Management Of Severe Acute Malnutrition Research Articles

Addressing deficits in malnutrition care in northern Sierra Leone; an educational intervention

Abstract The 2017 Sierra Leone National Nutrition Survey reported poor practice regarding the medical management of severe acute malnutrition and the provision of emergency food to patients, particularly in the northern city of Makeni. We developed a training package for paediatric nurses, aiming to design an easily reproducible format which could be utilised nationally. Our aims were to empower and educate staff to provide more consistent care by challenging the negative cultural perception of malnourished patients and increasing knowledge of key guidelines. A two-day course based around UNICEF guidance on malnutrition was developed with the financial support of the Sierra Leonean office of the World Health Organisation. We sought the advice of local staff on issues impacting the quality of malnutrition care, including cultural barriers, educational limitations and supply issues. Lectures and practical sessions were devised covering recognition, assessment and management. Communication skills were taught using role play, focussing on the key role of nurses in parental education, and nursing skills were reinforced using practical tasks. Local staff identified for their strong teaching and leadership were recruited as instructors and to provide feedback on session design and content. 21 candidates attended from across the region, with the majority based in inpatient feeding units. Candidates completed a pre- and post-course written examination and a qualitative feedback form. Pre-course exam results ranged from 35%-85% with an average of 65%; post-course results showed improvement with a range of 55%-100% and an average of 88%. Candidates rated the course on average 9.7 out of 10 and the written feedback was positive. We subsequently observed positive changes in clinical practice in the inpatient feeding units across the region. Based on these assessments the course achieved its aims. Further study is needed to know if noted clinical improvements were sustained. Key messages • Challenging local cultural perceptions of malnourished patients is crucial to establishing improvement in medical care for this group. • Sustainable educational intervention requires local instructors who can independently deliver teaching, and establishing this cohort at the course inception is critical to its ongoing success.

Recovery rate and predictors among children aged 6-59 months with severe acute malnutrition in Addis Ababa, Ethiopia: a retrospective follow-up study.

Severe acute malnutrition (SAM) is a critical public health concern in Ethiopia, contributing to high morbidity and mortality rates among children. Despite the improvement in hospital coverage and the development of standardized WHO treatment guidelines, recent reviews indicated a wide range in recovery rates (34%-88%) due to several context-specific factors. Understanding the factors influencing the recovery time can help inform targeted interventions and improve the overall management of SAM cases. Therefore, this study aimed to assess the time to recovery and predictors of children aged 6-59 months with severe acute malnutrition in Addis Ababa, Ethiopia, in 2023. An institutional-based retrospective follow-up study was conducted among children aged 6-59 months who were admitted to Tirunesh Beijing Hospital (TBH), Addis Ababa, Ethiopia, from July 2019 to June 2023. The Kaplan-Meir estimate and survival curve were used to compare the time to recovery using a log-rank test among different characteristics. A Cox proportional hazard regression analysis model was used to identify significant predictors of time to recovery. Finally, a p-value of <0.05 was used to declare a significant association. The median survival time to recovery was 17 (95% CI: 16.39-17.60) days, and the incidence rate of recovery from SAM was 37.8 per 1,000 child days. Moreover, exclusive breastfeeding [adjusted hazard ratio (aHR): 1.97, 95% CI: 1.45-2.68], amoxicillin provision (aHR = 1.62, 95% CI: 1.11-2.35), and deworming (aHR = 2.14, 95% CI: 1.48-3.09) were protective factors. However, complications at admission (aHR = 0.41, 95% CI: 0.23-0.73) and diarrhea during admission (aHR = 0.64, 95% CI: 0.45-0.91) were identified as risk factors of recovery from SAM. The time to recovery among the current study participants was low compared with the sphere standard. Besides, exclusive breastfeeding, complications at admission, diarrhea, amoxicillin provision, and deworming were independent predictors. Therefore, appropriate provision of routine medication and early management of medical comorbidity as per the national SAM management protocol can reduce the mortality of children with severe acute malnutrition significantly.

