Management Of Malnutrition In Children Research Articles

PREVALENCE AND MANAGEMENT OF MALNUTRITION IN CHILDREN WITH CONGENITAL HEART DISEASE : A COMPREHENSIVE SYSTEMATIC REVIEW

Background: Congenital heart disease is a congenital abnormality that affects the structure of the heart walls and vessels. Malnutrition has a significant impact on the likelihood of infection in children with congenital heart disease, which leads to poor treatment outcomes. The aim: The aim of this study to show about prevalence and management of malnutrition in children with congenital heart disease. Methods: By the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) 2020, this study was able to show that it met all of the requirements. This search approach, publications that came out between 2014 and 2024 were taken into account. Several different online reference sources, like Pubmed, SagePub, and Sciencedirect were used to do this. It was decided not to take into account review pieces, works that had already been published, or works that were only half done. Result: Five publications were found to be directly related to our ongoing systematic examination after a rigorous three-level screening approach. Subsequently, a comprehensive analysis of the complete text was conducted, and additional scrutiny was given to these articles. Conclusion: Nutrition is crucial in the treatment of chronic illness. It’s one of the most important factors affecting patients’ recovery after surgery and lowering the risk of infection in children with congenital heart disease.

Managing Undernutrition in Pediatric Oncology: A Consensus Statement Developed Using the Delphi Method by the Polish Society for Clinical Nutrition of Children and the Polish Society of Pediatric Oncology and Hematology.

"Managing Undernutrition in Pediatric Oncology" is a collaborative consensus statement of the Polish Society for Clinical Nutrition of Children and the Polish Society of Pediatric Oncology and Hematology. The early identification and accurate management of malnutrition in children receiving anticancer treatment are crucial components to integrate into comprehensive medical care. Given the scarcity of high-quality literature on this topic, a consensus statement process was chosen over other approaches, such as guidelines, to provide comprehensive recommendations. Nevertheless, an extensive literature review using the PubMed database was conducted. The following terms, namely pediatric, childhood, cancer, pediatric oncology, malnutrition, undernutrition, refeeding syndrome, nutritional support, and nutrition, were used. The consensus was reached through the Delphi method. Comprehensive recommendations aim to identify malnutrition early in children with cancer and optimize nutritional interventions in this group. The statement underscores the importance of baseline and ongoing assessments of nutritional status and the identification of the risk factors for malnutrition development, and it presents tools that can be used to achieve these goals. This consensus statement establishes a standardized approach to nutritional support, aiming to optimize outcomes in pediatric cancer patients.

Advancements in Inpatient Medical Management of Malnutrition in Children and Adolescents with Restrictive Eating Disorders

There is an urgent need to identify best practices for hospital treatment of youth with malnutrition secondary to restrictive eating disorders, including anorexia nervosa (AN) and avoidant/restrictive food intake disorder (ARFID). Certain physical health complications of malnutrition, such as bradycardia, hypotension, and hypothermia, often lead to hospitalization. These acute medical complications improve with refeeding, or short-term nutritional rehabilitation, and will resolve with ongoing recovery. Historically, refeeding was approached with extreme caution, with lower calorie protocols that advanced slowly and required weeks to restore medical stability.( 1 Shamim T. Golden N.H. Arden M. Filiberto L. Shenker I.R. Resolution of vital sign instability: an objective measure of medical stability in anorexia nervosa. J Adolesc Health. 2003; 32: 73-77 Abstract Full Text Full Text PDF PubMed Scopus (59) Google Scholar , 2 Garber A.K. Mauldin K. Michihata N. Buckelew S.M. Shafer M.A. Moscicki A.B. Higher calorie diets increase rate of weight gain and shorten hospital stay in hospitalized adolescents with anorexia nervosa. J Adolesc Health. 2013; 53: 579-584 Abstract Full Text Full Text PDF PubMed Scopus (85) Google Scholar , 3 Golden N.H. Keane-Miller C. Sainani K.L. Kapphahn C.J. Higher caloric intake in hospitalized adolescents with anorexia nervosa is associated with reduced length of stay and no increased rate of refeeding syndrome. J Adolesc Health. 2013; 53: 573-578 Abstract Full Text Full Text PDF PubMed Scopus (100) Google Scholar ) Prolonged hospitalizations place eating disorders among the top 6 most “common and costly” pediatric mental health diagnoses.( 4 Bardach N.S. Coker T.R. Zima B.T. Murphy J.M. Knapp P. Richardson L.P. Edwall G. Mangione-Smith R. Common and costly hospitalizations for pediatric mental health disorders. Pediatrics. 2014; 133: 602-609 Crossref PubMed Scopus (150) Google Scholar ) This paper reviews current evidence on refeeding approaches for hospitalized youth with eating disorders. Recent findings suggest that high calorie refeeding is a clinically safe method of inpatient management and, more importantly, improves clinical outcomes.

