Acute Malnutrition In Infants Research Articles

Clinical Profile and Risk Factors for Severe Acute Malnutrition in Infants Under 6 Months of Age Admitted to Tertiary Care Centre

Clinical Profile and Risk Factors for Severe Acute Malnutrition in Infants Under 6 Months of Age Admitted to Tertiary Care Centre

New WHO guideline on the prevention and management of acute malnutrition in infants and young children: remaining challenges

New WHO guideline on the prevention and management of acute malnutrition in infants and young children: remaining challenges

A Study of Reliability of Mid Upper Arm Circumference for Detection of Severe Acute Malnutrition in Infants Between 1-<6months of Age

Introduction: Severe Acute Malnutrition (SAM) in children below 6months of age is diagnosed in presence of either of (1) weight for height/length <-3 standard deviations (SD) of median WHO growth reference (in infants >45cm); (2) visible severe wasting; (3) presence of bipedal edema. Simple measuring tape with reorientation of health workers can detect beginning of childhood malnutrition. This study aims to study reliability of mid upper arm circumference (MUAC) for detection of SAM in infants aged 1-6 months of age.

Severe acute malnutrition among infants under 6 months of age in the teaching hospital of Borgou / Alibori in Northen Benin

Background: Acute malnutrition in infants under six months is a scourge that is little studied in relation to the global problem of child malnutrition. This paper aims to describe the sociodemographic, clinical, therapeutic, and outcome features of this phenomenon in the Teaching Hospital of Borgou /Alibori based in Parakou in northern Benin. Patients and methods: This was a two years case-control retrospective and descriptive study carried out in the pediatric care unit of the said hospital from January 1, 2016, to December 31, 2018. It included infants aged 1 to 6 months presenting with severe acute malnutrition defined according to the WHO criteria. Variables investigated were sociodemographic, clinical, therapeutic, and outcome-related. Results: Total of 78 out of 508 infants less than 6 months of age were severely malnourished (5.35%). Their mean age was 4.65 months±1.28. Contributory factors were early dietary diversification (69.2%), and maternal death (14.1%). Marasmus and kwashiorkor were their clinical expressions. Associated complications were gastrointestinal infections (38.5%), septicemia (17.9%), and HIV infection (5.1%). Diluted F-100 was the most used therapeutic food (46.1%) with a recovery rate estimated at 41% and mortality at 19.3%. Conclusion: Severe acute malnutrition in infants under six months of age is real and it involves three out of twenty infants admitted to the hospital. In-hospital mortality is significant. It is urgent to review the policies related to exclusive breast feeding promotion.

A narrative review of efficacy of antibiotics in treatment of children with severe acute malnutrition in community based out-patient treatment.

The World Health Organisation (WHO) updated guidelines on the management of severe acute malnutrition in infants and children (2013) recommends antibiotic treatment of uncomplicated severe acute malnutrition (SAM) in the community setting. As community-based treatment is gaining ground, this evidence review looks at the emerging data to improve the decision-making process. The databases of Pubmed, Google Scholar, Cochrane Database of Systematic Review were searched for experimental and observational studies in the English literature for the period of 2011-2021. The search identified seven studies: two interventional and five observational. Six of these studies showed significant improvement in recovery rates using weight for height Z-score-2. Emerging evidence supports the continuation of antibiotic treatment for uncomplicated SAM in out-patient settings, as recommended in the WHO guideline of 2013.

Maternal Time Use Drives Suboptimal Complementary Feeding Practices in the El Niño-Affected Eastern Ethiopia Community.