Quality Assessment of Management of Severe Acute Malnutrition with Complications at the URENI of Kati Reference Health Center 2022

Quality Assessment of Management of Severe Acute Malnutrition with Complications at the URENI of Kati Reference Health Center 2022

Anthropometric recovery of children 6-59 months with complicated severe acute malnutrition, treated in public hospitals of Sana’a City

Background: The management of severe acute malnutrition (SAM) in inpatient therapeutic feeding centers (TFCs) is a life-saving intervention for children 6-59 months in Yemen. Aims: To evaluate the anthropometric recovery of children admitted to the TFCs and transferred to complete treatment in outpatient programs (OTPs) of Sana’a City Public Hospitals. Methods: A prospective follow-up study for children admitted to TFCs from September 2023 to April 2024 was conducted. The anthropometry measurements of the Weight-for-Height Z score (WHZ) and Mid-Upper Arm Circumference (MUAC) were calculated and used to follow the progression in recovery until the discharge from OTPs. Results: Of the total 150 children admitted to TFCs, 48 (32%) were males, and 75 (50%) were aged 6-&lt;12 months; 99 (66%) had both WHZ &lt;-3 and MUAC &lt;11.5); 25 (17%) had WHZ &lt;-3; and 26 (17%) had MUAC&lt;11.5 cm. At the point of transfer from TFCs, 72% (108) were with SAM, and 28% (42/150) with Moderate Acute Malnutrition (MAM). At discharge from OTP, 19% (28/150) were with non-acute malnutrition (NAM); the progression to NAM was among 48% (20/42) and 7% (8/108) of children transferred with MAM and SAM, P value (&lt;0.001). In conclusion, 88% (132/150) of children transferred from TFCs were discharged as cured from OTP, 21% (28/132) of them were anthropometrically recovered, and 79% were prematurely discharged.

Locally Prepared Therapeutic Food for Treatment of Severely Underweight Children in Rural India: An Interventional Prospective Controlled Community-Based Study with Long Follow-Up:-'SAMMAN' Trial.

Severely underweight (SUW) children contribute significantly to under-five mortality and morbidity. There are WHO guidelines for the management of severe acute malnutrition but no specific guidelines for SUW management. The objectives were to achieve a recovery rate of 30% at 90 days of treatment for severe underweight (SUW) children aged 6-60 months, compare changes in weight-for-age Z (WAZ) scores, growth patterns, and case fatality rates between intervention and reference arms (RA), and reduce the prevalence of SUW in the intervention arm (IA). The target of a 30% recovery rate was achievable and significant based on our past research conducted in similar settings. Design: A prospective controlled community-based, longitudinal, two arms (IA, RA), intervention study with long follow-up was conducted between January 2011 and October 2023. Primary care for participants from 14 villages in rural Melghat, India. The study participants included SUW children aged 6-60 months and age-matched (±2 weeks) normal controls. The SAMMAN (Acronym for SAM-Management) intervention was comprised of local therapeutic food-micronutrient (LTF-MN) therapy for 90 days, intensive behavior change communication, infection treatment, and quarterly anthropometric records. SUW recovery, growth patterns, case fatality rate, prevalence at 90 days of therapy and at 60 months of age, and survival until early adolescence were assessed. ANCOVA analysis was used to obtain changes in Z-scores. In the IA, the recovery rate was 36.8% at 90 days and 78.2% at 60 months of age. The mean difference in change in WAZ scores between the intervention arm and the reference arm was statistically significant (p < 0.0001). Growth patterns were similar between the two arms up to early adolescence. The SUW case fatality rate was significantly lower in the IA (0.9%) as compared to 4.62% in the RA at 60 months (p = 0.022). The reduction in SUW prevalence in intervention villages was higher than in the control villages (p < 0.001). The cost of management per SUW child was 3888 INR (47 USD) less than RUTF. The SAMMAN intervention is safe and cost-effective for significantly improving WAZ scores, sustainable, and hence replicable in resource-limited areas.