MANAGEMENT OF MALNUTRITION IN CHILDREN WITH AYURVEDA INTERVENTIONS: A REVIEW

In India, malnutrition remains a significant and challenging public health issue despite dietary rehabilitation and the effort of the government to tackle malnutrition. Childhood malnutrition is an underlying cause of an estimated 35% of all deaths among children under five and 21% of global disability-adjusted life years lost among less than five children. In Ayurveda, malnutrition in children is described as balashosha, karshya, phakka and parigarbhika. A large number of clinical studies on the management of malnutrition with Ayurveda drugs have been conducted and published. The purpose of this study is to evaluate the effect of Ayurveda interventions in the management of malnutrition in children. This review is accomplished using a complete and organized search of the available literature in Ayurveda texts and published articles. The searches were performed using various databases, including PubMed, Scopus, MedLine, and Google Scholar. Ayurveda drugs described for managing karshya and balashosha are formulated to meet all the deficiencies and cure the same. The findings of this review suggest that Ayurveda drugs, along with nutritional rehabilitation, proves to be more effective than nutritional rehabilitation alone, which may be due to the presence of deepana, pachana, brimhana and rasayana property of the Ayurveda drug. These findings will provide a substratum for future research studies for generating good-quality evidence that can help design new health policies to combat malnutrition effectively.

Community Health Volunteer Up skilling Increase Community-Based Stunting Early Detection Knowledge

Stunting becomes a public health concern and is still commonly found in the world. The number of new cases of stunting increases every year as it can be caused by poor nutritional status, lack of knowledge, barriers to access to health services, inability to meet nutritional needs. This steady phenomenon can lead to a decrease several quality aspects of future generation. Community-based activities are an alternative solution in stunting management. Health cadres as part of the community and an extension of health workers are expected to be able to carry out early detection and treatment of stunting in toddlers. Capacity building for health cadres is a necessity through regular coaching. This study aims to identify the effect of up-skilling health cadres on knowledge of community-based stunting early detection. The research design used a quasi-experimental type of pre and post-test with a control group. The sample was 33 health cadres for each intervention and control group through purposive sampling technique. The research was conducted in the work area of the Undaan and Dawe Primary Health Centers, Kudus Regency in October-November 2021. The research instrument used was a questionnaire on health cadres' knowledge towards assessment and management of malnutrition in children and a knowledge scale about inpatient management of severely malnourished children with a reliability value of = 0.83. Health cadres receive coaching in four sessions over two days with a duration of 45-60 minutes/session in the form of interactive lectures and demonstrations. Data analysis using Wilcoxon and Mann Whitney test. Up skilling of health cadres increased knowledge of community-based early detection of stunting with p-value = 0.001 (p <0.05). Incorporating various methods in training is suggested in improving health cadres’ knowledge in finding new cases of stunting in the community while adjointly integrating it with child health service programs in primary health care facilities.

Impact of a pediatric oncology nutrition program: Lessons learnt over a decade.