Ethiopia is affected by recurrent drought and food-insecurity crises, including El Niño. El Niño started in mid-2014, worsened in 2015, and continued in 2016, leading to a widespread food-insecurity emergency resulting in a surge in the rate of acute malnutrition in infants due to suboptimal feeding practices. This study explored how El Niño influenced complementary feeding practices in the eastern Ethiopia community from March to September 2016. It was an exploratory qualitative study with a basic interpretative qualitative approach. A general inductive approach was used for the analysis. The study involved 11 focus group discussions (FGD) with a total of 76 people, including three with mothers, three with Health Development Army (HDA) leaders, two with fathers, two with traditional birth attendants, and one with religious leaders. El Niño resulted in failed crops and loss of livestock, resulting in reduced dietary diversity and meal frequency. El Niño resulted in suboptimal complementary feeding practices by reducing food access and altering livelihood and coping strategies, reducing the time mothers allocated to child feeding, keeping them away from home, and stressing community health services. The maternal suboptimal time allocation is central to the poor complementary feeding practices. Thus, the women should be supported with climate-resilient livelihood options in their villages, allowing them to feed their children and attend education sessions with HDA leaders.

Therapeutic Food Development from Maize Grains, Pulses, and Cooking Banana Fruits for the Prevention of Severe Acute Malnutrition.

In children under five years of age, severe acute malnutrition is a complex and challenging problem, especially those living in poor communities. Therefore, this study aimed to formulate ready-to-use therapeutic foods from affordable, locally available cereals, pulses, and banana fruits to overcome the problem of severe acute malnutrition. Maize grains, pulses (soybeans), and cooking banana fruits were ingredients used in formulations of ready-to-use therapeutic foods (RUTF). A completely randomized design was done with two replicates. Data were analyzed using analysis of variance. A significant difference existed in the appearance and consistency for RUTF1, RUTF2, and RUTF3 samples (P < 0.05). The study findings revealed that the moisture content varied from 6.7 to 13.4%, energy from 513.2 to 642.41 kcal/100 g, protein from 13.9 to 19.34%%, and crude fat from 24.12 to 35.54%. The calcium content ranged from 225 to 302 g/100 mg, iron from 10.34 to 12.26 g/100 mg, and zinc from 10 to 20 g/100 mg. In this study, the phytate content varied from 314.74 to 369.3 μg/g and crude tannin, from 101.36 to 153.25 μg/g. This study concluded that the ingredients used in the RUTF1, RUTF2, and RUTF3 formulations met the standard ready-to-use therapeutic foods. Therefore, it is important to prescribe ready-to-use dietary supplements made from inexpensive, locally available, and culturally acceptable foods to prevent severe acute malnutrition in infants.

Prevalence and Biochemical Risk Factors of Severe Acute Malnutrition in Infants Under 6 Months Old in Single Tertiary Referral Hospital

Severe acute malnutrition remains to be a burden in developing countries, including Indonesia. Recent studies and researches started to highlight the importance of recognizing severe acute malnutrition in infants under 6 months old. This is a cross-sectional study aims to know the prevalence and biochemical risk factors of severe acute malnutrition in infants under 6 months old in our single tertiary referral hospital, Sanglah General Hospital, Denpasar, Bali, Indonesia. From January 2017 to December 2018, there were 138 children with severe acute malnutrition admitted to Sanglah General Hospital, Denpasar. From 138 subjects, 19 were below 6 months old of age (13,8%) and 119 were older than 6 months old (86,2%). Majority of our study samples were males with ratio of 1,5:1, had length of stay of more than 15 days (60,9%) and were marasmic (96,4%). Death occurred in 44,9% of study samples. Bivariate analysis including gender, length of stay, death, comorbidities, anemia, hypoalbuminemia, hypokalemia, hyponatremia and hypocalcemia. Of all the variables analyzed, only hypocalcemia yielded significant result with prevalence ratio between below and older than 6 months old age group was 0,432 (<i>p value </i>0,045). The prevalence of hypocalcemia in infants under 6 months old with acute severe malnutrition is lower than children above 6 months old of age.

