The menace and outcome of severe acute malnutrition and diphtheria cases among paediatric under-five in-patients at Nguru North - east Nigeria.

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.

Children with both severe wasting and severe stunting (SWSS) represent an extreme form of malnutrition and are prone to develop severe infection. The study aims to demonstrate clinical features and aetiology of diarrhoea among children with SWSS compared to those with either severe wasting (SW) or severe stunting (SS), which may help in early identification of high-risk children. Data were extracted from the database of the diarrhoeal disease surveillance system (DDSS) of Dhaka Hospital, icddr,b from 2008 to 2017. Among 14403 under-five diarrhoeal children, 149 had concurrent SWSS (WLZ/WHZ ˂-3 with LAZ/HAZ ˂-3), 795 had SW (WLZ/WHZ ˂-3 but LAZ/HAZ ≥-3) alone, and 1000 had only SS (LAZ/HAZ ˂-3 but WLZ/WHZ ≥-3). In logistic regression analysis after adjusting for potential confounders, dehydrating diarrhoea and slum dwelling were independently associated with SWSS vs. SW (P<0.05). When compared with SS, dehydration and maternal illiteracy were independently associated with SWSS (P<0.05). In comparison with SW or SS, SWSS less often included infection with rotavirus (P<0.05). Dehydration was independently associated with SW vs. SS after adjusting for potential confounders (P<0.05). Children with SWSS more often presented with dehydrating diarrhoea (69%) than children who had either SW (55%) or SS (43%). However, SWSS patients less frequently presented with rotavirus-associated diarrhoeal illnesses. This result underscores the importance of early detection and prompt management of dehydrating diarrhoea in children with concomitant severe wasting and severe stunting to reduce morbidity and mortality in these children, especially in poor settings.

Background: Nutrition is still a global health issue, and improving nutrition is among the targets of the Sustainable Developmental Goals (SDGs). One of Indonesia’s SDGs indicators is to reduce prevalence of malnutrition in children. Indonesia, as a developing country, implements a comprehensive malnutrition treatment program for children, including various aspects related to management of children with acute malnutrition. The purpose of this study was to identify factors associated with the outcome of children hospitalized with acute severe malnutrition. Methods: This cross sectional study enrolled 195 children with severe acute malnutrition, admitted to hospital from November 2016 to August 2017. Statistical Analysis was conducted using multivariable logistic regression to identify factors associated with the outcome. Adjusted Ratio with Confident Interval 95% and the value of P <0 .05 was considered significant. Result: A total of 195 children were diagnosed havings acute severe malnutrition. A history of complete immunization status (p value <0.001) was proved to be directly proportional to the recovery rate of patients with acute severe malnutrition. Provision of other types of antibiotic (p value 0.001) showed to increase recovery rates of patients with acute severe malnutrition. Several comorbid diseases reduced recovery rates such as pneumonia (Crude OR 0.619) tuberculosis (Crude OR 0.606) and HIV (p value 0.08). Conclusions: This study shows that although the provided treatments are appropriate with the standard treatment for severe malnutrition, they still encounter high levels of morbidity. Further large-scale studies should be conducted to develop better interventions and management of acute severe malnutrition, in order to achieve better outcome.

Background: Severe acute malnutrition (SAM) is one of the major public health problems associated with increased mortality in under-five children. In low-income countries, renal dysfunction (RD) contributes to about 34% mortality in under-five children with severe acute malnutrition. This study aimed to determine the impacts of severe acute malnutrition on the kidney among the admitted under-five children. Methods: In this prospective longitudinal observational study, a total of 190 children aged 6 to 59 months were enrolled from Iringa and Dodoma tertiary hospitals. Socio-demographic, clinical and laboratory data were collected using a structured questionnaire. Estimated Glomerular Filtration Rate (eGFR) and urine albumin creatinine ratio (uACR) were used to determine RD. Data analysis was done using SPSS version 26 and statistical significance was assumed for factors with p-value Results: Out of 190 children with severe acute malnutrition, 36 (19%) had renal dysfunction. Factors associated with RD in malnourished children were the history of local herbs used within one week (AOR = 5.85, 95% CI [1.41, 24.319], p = 0.0152), Acute watery diarrhea with severe dehydration (AOR = 2.15, 95% CI [1.033, 4.711], p = 0.0166), and positive urine leukocytes (AOR = 19.91, 95% CI [4.09, 96.989], p = 0.0002). At three months of follow up, out of 36 children with RD, 20 (55.56%) attained full recovery, while 4 (11.11%) developed chronic kidney disease (CKD). Children with RD had prolonged hospital stays for more than 14 days with a mean 12.25 ± 5.00 days compared to those with no RD with a mean 6.29 ± 1.68 days (p Conclusion: Renal dysfunction is common among children with severe acute malnutrition. It is associated with prolonged hospital stays and increased mortality. Further studies which can determine the burden of RD in children with severe acute malnutrition as compared to those with no severe acute malnutrition are needed.