The management of malnutrition in children with cancer remains a challenge in low-middle-income countries (LMICs). We describe our pediatric oncology nutrition program and its impact over the past decade. We evaluated the impact of our nutrition program in accordance with the International Society of Paediatric Oncology-Paediatric Oncology in Developing Countries (SIOP PODC) Nutritional Program Evaluation in the areas of service delivery (number served, increments in delivery, number of trained care providers), patients at-risk (proportion identified with malnutrition at diagnosis/follow-up), and efficiency of nutritional interventions (proportion assessed, proportion achieved healthy weight, clinicians trained). We analyzed available data for trends between 2009 and 2020, and comparisons were made using the Fisher t test. This study was approved by our institutional ethics committee. From 2010 to 2020, 17749 children treated at our center were beneficiaries of the nutritional program, including assessment and intervention. During this period, trained pediatric nutritionists increased from 2 to 8; SIOP PODC level from 2 to 3-4, and nutrition budget increased 15-fold. At diagnosis (n=5618) and six-month follow-up (n=2674), 59.6% and 51.2% children were undernourished, 34.8% and 43% well nourished, and 4.7% and 5.7% overnourished. From 2016 onward, fewer children were undernourished at follow-up-69.5% (2016), 60% (2018), 54% (2019), and 55% (2020, P<0.001). The program helped train over 500 clinicians in nutrition. Improved financial support and capacity building have helped build and sustain an effective nutrition program. Priority areas include implementation of best practices, early nutritional intervention, continued education, and locally relevant research.

Effect of Moringa supplementation in the management of moderate malnutrition in children under 5 receiving ready-to-use supplementary foods in Niger: A randomized clinical trial

Each year in Niger, more than 40% of children under 5 years suffer from chronic malnutrition and more than 10% from acute malnutrition. The national nutrition rehabilitation protocol encourages the use of local foods. The objective of this work is to analyze the impact of supplementation in Moringa oleifera. We conducted a randomized double-blind clinical trial in 400 children with moderate acute malnutrition (MAM) aged 6 to 59 months admitted to outpatient nutritional recovery centers (CRENAM). The children were divided into two groups; one group received Ready-to-Use Supplemental Foods (RUSF) and dry leaf powder from Moringa oleifera and the other group received RUSF and placebo. We did not find any difference on average weight gain between the two groups or on mid-upper arm circumference and size. The median length of stay in CRENAM was 5 and 4 weeks for Moringa and placebo respectively, with no statistical difference (P=0.522). The cure rate was 82% (2.72) in the Moringa group with a RR of 1.03 (0.94 to 1.13) slightly in favor of Moringa. Renal and hepatic toxicity of Moringa was not observed. From this clinical trial, it could be held that Moringa supplementation, despite the presence of nutritional indices in favor of Moringa, does not have a significant effect on the nutritional recovery of MAM children but that Moringa has no renal or hepatic toxicity. Supplementation in subjects already on dietetic treatment, dose reduced to minimum and duration of supplementation seems to have played a role in this absence of effect of Moringa.

Utilization of Guidelines for Management of Severe Acute Malnutrition in Children Aged 6-59 Months in Busia County Referral Hospital

Background: Malnutrition is responsible for 35% of deaths among children under five years of age globally. The prevalence of severe acute malnutrition in Kenya is estimated to be 6%. In Busia County Referral Hospital case fatality rate for children with severe acute malnutrition in 2014 was 26%. World Health Organization (WHO) has developed guidelines for the management of severe acute malnutrition in children. The use of these guidelines in treatment of children with malnutrition reduces mortality related to malnutrition. Objective: The objective of the study was to assess the utilization of guidelines for management of severe acute malnutrition in children aged 6-59 months in Busia County Referral Hospital. Methods: This was cross-sectional, descriptive study. Purposive sampling was used to select the study sample. A checklist was used to verify documentation of guidelines for management of malnutrition in children from the in-patient files. An overall guidelines utilization scoring tool was developed and used to rate the overall utilization of the guidelines. Data on the supply of essential nutritional commodities was obtained through key informant interviews. Descriptive data was analysed using mean, mode and median. Findings were presented in form of frequency tables and bar charts. Results: A total of ninety-six (96) participants were recruited for the study. The mean age of the participants was 21.85 months. There was significantly higher proportion of children with MUAC less than 11.5cm among 6 to 12 months 20(69.0%) [OR=9.26; 95%CI=2.82-30.39; P&lt;0.001] and 13 to 24 months 16(44.4%) [OR=3.33; 95%CI=1.10-10.09; P=0.033] compared to those aged 25 to 59 months 6(19.4%). Mean weight had increased from 7.97Kg at admission to 8.45Kg at 7 days and this difference was significant (p&lt;0.0001) after paired samples t test was computed. The average utilization of the guidelines was 86.4%. Conclusion and recommendations : Guidelines for management of severe acute malnutrition were adequately utilized in Busia County Referral Hospital. Periodic training of all health workers involved in the care of children with severe acute malnutrition was recommended to ensure optimum utilization of the guidelines for management of severe acute malnutrition. Keywords: Utilization, Guidelines, Severe acute malnutrition, management, under five years. DOI: 10.7176/JHMN/86-03 Publication date: February 28 th 2021