Infant malnutrition treatment in Kenya: Health worker and breastfeeding peer supporter experiences

Acute malnutrition in infants under 6 months (u6m) is increasingly recognised as a global public health problem. The World Health Organisation (WHO) guidelines for inpatient nutritional rehabilitation of infants u6m is re‐lactation: the re‐establishment of exclusive breastfeeding. Evidence suggests these guidelines are rarely followed in many low‐income settings. Two studies of infant nutritional rehabilitation undertaken in three public hospitals in coastal Kenya employed breastfeeding peer supporters (BFPSs) to facilitate WHO guideline implementation. To explore the acceptability of the strategy to health workers (HWs) and the BFPSs, in‐depth interviews were conducted with 20 HWs and five BFPSs in the three study hospitals. The HWs reported that the presence of the BFPSs changed the way infant nutritional rehabilitation was managed, increasing efforts at relactation and decreasing reliance on supplemental milk. BFPSs were said to help address staff shortages and had dedicated time to support and assist the mothers. Key to the success of the BFPSs was the social relationships they were able to establish with the mothers due to the similarity in their experiences and backgrounds. Despite the success of the BFPSs, human resource management and infrastructure challenges remained. BFPSs can successfully be employed to facilitate the implementation of the WHO guidelines for the nutritional rehabilitation of acutely malnourished infants u6m in hospitals in Kenya, establishing supportive social relationships and trust with the mothers of the acutely malnourished infants and helping to address the issue of human resource shortages.

Mid-upper arm circumference cut-off for detection of severe acute malnutrition in infants aged between one and six months

Objective: To find the MUAC cut-off for detection of severe acute malnutrition in infants between 1to 6 months of age. Material and Methods: A prospective observational study at IPD and OPD of atertiary care hospital. 303 infants between one and six months of age above the length of 45cmswere included in the study. In infants between one and six months of age, the length, weight, andMUAC were measured. SAM infants were identified using the WHO definition. Sensitivity, specificity,and Youden index for a particular MUAC was calculated in SAM infants. Results: 11cms was found tohave a sensitivity of 85.1% and specificity of 65.9%. It had the maximum Youden index of 0.55 witha positive likelihood ratio of 2.79 and a negative likelihood ratio of 0.21. Conclusions: MUAC of11cms can be used as a cut-off for SAM infants between 1 to 6 months of age. MUAC does not varywith gender. Weight and MUAC are significantly lower in SAM infants. But there is no difference whenit comes to length as in acute malnutrition, the weight and MUAC are affected but length is not.

A novel RET gene mutation in a neonate with total colonic aganglionosis and renal agenesis: a case report

Objective: To find the MUAC cut-off for detection of severe acute malnutrition in infants between 1to 6 months of age. Material and Methods: A prospective observational study at IPD and OPD of atertiary care hospital. 303 infants between one and six months of age above the length of 45cmswere included in the study. In infants between one and six months of age, the length, weight, andMUAC were measured. SAM infants were identified using the WHO definition. Sensitivity, specificity,and Youden index for a particular MUAC was calculated in SAM infants. Results: 11cms was found tohave a sensitivity of 85.1% and specificity of 65.9%. It had the maximum Youden index of 0.55 witha positive likelihood ratio of 2.79 and a negative likelihood ratio of 0.21. Conclusions: MUAC of11cms can be used as a cut-off for SAM infants between 1 to 6 months of age. MUAC does not varywith gender. Weight and MUAC are significantly lower in SAM infants. But there is no difference whenit comes to length as in acute malnutrition, the weight and MUAC are affected but length is not.

Antimicrobial and micronutrient interventions for the management of infants under 6 months of age identified with severe malnutrition: a literature review.