Background: Globally, severe acute malnutrition (SAM) remains a major killer of children under 5 years of age. The highest magnitude is seen in sub-Saharan Africa, including Ethiopia. Hypoglycemia is the most common complication of severe acute malnutrition (SAM) and the most life-threatening condition in pediatric society. This study aimed to assess the prevalence of hypoglycemia and its associated factors among under-five children with severe acute malnutrition. Methods: A cross-sectional retrospective study was conducted among 378 randomly selected samples who were admitted to public hospitals in the East Gojjam zone from 2018 to 2021. Data was extracted from the medical records of the children and entered into SPSS version 26, Variables with a p – value &lt; 0.25 in the Bivariate analysis were candidates for multivariable logistic regression and those with a p – value &lt; 0.05 in the multivariable analysis were considered as having a statistically significant association with hypoglycemia among severe acute malnutrition. Results: Out of 378 respondents, 50 (13.2%) had hypoglycemia with severe acute malnutrition patients. Children admitted between the ages of 0-6 months were 2.93 (AOR = 1.57-6.25, p = 0.000), shocks were 4.6 (AOR = 1.25-17.42, p = 0.034), and fully immunized children were (AOR: 2.61 (1.01- 6.77, p = 0.048) was significantly associated with hypoglycemia with severe acute malnutrition. Conclusion and recommendation: The prevalence of hypoglycemia with severe acute malnutrition was 13.2%. We also recommend a longitudinal study should be done among children who develop hypoglycemia with severe acute malnutrition to determine the long-term consequences, especially the neurodevelopmental sequelae associated with this condition.

Severe Acute Malnutrition Among Under-Five Children in Low- and Middle-Income Countries: A Hierarchical Analysis of Associated Risk Factors

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.

Although Bangladesh has achieved remarkable economic growth and improved various health indicators, childhood malnutrition still is a big concern in improving child health in Bangladesh. This paper explores the prevalence and trends of severe acute malnutrition, moderate acute malnutrition and global acute malnutrition, as well as their socio-demographic factors and socio-economic differentials using the last seven rounds (1996-97, 1999-2000, 2004, 2007, 2011, 2014 and 2017-18) of Bangladesh Demographic and Health Survey, a nationally representative cross-sectional survey. Results show that the prevalence of all severe acute malnutrition, moderate acute malnutrition and global acute malnutrition has declined from 1996-97 to 2017-18 in Bangladesh: severe acute malnutrition from 6.8 per cent to 1.5 per cent; moderate acute malnutrition from 13.9 per cent to 6.9 per cent; and global acute malnutrition from 20.7 per cent to 8.4 per cent. On the other hand, the overall percentage change in the prevalence of severe, moderate and global acute malnutrition accounts for 78 per cent, 50.3 per cent and 59.4 per cent, respectively. The rate of annual decline of severe acute malnutrition is higher among rural children (7.02 per cent) and lower in those in urban areas (5.04 per cent). Child age (6-12 months), child size at birth (smaller), father’s occupation, administrative division and mother’s BMI are strongly related to severe, moderate, and global acute malnutrition. This paper also suggests that there is substantial room to upgrade the nutritional status of children aged 6-59 months in Bangladesh.