Potential consequences of expanded MUAC-only programs on targeting of acutely malnourished children and ready-to-use-therapeutic-food allocation: lessons from cross-sectional surveys

BackgroundSome of the recently piloted innovative approaches for the management of acute malnutrition in children use the “expanded MUAC-only” approach, with Mid Upper Arm Circumference (MUAC) < 125 mm as the sole anthropometric criterion for screening and admission, classification of cases as severe using the 115 mm cut-off, and use Ready-to-Use-Therapeutic-Food (RUTF) for the management of both moderate (MAM) and severe (SAM) cases of acute malnutrition. Our study aimed at exploring the potential consequences of this “expanded MUAC-only” program scenario on the eligibility for treatment and RUTF allocation, as compared with the existing WHO normative guidance.MethodsWe analyzed data from 550 population representative cross-sectional cluster surveys conducted since 2007. We retrieved all children classified as SAM and MAM according to currently used case definitions, and calculated the proportions of SAM children who would be excluded from treatment, misclassified as MAM, or whose specific risks (because of having both MUAC and weight-for height deficits) would be ignored. We also analyzed the expected changes in the number and demographics (sex, age) of children meant to receive RUTF according to the new approach.ResultsWe found that approximately one quarter of SAM children would not be detected and eligible for treatment under the “expanded MUAC-only” scenario, and another 20% would be classified as MAM. A further 17% of the total SAM children would be admitted and followed only according to their MUAC or oedema status, while they also present with a severe weight-for height deficit on admission. Considering MAM targeting, about half of the MAM children would be left undetected. This scenario also shows a 2.5 time increase in the number of children targeted with RUTF, with approximately 70% of MAM and 30% of SAM cases among this new RUTF target.ConclusionsThis empirical evidence suggests that adoption of “expanded MUAC-only” programs would likely lead to a priori exclusion from treatment or misclassifying as MAM a large proportion of SAM cases, while redirecting programmatic costs in favor of those less in need. It underscores the need to explore other options for improving the impact of programs addressing the needs of acutely malnourished children.

Management of Malnutrition in Rural Mali

In Mali, according to DHS III (Demographic and Health Survey) in 2001, the global rate of malnutrition (weight for age <2 sd) among under-five children was 38%. The purpose of this study was to assess the management of malnutrition in children (0-59 months old) by the professionals in the intervention areas of 'Strategy for Accelerated Child Survival and Growth', according to IMCI guidelines. We carried out a cross-sectional survey in three randomly selected health districts (Kolokani, Niono and Koro) and involved 27 health centres, 180 children and 180 mothers. We did direct observation of consultations and interrogated the mothers. The study found that the equipement and tools necessary for nutritional status assessment were available but seldom used in practice. Nutrition training was provided only to the health staff of Kolokani where 78% of the staff were trained in IMCI and 55% in IEC (Information Education and Communication). The indicatory weight-for-age was used to assess nutritional status of 64% children in Kolokani vs. 42% in Koro and 4% in Niono. IMCI classification was used only in Kolokani (57% of children). The management of severe malnbutrition in children was more correct in Kolokani (100%) than in Koro (33%) and Niono (0%). Twenty- eight percent of mothers/caretakers knew the appropiate duration of exclusive breastfeeding, but only 5% knew that vitamin A supplementation should be done every 6 months. Our findings suggest that nutritional status assessment is performed better in the health districts where staffs are training in IMCI. We recommend training the health staff in the other health districts and the intensification of behavioural change communication for mothers.