Efficacy of a Reduced Dose of Ready-to-Use Therapeutic Foods in the Management of Severe Acute Malnutrition: A Non-inferiority Randomized Controlled Trial

Efficacy of a Reduced Dose of Ready-to-Use Therapeutic Foods in the Management of Severe Acute Malnutrition: A Non-inferiority Randomized Controlled Trial

Impact of maternal education on the development of severe acute malnourished children

Background: Severe acute malnutrition (SAM) is a grave form of undernutrition that has been recognized as a medical and social disorder. Various factors contribute to the development of SAM, but the impact of maternal education on the nutritional status and development of the child is of paramount importance since focused interventions in this aspect can yield promising results. Aims and Objectives: The aims and objectives of the study are to assess the impact of maternal education on the development of children with SAM. Materials and Methods: A total of 125 SAM children in the age group 12–30 months were enrolled in this prospective observational study from among those admitted to the nutritional rehabilitation center of a tertiary care center in central India. The developmental status of SAM children was assessed using the Developmental Assessment Scale of Indian Infants. The association of maternal education with the development of SAM children was analyzed. Results: Overall developmental delay was observed in 44.8% of SAM children, whereas motor and mental development delay was noted in 45.6% and 44% of SAM children. The maternal education level was significantly associated with the overall development of the SAM child. (P=0.043 for motor development, P=0.017 for mental development, P=0.023 for motor developmental delay). Conclusion: Maternal education plays a key role in improving the developmental status of SAM children, who are more prone to developmental delays across various domains. Efforts toward enhancing maternal education, especially knowledge regarding child nutrition and development, can reduce the incidence and improve the management of SAM in children.

Therapeutic and Evolutionary Profiles of Children Aged 0-59 Months: A Case Study of Severe Acute Malnourished Treated at Hôpital Notre Dame Des Apôtres, N&amp;apos;Djamena

According to the World Health Organization, malnutrition is a pathological condition resulting from the relative or absolute insufficiency or excess of one or more essential nutrients, whether manifested clinically or detected only by biological, anthropometric or physiological analyses. It remains a major public health problem. The aim of this study was therefore to determine the therapeutic and evolutionary profiles of Severe Acute Malnutrition patients at Notre Dame des Apôtres Hospital in N&amp;apos;Djaména (Chad). This was a prospective, descriptive study carried out on 7 months, from January 1 to July 31, 2023. This included all severely acutely malnourished children with medical complications admitted to the hospital&amp;apos;s therapeutic nutrition unit. The variables studied were therapeutic and evolutionary. Data were entered and analyzed using Excel 2016 spreadsheet and SSPS 18.0 software. Among the 1454 children admitted to the unit during our study, 41.82% were stabilized, 6.75% cured and 0.79% abandoned, with an average length of stay of 8.67 days. The mortality rate was 1.76%. Children on F75 accounted for 46%, 37% on plumpy nut and 10% on F100. Antibiotics and multivitamins are routinely used in the management of malnourished children. The results of this study show that parent education could be an asset in the management of severe acute malnutrition.

Barriers and facilitators of severe acute malnutrition management at Felege Hiwot Comprehensive Specialized Hospital, Bahir Dar, North West Ethiopia, descriptive phenomenological study.

