Risk and Adverse Outcome Factors of Severe Acute Malnutrition in Children: A Hospital-Based Study in Odisha.

Kedarnath Das,Nirmal K Mohakud,Suchismita Mohapatra,Arakhita Swain,Swarnalata Das

doi:10.7759/cureus.18364

Abstract

Background Malnutrition is prevalent in 41% of children less than five years old in developing countries.ObjectiveTo determine the clinical spectrum, identify the risk factors, and find out the factors responsible for the adverse outcomes of severe acute malnutrition (SAM) in children.MethodsIn this prospective cohort, children aged one month to five years with SAM from October 2016 to September 2018 were enrolled. Clinical profile, contributing factors, treatment, and outcome of cases (n=198) were noted.ResultsSAM was diagnosed in 323 (1.6%) of admitted cases. The unimmunized children were 123 (62.1%). Common co-morbidities were acute gastroenteritis (n=89, 44.9%), respiratory tract infection (n=88, 44.4%), and septicemia (n=54, 26.7%). Children not on exclusive breastfeeding (n=157, 79.1%), early complementary feeding (<6 months) (n=157, 88.2%), bottle-feeding (n=138, 77.55%), low birth weight (157, 79.1%), living in kutcha houses (115, 58.2%), and unavailability of safe drinking water (131, 66.4%) were the significant risk factors. Pneumonia, diarrhea, nutritional edema, hypothermia, and circulatory shock at the time of admission were responsible for adverse outcomes. One hundred and eighty-three (92.4%) children were cured and discharged and 15 (7.6%) children died.ConclusionsWrong feeding practices and unavailability of safe drinking water have an important bearing on the development of SAM children. Pneumonia, diarrhea, nutritional edema, hypothermia, and circulatory shock at the time of admission were responsible for adverse outcomes.

Highlights

Malnutrition attributes to 33% of global deaths and 45% of deaths in under-five children in South Asia and Sub-Saharan Africa [1,2]
Diarrhea, nutritional edema, hypothermia, and circulatory shock at the time of admission were responsible for adverse outcomes
Wrong feeding practices and unavailability of safe drinking water have an important bearing on the development of severe acute malnutrition (SAM) children

Summary

Introduction

Malnutrition attributes to 33% of global deaths and 45% of deaths in under-five children in South Asia and Sub-Saharan Africa [1,2]. Severe acute malnutrition (SAM) is managed as per the 10 steps of standardized inpatient treatment as per the 2016 modification of guidelines [4]. The ready-to-use therapeutic foods F-75 and F-100 have increased the feasibility of community management. Despite this standardized protocol of care, in-patient mortality is as high as 10%-40% [4], and the reasons are yet to be elucidated. In India, more than 33% of deaths under five years of age are associated with malnutrition [3]. This might be due to change in innate and adaptive immunity as a result of nutrient and micronutrient deficiencies [5]. Malnutrition is prevalent in 41% of children less than five years old in developing countries

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Conclusion