BackgroundInfants under 6 months (U6M) contribute a significant proportion of the burden and mortality of severe malnutrition globally. Evidence of underlying aetiology in this population is sparse, but it is known that the group includes ex-preterm and low birthweight (LBW) infants. They represent a unique population given their dependence on breastmilk or a safe, secure alternative. Nutrition agencies and health providers struggle to make programming decisions on which interventions should be provided to this group based upon the 2013 WHO Guidelines for the ‘Management of Severe Acute Malnutrition in Infants and Young Children’ since there are no published interventional trial data focussed on this population. Interim guidance for this group might be informed by evidence of safety and efficacy in adjacent population groups.MethodologyA narrative literature review was performed of systematic reviews, meta-analyses and randomised controlled trials of antimicrobial and micronutrient interventions (antibiotics, deworming, vitamin A, vitamin D, iron, zinc, folic acid and oral rehydration solution (ORS) for malnutrition) across the population groups of low birthweight/preterm infants, infants under 6 months, infants and children over 6 months with acute malnutrition or through supplementation to breastfeeding mothers. Outcomes of interest were safety and efficacy, in terms of mortality and morbidity.ResultsNinety-four articles were identified for inclusion within this review. None of these studied interventions exclusively in severely malnourished infants U6M. 64% reported on the safety of studied interventions. Significant heterogeneity was identified in definitions of study populations, interventions provided, and outcomes studied. The evidence for efficacy and safety across population groups is reviewed and presented for the interventions listed.ConclusionsThe direct evidence base for medical interventions for severely malnourished infants U6M is sparse. Our review identifies a specific need for accurate micronutrient profiling and interventional studies of micronutrients and oral fluid management of diarrhoea amongst infants U6M meeting anthropometric criteria for severe malnutrition. Indirect evidence presented in this review may help shape interim policy and programming decisions as well as the future research agenda for the management of infants U6M identified as malnourished.

Community-Based Management of Acute Malnutrition in Infants Under 6 Months of Age

Abstract Objectives To examine the outcomes of acutely malnourished infants under 6 months (u6m) who could not be hospitalized or exclusively breastfed and were instead treated under the community management of acute malnutrition (CMAM) model using ready to use therapeutic food (RUTF) or a supplemental food. Methods The study was a retrospective chart review of 323 infants u6m with severe acute malnutrition (SAM) or moderate acute malnutrition (MAM) seen across 20 CMAM clinics in rural southern Malawi who could not be admitted to inpatient care, which is the established standard of care for acute malnutrition in infants u6m. Infants with SAM were given 175 kcal/kg/day of RUTF and those with MAM were given 75 kcal/kg/day RUTF or supplemental food, based on availability. Nutritional counseling was provided to the caregivers of all participants, and mothers were counseled about improved breastfeeding practices. Infants were reassessed every two weeks. Outcomes included successful nutritional recovery (achieving WHZ of ≥−2 without edema), failure to achieve recovery after 12 weeks, hospitalization, death, and loss to follow up. Demographic information was also collected. Continuous variables were compared using Student's t test. Categorical variables were compared using Fisher's exact test. Results 130 infants u6m with SAM and 193 with MAM were treated using the same CMAM model used in 6–59 month-old children. About 90% of children in both groups were breastfeeding. Mean duration of therapy was 31.5 days for SAM and 20.8 days for MAM. Recovery rates were high in both groups (SAM 75%; MAM 81%). Recovery rates and other outcomes were similar to older children who were being treated contemporaneously at the same sites in the context of randomized clinical trials. Conclusions When inpatient care is not possible, therapeutic and supplementary foods provided to infants u6m with acute malnutrition is a viable treatment option. Making this option available has the potential to massively scale up the number of infants treated, with acceptable recovery rates, and at a relatively low cost to the health care system. Funding Sources None.

BUN and creatinine in Severe Acute Malnutrition in Infants and Children

BUN and creatinine in Severe Acute Malnutrition in Infants and Children

Informing the management of acute malnutrition in infants aged under 6 months (MAMI): risk factor analysis using nationally-representative demographic & health survey secondary data.