Malnutrition is a clinical condition that affects all age groups, and it remains a major public health threat in Sub-Saharan Africa. As a result, this research aimed to investigate the barriers and facilitators of treating severe acute malnutrition at Felege Hiwot Comprehensive Specialized Hospital in Bahir Dar City, North West Ethiopia. A descriptive phenomenological study was conducted from February to April 2021. The final sample size taken was fifteen based on data saturation. In-depth and key informant interviews were conducted with nine caregivers, three healthcare workers, and three healthcare managers supported by observation. A criterion-based, heterogeneous purposive sampling technique was used to select the study participants. Each interview was audio-taped to ensure data quality. Thematic analysis was done to analyze the data using Atlas. ti version 7 software. Two major themes and six sub-themes emerged. Barriers related to severe acute malnutrition management include subthemes on socio-economic and socio-cultural conditions, perceived causes of severe acute malnutrition and its management, and the healthcare context. Facilitators of severe acute malnutrition management include severe acute malnutrition identification, service delivery, and being a member of community-based health insurance. Effective management of severe acute malnutrition was affected by a multiplicity of factors. The results reaffirm how socioeconomic and sociocultural conditions, perceived causes of severe acute malnutrition (SAM) and its management and the health care context were the major barriers, while able to identifying severe acute malnutrition, service delivery, and is a member of community-based health insurance were the major facilitators for SAM management. Therefore, special attention shall be given to SAM management.

Micronutrient supplementation practices in relation to the World Health Organisation 2013 guidelines on management of severe acute malnutrition.

In 2013, the World Health Organisation (WHO) updated the recommendations for micronutrient deficiency correction in hospitalised under-5 children with complicated severe acute malnutrition (SAM). This study aimed to describe the micronutrient deficiency correction practices in relation to WHO 2013 recommendations. Data from medical records of under-5 children admitted for SAM management at two hospitals in South Africa and three tertiary hospitals in Ghana were extracted. Micronutrient correction practices were compared to the WHO 2013 recommendations by considering the dosage, timing of micronutrient supplementation (vitamin A, ironand folic acid) and therapeutic feeds administered. In total, 723 medical records were included. Nearly half (48.3%) of the children received at least one of the studied micronutrients as a supplement. Vitamin A was supplemented in 27.4% of the children, while iron and folic acid were supplemented in 9.5% and 34.9%, respectively. Among the children who received vitamin A, 60.1% received the first dose on Day 1 of admission. Also, 46.4% of the iron-supplemented children received iron within the first week of admission. Vitamin A, iron and folic acid were administered within the dose range of 100,000-180,000 IU, 3.1-7.7 mg per kg per day, and 3-5 mg per day, respectively. Additionally, 71.7% of the children reportedly received therapeutic feeds that met WHO recommendations.The micronutrient deficiency correction practices regarding dose and timing differed from the 2013 WHO guidelines. Qualitative studies investigating the reasons for the disparities are recommended.

Effectiveness of Home-Based Administration of Ready to Use Therapeutic Formula (RUTF) in the Management of Severe Acute Malnutrition (SAM)

Objective: To evaluate the growth of children with uncomplicated Severe Acute Malnutrition (SAM) treated with Ready-to-Use Therapeutic Formula (RUTF) on an outpatient department basis. Methodology: This prospective observational study was conducted on 66 children at the Outpatient setting of the MCH Centre, Federal Government Polyclinic Hospital, Islamabad, Pakistan, from January 2023 to June 2023, after approval from the hospital’s ethical committee. Children aged 6-59 months suffering from severe acute malnutrition (SAM) were selected for nutritional rehabilitation with Ready-to-Use Therapeutic Formula (RUTF) after meeting the selection criteria defined by WHO. RUTF is a nutrient mixture formulated primarily for the therapy of severe acute malnutrition without complications. Results: The mean age of patients was 16.98±6.12 months. Out of 66 patients, 26 (39.3%) were male, and 40 (60.6%) were female. The mean weight before RUTF treatment was 6.53±1.21 kg, mean Height/Length was 71.65±7.01 cm, mean MUAC was 10.88±0.36 cm, mean BSR was 91.21±2.32 mg/dL, and mean weight after RUTF treatment was 9.17±1.53 kg. There was a significant difference in the weight of children after RUTF treatment (6.53±1.21 vs 9.17±1.53, p=0.0001) with no side effects. The weight increased after treatment with RUTF. Conclusion: According to WHO recommendations, we conclude that RUTF is helpful in enhancing weight gain in children with uncomplicated severe acute malnutrition under the age of five. RUTF

Arm circumference for age, arm circumference and weight-for-height z-score for the evaluation of severe acute malnutrition: a retrospective cohort study in eastern Democratic Republic of Congo.

