology: ensus method was used and a retrospective data of about 1639 under five children admitted to Felegehiwot Referral Hospital (pediatrics department) form November 2012 –November 2013 were studied for severe acute malnutrition and its treatment responses. Results: In the study period, a total of 1639 children less than 5 years of age were admitted to FHRH pediatric department, and out of that 145 were under five years old with a diagnosis of malnutrition malnourished characteristics. Hence, the proportion of under five aged children affected with malnutrition from this one-year retrospective data in FHRH was about 8.8%. From the total of 145 malnourished children, about 93(64.1%) were detected for wasting/acute malnutrition and about 36 (24.8%) were affected with severe wasting or severe acute malnutrition (SAM). Among the malnourished children, about 133(91.7 %) were detected for stunting (chronic malnutrition) and about 65(44.8%) were affected with severe stunting. Conclusions: The findings of this study showed that the proportion of malnutrition in under five children is high especially during 1-2 years old group. Among the malnourished children detected (145), the level of stunting/chronic malnutrition was higher than wasting/acute malnutrition (91.7% vs64.1%, respectively). The level of severe chronic stunting investigated was also found higher than the level of SAM (44.8% vs 24.8%, respectively). Better responses of treatment and condition at discharge were observed by using different therapeutic combinations after admission. To reduce childhood malnutrition especially in under five children, due emphasis should be given in improving the knowledge and practice of parents on appropriate infant and young child feeding practices and treatment service practices from nearby health facilities.

A cross sectional descriptive study was conducted using a structured questionnaire and anthropometric measurements to assess chronic malnutrition (stunting) and acute malnutrition (wasting) for 570 children at 60 to 180 months age, including 294 girls and 276 boys at Dar EL Salam, Khartoum State, Sudan. The prevalence of malnutrition was calculated using World Health Organization (WHO) Anthro Plus; it was shown that severe and moderate chronic malnutrition in both male and female was 4.6 and 15.25%, respectively. The prevalence of chronic malnutrition (stunting) in male was 6.2 and 17.43% for severe and moderate stunting and in females was 3.03 and 12.85% for severe and moderate stunting, respectively. The prevalence of acute malnutrition in both males and females according to the BMI-for-age body mass index (BMI) was 6.99 and 19.19% for severe and moderate acute malnutrition. The prevalence of acute malnutrition (wasting) in males was 6.66 and 19.66% for severe and moderate acute malnutrition and in female was 6.95 and 18.93% for severe and moderate acute malnutrition. Key words: Cross-sectional study, chronic malnutrition, acute malnutrition, World Health Organization (WHO) Anthro Plus.

476 5. C hildhood malnutrition encompasses a plethora of nutritional disorders that include stunting, underweight, wasting, severe acute malnutrition (SAM), and micronutrient deficiency disorders. Overweight and obesity, at the other end of the nutritional spectrum, are also manifestations of childhood malnutrition. Nearly 24 million children (younger than 5 years) worldwide experience SAM. The vast majority is located in Africa and Asia (8 million are in India alone). A child with SAM is 10 times more likely to die than a wellnourished child. SAM is one of the top 3 nutrition-related causes of death in children younger than 5 years. Estimates of deaths directly attributable to SAM varied from 0.5 to 2 million annually. Moderate and severe child malnutrition account for 40% to 50% of all deaths in children younger than 5 years. If the United Nations Millennium Development Goals (http://www.un.org/millennium goals) of reducing children malnutrition and mortality by 50% by 2015 are to be met, SAM needs to be prevented and controlled effectively.