BackgroundTackling malnutrition is a global health priority, helping children both survive and thrive. Acute malnutrition (wasting) in infants aged under 6 months (u6m) is often neglected. Worldwide, some 8.5 million infants u6m are affected yet recent World Health Organization malnutrition guidelines highlight numerous evidence gaps on how to best manage them. To inform future research, policy and programming, we aimed to identify risk factors associated with infant u6m wasting.MethodsWe did secondary data analysis of nationally representative, cross sectional Demographic and Health Surveys conducted in the last 10 years. We compared wasted infants u6m (weight-for-length <−2 z-scores) vs. non-wasted (weight-for-length ≥−2 z-score). We used simple and adjusted (for infant age, sex, socio-economic status) logistic regression to calculate odds of wasting associated with risk factors spanning three broad categories: household-related; maternal-related; infant-related.ResultsWe analysed 16,123 infants u6m from 20 countries. Multiple risk factors were statistically associated with wasting. These included: poverty (Odds ratio, OR 1.22 (95% CI [1.01–1.48], p = 0.04)); low maternal body mass index (adjusted OR 1.53(1.29–1.80, p < 0.001); small infant size at birth (aOR 1.32(1.10–1.58, p < 0.01)); delayed start of breastfeeding (aOR 1.31(1.13–1.51, p < 0.001)); prelacteal feed (aOR 1.34(1.18–1.53, p < 0.001)); recent history of diarrhoea (aOR 1.37(1.12–1.67, p < 0.01)); mother disempowered (experiences violence; does not make decisions about health issues; does not engage with health services such as antenatal care, does not give birth in a health facility). ‘Protective’ factors associated with significantly decreased odds of infant u6m wasting included: educated mother (OR 0.64(0.54–0.76, p < 0.001)); mother in work (OR 0.82(0.72–0.94, p < 0.01)); currently breastfed (aOR 0.62(0.42–0.91, p = 0.02)), exclusively breastfed (aOR 0.84(0.73–0.97, p = 0.02).DiscussionInfant u6m wasting is a complex, multifactorial problem associated with many risk factors; knowing them will help shape international and national management strategies. Whilst our observational study cannot prove causation, many factors identified are biologically plausible and/or socially important. They should be considered when assessing and managing infants u6m. Although supporting breastfeeding is core to future interventions, this alone is unlikely to be sufficient; strategies should involve multiple sectors, beyond just health and nutrition. By noting our results, future intervention studies could focus resources and maximise chances of achieving impact.

Inpatient and outpatient treatment for acute malnutrition in infants under 6 months; a qualitative study from Senegal

BackgroundTreatment of acute malnutrition in infants under 6 months is a relevant topic regarding the global problem of maternal and child malnutrition. While treatment for older age groups has shifted more towards an outpatient, community based approach, young infants are mostly treated in hospital. This study aims to describe barriers and facilitators for outpatient and inpatient treatment of malnourished infants under 6 months in Senegal.MethodsThis qualitative descriptive study uses in-depth interviews with health workers and focus group discussions with mothers of malnourished infants, conducted from June to September 2015 in two case clinics. In data analysis, Collins’ 3 key factors for a successful nutrition program were used as a theoretical framework: access, quality of care and community engagement.ResultsWithin Collins’ 3 key factors, 9 facilitators and barriers have emerged from the data. Key factor access: Outpatient care was perceived as more accessible than inpatient concerning distance and cost, given that there is a milk supplement available. Trust could be more easily generated in an outpatient setting. Key factor quality of care: The cup and spoon re-lactation technique was efficiently used in outpatient setting, but needed close supervision. Basic medical care could be offered to outpatients provided that referral of complicated cases was adequate. Health education was more intensive with inpatients, but could be done with outpatients. Key factor community engagement: The community appeared to play a key role in treating malnourished young infants because of its influence on health seeking behaviour, peer support and breastfeeding practices.ConclusionsOutpatient care does facilitate access, provided that an affordable milk supplement is available. Quality of care can be guaranteed using an appropriate re-lactation technique and a referral system for complications. The community has the potential to be much engaged, though more attention is required for breastfeeding education. In view of the magnitude of the health problem of young infant malnutrition and its strong relationship with breastfeeding practices, an outpatient community-based treatment approach needs to be considered.