Severe Acute Malnutrition (SAM) is a major health risk for children under five. Various factors, such as poor food intake, infections, family size, healthcare participation, maternal nutrition knowledge, and parenting practices, contribute to SAM. However, no studies have specifically examined these factors in under-five children in Grobogan Regency. This study aims to analyze the risk factors associated with severe acute malnutrition among children under five years old in Grobogan Regency. The study employed a quantitative case-control design involving children aged 0-59 months in Grobogan Regency, with 11 children with Severe Acute Malnutrition (SAM) as the case group obtained through total sampling, and 11 well-nourished children as the control group selected via matching. Key variables examined included energy, protein, fat, and carbohydrate intake, as well as infectious diseases, family size, participation in posyandu, maternal nutrition knowledge, and parenting practices. Descriptive analysis outlined the subjects and variables, with bivariate analysis using the Chi-Square test at a 95% confidence level (α=0.05). The results study show that the statistical analysis indicated that inadequate energy intake was significantly associated with SAM (p=0.008, OR=26.667), suggesting that children under five with insufficient energy intake are 26.667 times more likely to experience severe acute malnutrition compared to those with adequate energy intake. In contrast, adequate intake of protein, fat, and carbohydrates, as well as factors such as infectious diseases, family size (p=0.080), participation in posyandu (p=1.000), maternal nutrition knowledge (p=0.476), and parenting practices (p=0.198), did not demonstrate significant associations with SAM among these children. The conclusion is adequate energy intake has been identified as a significant risk factor for SAM among under-five children in Grobogan Regency. Conversely, factors such as adequate intake of protein, fat, and carbohydrates, infectious diseases, family size, participation in posyandu, maternal nutrition knowledge, and parenting practices were not recognized as significant risk factors.

BackgroundThe analysis of acute malnutrition in 2018 for the Integrated Phase Classification of Food Security in Yemen shows that high malnutrition rates are present in Abyan governorate (23%) and Lahj governorate (21%). This analysis was community based addressed all children and mostly due to problems related to food intake. The role of diseases was not yet addressed in Yemen. The aim of this study is to assess acute and chronic malnutrition among hospitalized children at 12–59 months of age in Lahj and Abyan governorates in Yemen.MethodologyA cross-sectional, multi-center study is designed. The assessment of the nutritional status was measured by standardized anthropometry of 951 sick children at 12–59 months of age.ResultsThe prevalence of Global acute malnutrition (GAM) among the sick children seeking care in health facilities in Lahj and Abyan is 21%. More specifically; the prevalence of moderate acute malnutrition (MAM) is 15.1% while the prevalence of severe acute malnutrition (SAM) is 6.2%. The prevalence of acute malnutrition (wasting) among the studied sick children in lahj is 23.4% while in Abyan is 19.3%. The prevalence of MAM in Lahj is 17.7% and the prevalence of SAM is 5.7%. The prevalence of acute malnutrition (wasting) in Abyan is 12.6% while the prevalence of SAM in Abyan is 6.7%. The prevalence of acute malnutrition among male children (25.2%) is significantly higher than among female children (17.5%). The prevalence of the chronic malnutrition (Stunting) in the studied sick children is 41.3%; the prevalence of stunting in Lahj is 41% while in Abyan is 41.7%.ConclusionsHigh acute and chronic malnutrition rates were identified among sick children seeking care in health facilities in lahj and Abyan, and higher than the SPHERE indicators of malnutrition. Boys are more exposed than girls to acute and chronic malnutrition.

Acute childhood malnutrition affects about a tenth of the world’s children under 5 years of age, particularly those living in circumstances of extreme poverty in the developing world.1 2 Malnutrition...

BackgroundLow- and Middle-Income Countries (LMIC) have remained plagued with the burden of severe acute malnutrition (SAM). The decomposition of the educational inequalities in SAM across individual, household and neighbourhood characteristics in LMIC has not been explored. This study aims to decompose educational-related inequalities in the development of SAM among under-five children in LMIC and identify the risk factors that contribute to the inequalities.MethodsWe pooled successive secondary data from the Demographic and Health Survey conducted between 2010 and 2018 in 51 LMIC. We analysed data of 532,680 under-five children nested within 55,823 neighbourhoods. Severe acute malnutrition was the outcome variable while the literacy status of mothers was the main exposure variable. The explanatory variables cut across the individual-, household- and neighbourhood-level factors of the mother-child pair. Oaxaca-Blinder decomposition method was used at p = 0.05.ResultsThe proportion of children whose mothers were not educated ranged from 0.1% in Armenia and Kyrgyz Republic to as much as 86.1% in Niger. The overall prevalence of SAM in the group of children whose mothers had no education was 5.8% compared with 4.2% among those whose mothers were educated, this varied within each country. Fourteen countries (Cameroon(p < 0.001), Chad(p < 0.001), Comoro(p = 0.047), Burkina Faso(p < 0.001), Ethiopia(p < 0.001), India(p < 0.001), Kenya(p < 0.001), Mozambique(p = 0.012), Namibia(p = 0.001), Nigeria(p < 0.001), Pakistan(p < 0.001), Senegal(p = 0.003), Togo(p = 0.013), and Timor Leste(p < 0.001) had statistically significant pro-illiterate inequality while no country showed statistically significant pro-literate inequality. We found significant differences in SAM prevalence across child’s age (p < 0.001), child’s sex(p < 0.001), maternal age(p = 0.001), household wealth quintile(p = 0.001), mother’s access to media(p = 0.001), birth weight(p < 0.001) and neighbourhood socioeconomic status disadvantage(p < 0.001). On the average, neighbourhood socioeconomic status disadvantage, location of residence were the most important factors in most countries. Other contributors to the explanation of educational inequalities are birth weight, maternal age and toilet type.ConclusionsSAM is prevalent in most LMIC with wide educational inequalities explained by individual, household and community-level factors. Promotion of women education should be strengthened as better education among women will close the gaps and reduce the burden of SAM generally. We recommend further studies of other determinate causes of inequalities in severe acute malnutrition in LMIC.