Background Majority of children with cancer live in low and middle-income countries (LMIC) where survival is disproportionately low compared to high-income countries (HIC). Among the challenges of managing childhood cancers in LMIC is late presentation, advanced disease, and the prevalence of severe malnutrition. Advanced disease and severe acute malnutrition are associated with poor treatment outcomes. Methodology This was a descriptive study conducted in Tanzania at Ocean Road Cancer Institute (ORCI) in 2010. Children and adolescents below 18 years were longitudinally enrolled in the study. Pathological diagnosis was made by examination of tissue biopsies, fine needle aspiration (FNAC) or bone marrow aspiration cytology (BMAC). Stage of disease at presentation was determined by physical examination and radiological investigations such as chest x-ray and ultrasonography. World Health Organization (WHO) anthropometric measurement chart was used to interpret measured Mid-upper arm circumference (MUAC) for age. Body mass index (BMI) is affected by tumour weight hence was not used to assess malnutrition in this study. Results One hundred and fifty-one (151) patients were enrolled in the study. The mean age at presentation was 5.8 years (range 3-17years), and 51.7% of participants were males. Three quarters (76.6%) of patients attended the first health facility within a month of onset of symptoms, but forty per cent (40%) of patients took six (6) months to reach ORCI for treatment. Eighty-six percent (86%) of patients presented with advanced disease (50.8% - locally advanced, 35.1% - metastatic disease). Metastatic disease was more frequent in patients with Neuroblastoma (NB) and Non Hodgikins Lymphoma (NHL) (66.6% each), Burkitt’s lymphoma (BL) (50%), Soft tissue sarcoma (STS) (40%) and Wilm’s tumour (WT) (35.3%). Severe wasting was seen in 12.6% of patients, and more prevalent among patients with BL (31.3%) and WT (25%). Conclusion Even though most patients sought health care early, they reached ORCI late with advanced disease (86%), and 12.6% had severe acute malnutrition. Keywords: Children, Cancer, Advanced Disease, Malnutrition.

BackgroundEven with significant strides in technology, medicine, and science, the burden of malnutrition continues to weigh heavily on children, particularly in developing nations like India. This issue of malnutrition is particularly acute in developing and underdeveloped countries, including India. While India has made progress in reducing child malnutrition, severe malnutrition (acute and chronic) remains a critical public health concern, especially in regions like the Aspirational Districts (ADs), which are more resource-deficient regions.MethodThis study used data from the National Family Health Survey-5(NFHS-5) to examine the prevalence and predictors of severe malnutrition among children under five years in both ADs and non-ADs. Thedescriptive statistics and logistic regression models were used andwe examined how residence in ADs influences the likelihood of severe malnutrition, accounting for socio-economic, demographic, household, and parental factors. The novelty of this study lies in addressing a critical research gap by examining all three severe malnutrition indicators: severe wasting(SW), severe stunting (SS), and severe underweight(SU), simultaneously and comparing their prevalence between ADs and non-ADs. This approach provides crucial evidence on the state of child malnutrition in resource-limited regions.ResultsThe study revealed that children in ADs have increased odds of SS, SW, and SU after accounting for different factors. Children who were male, had low birth weight, were of higher birth order, were anemic, experienced diarrheal episodes, resided in rural areas, had mothers with no education, belonged to poor wealth status, belonged to Scheduled Caste/Tribe families and had no exposure to mass media were more likely to be SS, SW, and SU.ConclusionThese findings are crucial to address regional inequalities in severe malnourishment, and targeted interventions in these resource-limited areas are pertinent. Improving nutrition programs, raising awareness among mothers, and providing socio-economic support, especially in rural areas can reduce the odds of severe malnourishment and contribute to achieving global Sustainable Development Goals related to health, hunger, and poverty.

Introduction: Severe Acute Malnutrition (SAM) is a unique type of severe malnutrition and is different from severe underweight and severe stunting. This study evaluated the clinical manifestations among the children admitted to the SCB medical college and SVP PGIP and elucidated further the factors associated with severe malnutrition among the undernourished children and finally the outcome in terms of cured or mortality. Materials and Methods: This hospital-based cross-sectional time-bound study with follow-up component was conducted by using technique of sampling without replacement. Children aged 1-60 months admitted to SCB MCH and SVPPGIP during September 2013 to September 2015, having features of SAM were considered for the study population. After detailed history and physical examination, relevant investigations were done and critical analysis made. Results: Total 130 patients with SAM constituted the study population. The overall prevalence of SAM was 2.5 %. Majority were non edematous SAM (Marasmus) (77%) and rest were oedematous (Kwashiorkor).There was no variation in sex as both male and female patients were with equal percentage (50%). About 12.3 % of children with SAM were less than 2 months, 47.7 % between 2 to 12 months, and 40% were above 12 months. Conclusion: Malnutrition is predicted by age less than two years, living with single parent, taking unbalanced diet, lack or incomplete immunization and low level of maternal education. Co-morbidities associated with malnutrition were pneumonia, pulmonary tuberculosis, urinary tract infection. Mortality is predicted by age less than one year, peasant parents, having severe malnutrition, dehydration, hypothermia, and hypoglycemia.