Managing acute malnutrition in infants aged less than six months: A qualitative assessment in niger public hospitals

Quality management of severe acute malnutrition (SAM) in infants < 6 months of age is a key strategy within the “1000 days window of opportunity”. It prevents early child death, secures optimal growth and forms a foundation for full adulthood potentials. Most studies to date on management of SAM in infants relied on informants from Non-Governmental Organizations staff or government public health officials but little is known from hospital practitioners. From June to August 2013, a qualitative appraisal of hospital practitioners’ views on the current quality of care for malnourished infants was conducted in the eight main hospitals of Niger. These eight hospitals included two National Referral Hospitals (Lamorde and Zinder) and six Regional Referral Hospitals (Poudriere, Dosso, Tahoua, Maradi, Diffa and Agadez). Authorization for the review was given by the Ministry of Health of Niger. Health workers (HW) present during surveyors’ visits were included in the study. Two (2) specific objectives were considered: 1) Determine HW perceptions and current use of the Supplemental Suckling Technique (SST) and 2) Collect HW propositions on feasibility to organize outpatient treatment of SAM in infants less than six months. Self-designed interview guide was used. Data were analysed manually and saturation in the occurrence of responses were the criteria used to retain items. The Supplemental Suckling Technique (SST), though firmly recommended by national guidelines to ensure continuation of breastfeeding and adequate nutrients intake from supplemental milks especially in a small infant, was rarely used. Main reasons advanced by staff were work overload, inadequate training, and lack of compliance from mothers. Before being discharged from hospital, mothers were counseled on continuation of treatment, follow up visits at peripheral health center (PHC) and feeding options at home. However, hospital staff had no indication whether mothers were seen at the referred PHC, nor if counseling was practiced at home. The proposed outpatient treatment model for selected cases without medical complications should relieve hospital caseloads, strengthen referral and improve breastfeeding support to mothers after discharge from hospital. Keywords: Malnutrition, infant feeding, inpatient treatment, qualitative assessment, Niger

Admission profile and discharge outcomes for infants aged less than 6 months admitted to inpatient therapeutic care in 10 countries. A secondary data analysis.

Evidence on the management of acute malnutrition in infants aged less than 6 months (infants <6mo) is scarce. To understand outcomes using current protocols, we analysed a sample of 24 045 children aged 0-60 months from 21 datasets of inpatient therapeutic care programmes in 10 countries. We compared the proportion of admissions, the anthropometric profile at admission and the discharge outcomes between infants <6mo and children aged 6-60 months (older children). Infants <6mo accounted for 12% of admissions. The quality of anthropometric data at admission was more problematic in infants <6mo than in older children with a greater proportion of missing data (a 6.9 percentage point difference for length values, 95% CI: 6.0; 7.9, P < 0.01), anthropometric measures that could not be converted to indices (a 15.6 percentage point difference for weight-for-length z-score values, 95% CI: 14.3; 16.9, P < 0.01) and anthropometric indices that were flagged as outliers (a 2.7 percentage point difference for any anthropometric index being flagged as an outlier, 95% CI: 1.7; 3.8, P < 0.01). A high proportion of both infants <6mo and older children were discharged as recovered. Infants <6mo showed a greater risk of death during treatment (risk ratio 1.30, 95% CI: 1.09; 1.56, P < 0.01). Infants <6mo represent an important proportion of admissions to therapeutic feeding programmes, and there are crucial challenges associated with their care. Systematic compilation and analysis of routine data for infants <6mo is necessary for monitoring programme performance and should be promoted as a tool to monitor the impact of new guidelines on care.

Mid upper Arm Circumference for Detection of Severe Acute Malnutrition in Infants Aged Between One and Six Months.

This study conducted among 302 infants aimed to determine the most suitable mid upper arm circumference cutoff to diagnose severe acute malnutrition (weight-for-length <-3 SD) in infants aged between 1 and 6 months. The cut off of 11.0 cm had the best performance (Youden index 0.63, sensitivity 82.5%, specificity 80.3%).

Research priorities to improve the management of acute malnutrition in infants aged less than six months (MAMI).

By engaging expert opinion, Marko Kerac and colleagues set research priorities for the management of acute malnutrition in infants.