Up to half of all children presenting to Nutrition Rehabilitation Units (NRUs) in Malawi with severe acute malnutrition (SAM) are infected with HIV. There are many similarities in the clinical presentation of SAM and HIV. It is important to identify HIV infected children, in order to improve case management. This study aims to identify features suggestive of HIV in children with SAM. All 1024 children admitted to the Blantyre NRU between July 2006 and March 2007 had demographic, anthropometric and clinical characteristics documented on admission. HIV status was known for 904 children, with 445 (43%) seropositive and 459 (45%) seronegative. Features associated with HIV were determined. Associations were found for the following signs: chronic ear discharge (OR 14.6, 95%CI 5.8-36.7), lymphadenopathy (6.4, 3.5-11.7), clubbing (4.9, 2.6-9.4), marasmus (4.9, 3.5-6.8), hepato-splenomegally (3.2, 1.8-5.6), and oral candida (2.4, 1.8-3.27). Any one of these signs was present in 74% of the HIV seropositive, and 38% of HIV uninfected children. A history of recurrent respiratory infection (OR 9.6, 4.8-18.6), persistent fever, recent outpatient attendance, or hospital admission were also associated with HIV. Persistent diarrhoea was no more frequent in HIV (OR 1.1). Orphaning (OR 2.1, 1.4-3.3) or a household contact with TB (OR 1.7, 1.1-2.6), were more common in HIV. Each of these features were present in >10% of seropositive children. HIV infected children were more stunted, wasted, and anaemic than uninfected children. Features commonly associated with HIV were often present in uninfected children with SAM, and HIV could neither be diagnosed, nor excluded using these. We recommend HIV testing be offered to all children with SAM where HIV is prevalent.

Background: Children with moderate acute malnutrition (MAM) have an increased list of mortality, infections and impaired physical and cognitive development compared to well-nourished children. The Objectives of this study were to diagnose Severe Acute Malnutrition (SAM) and Moderate Acute Malnutrition (MAM) using WHO growth charts as a criterion and to compare the WHO classification with the IAP classification in the diagnosis of SAM and MAM.Methods: A two-year duration cross-sectional study conducted in Pediatric outpatient clinic of a rural hospital from January 2013 to December 2014. In case of moderate acute malnutrition (MAM) was diagnosed as weight-for-height &gt;-3 but &lt;-2 Z scores of the median according to WHO growth standards. We defined MAM as mid-upper am circumference (MUAC) of &gt;11.0 cm and &lt;12.5 cm with no bilateral pitting edema and SAM as MUAC less than 11.5 cm. We compared the values with the IAP charts for diagnosis of malnutrition. Our set up is not a nutrition rehabilitation centre, feeding programmes were not implemented.Results: The distribution of prevalence of SAM and MAM differs significantly across three age groups studied (P-value &lt;0.001). However, it did not differ significantly between boys and girls aged between 6 months to 6 years (P-value &gt;0.05). Of 90 SAM cases, 55 cases (61.1%) had Grade 1 IAP grade of malnutrition, 28 cases (31.1%) had Grade 2 IAP grade of malnutrition, 7 cases (7.8%) had Grade 3 IAP grade of malnutrition. None of the SAM cases fell in Grade 4 IAP. The distribution of prevalence of SAM and MAM differs significantly across various IAP grades of malnutrition (P-value &lt;0.001).Conclusions: The IAP charts used for diagnosing malnutrition did not have any comparative value with the WHO charts used for the SAM MAM detection. WHO grading of SAM and MAM is more sensitive than IAP grading in early diagnosis of under nutrition and facilitate early treatment. Not having a targeted nutrition-specific intervention to address MAM in this set up places these children with MAM at excessive risk of adverse outcomes. Further preventive and curative approaches should urgently be considered.

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.