Risk factors for severe acute malnutrition in under-five children: a case-control study in a rural part of India

Acute malnutrition in children <5 years of age has a direct relationship with medical complications and mortality. We aimed to describe the etiologic factors in children with moderate and severe non-illness-related acute malnutrition who required hospitalization for treatment of malnutrition in two high-complexity hospital centers in Bogotá, Colombia. This is a multicenter case series (December 2016 to December 2020) including patients aged 1-59 months with a weight/height indicator less than -2 SD. Electronic health records were reviewed, and demographic (sex, age, city of origin, and socioeconomic status) and clinical data (gestational age at birth, edema, and nutrition status) were collected. Descriptive analysis of information was performed. An exploratory bivariate analysis by diagnostic categories of moderate and severe acute malnutrition vs days of hospitalization was also performed. Forty-five patients were included, 62.2% of whom were male, with a median age of 14 months (Q1-Q3: 7-24). The main etiologic factors of malnutrition were related to problems with total food intake (33.3%), transition in consistency of feeding (31.1%), and breastfeeding technique (22.2%). Only 13.3% had problems related to food insecurity. There were no statistically significant differences between moderate (median: 7 days; Q1-Q3: 5-12) and severe (median: 8 days; Q1-Q3: 5-16) acute malnutrition when compared by days of hospitalization. The main etiologic factors of malnutrition in our study population were related to problems in the amount of food provided and transition in consistency of complementary feeding.

The association between severe acute malnutrition (SAM) in early childhood and liver fat in adults is unknown. We hypothesized that exposure to SAM, especially severe wasting, is associated with fatty liver later in life. In this observational study, abdominal CT was used to quantify mean liver attenuation (MLA) and liver:spleen attenuation ratio (L/S). Birth weight (BW), serum lipids, insulin resistance (homeostatic model assessment), anthropometry and intrabdominal fat were collected. Mean differences between diagnostic groups were tested and hierarchical regression analysis determined the best predictors of liver fat. We studied 88 adult SAM survivors and 84 community participants (CPs); age 29.0 ± 8.4 years, BMI 23.5 ± 5.0 kg/m2 (mean ± SDs). SAM survivors had less liver fat than CPs (using L/S) (p = 0.025). Severe wasting survivors (SWs) had lower BW (-0.51 kg; p = 0.02), were younger, thinner and had smaller waist circumference than oedematous malnutrition survivors (OMs). In the final regression model adjusting for age, sex, birth weight and SAM phenotype (i.e., oedematous malnutrition or severe wasting), SWs had more liver fat than OMs (using MLA) (B = 2.6 ± 1.3; p = 0.04) but similar liver fat using L/S (p = 0.07) and lower BW infants had less liver fat (MLA) (B = -1.8 ± 0.8; p = 0.03). Greater liver fat in SWs than OMs, despite having less body fat, supports our hypothesis of greater cardiometabolic risk in SWs. Other postnatal factors might influence greater liver fat in survivors of severe wasting, suggesting the need to monitor infants exposed to SAM beyond the acute episode.

Background Globally, the mortality and morbidity estimates from Severe Acute Malnutrition (SAM) in under-five children (0-59 months) are highly significant in low-income countries. This study aims to contribute to the fight against SAM in under-five Chadian children. Method A cross-sectional study was performed on data collected from surveys conducted for 30 days on 326 hospitalized patients with SAM of under- five children. The participants included in the study fulfilled the admission criteria at the therapeutic nutritional unit (TNU) of Alerte Sante. This study assessed the sociodemographic characteristics, factors related to healthcare access, dietary patterns and clinical factors, and length of hospitalization and outcomes for the admitted children. MAS types were classified using the mid-upper arm centimeter (MUAC), WHO Weight- to-Height Z-score (WHZ) scale, and edema assessment. Results Among the study population, the male gender was predominant (65.6%). Most of the children (85.9%) belong to Muslim households. Children aged between 12 and 23 months were mainly represented. Marasmus type of SAM was around 90%. The most prevalent chief complaint for admission was Diarrhea (18.8%). The findings revealed 69% of patients discharged after recovery, 11 (3.37%) deaths, from which 54.5% belong to the age group of 12-24 months. Conclusion SAM is still prevalent in N’Djamena for under-five children. The study found several socio-demographic factors associated with SAM. Considering the strong association between diarrhea and related highest- case fatalities, advocacy and health education regarding breastfeeding, hygiene, and nutrition will immensely help