Little is known about the use of mid-upper arm circumference for age (MUACZ) for diagnosing of severe acute malnutrition (SAM) and its correlation with WHZ (weight-for-height Z-score) in an area endemic for severe acute malnutrition (SAM) and with a high prevalence of kwashiorkor. Our study aims to analyze the concordance between the diagnostic criteria of SAM in a region presenting these characteristics. We analyzed a database of children admitted from 1987 to 2008 for the management of SAM in Eastern Democratic Republic of Congo. Anthropometric indicators (z-score) were calculated and classified into 3 categories according to WHO standards. Cohen's kappa coefficient (κ) was calculated to assess the concordance between these indicators. Out of the 9969 selected children aged 6 to 59 months, 30.2% had nutritional edema, 70.1% had a height-for-age (HAZ) z-score <-2, 11.5% WHZ<-3 z-score, 14.9% had a MUAC < 115mm and 21.8% had a MUACZ <-3 z-score. With the classic combination WHZ and MUAC, 36% of children with SAM had both criteria at the same time and MUAC alone being the indicator that recruited more children with SAM (77%) compared with 65% with WHZ only. By replacing MUAC with MUACZ, 34% of SAM children fulfilled both criteria, WHZ and MUACZ. MUACZ alone recruited more children with SAM (88%) compared with 46% with WHZ alone. Considering these three indicators together, MUACZ remained the indicator that recruited more children with SAM (85%). WHZ and MUAC showed a moderate agreement [ κ (95% CI) = 0.408(0.392-0.424)], WHZ and MUACZ a weak agreement [ κ (95% CI) = 0.363(0.347-0.379)] and MUAC and MUACZ a good agreement [ κ (95% CI) = 0.604 (0.590-0.618)]. Adjusting MUAC according to age improves its effectiveness in identifying severe acute malnutrition. With low concordance, MUAC and WHZ remain complementary in our context. MUACZ proves to be crucial, especially in the presence of kwashiorkor and chronic malnutrition, becoming a valuable tool for assessing severe acute malnutrition in our context.

Perspective on alternative therapeutic feeds to treat severe acute malnutrition in children aged between 6 and 59 months in sub-Saharan Africa: a narrative review.

Worldwide, nearly 200 million children younger than 5 years old suffer from stunting and wasting, 2 different types of undernutrition. Moreover, 45% of deaths among children in that age group are associated with these conditions. Severe acute malnutrition (SAM) refers to children with a weight-for-height z score < -3, a midupper arm circumference < 115 mm, or the presence of bilateral edema, and is especially prevalent in low- and middle-income countries. Undernutrition in children can have a major impact on both their physical and cognitive development. It can lead to infections and death if it remains undetected or untreated. The use of therapeutic feeds is an important component in the management of SAM, which remains a challenge in poorly resourced countries. The aim of this review was to assess the alternatives to the standard therapeutic foods used to treat SAM and to summarize their advantages and disadvantages, providing an overview of current research. A literature search was performed from September to November 2022 using PubMed, the Trip medical database, and the German Institute for Medical Documentation and Information (DIMDI). This review includes 13 randomized controlled trials testing alternatives to the standard therapeutic foods used to treat SAM by using alternative ingredients or a reduced dosage. The results show that, while a few alternative ready-to-use therapeutic food formulas lead to recovery rates similar to those seen with the standard protocol, many alternatives were less effective in the affected children. Thus, the evidence is not yet strong enough to change the World Health Organization's guidelines. The review identifies promising results of treatment alternatives related to treatment outcomes and costs. Additional research should focus on the interventions that positively impact the recovery process of severely malnourished children to facilitate the treatment and enable greater treatment coverage worldwide.

Acute malnutrition relapse and associated factors among 6-59 months old children treated in the community-based management of acute malnutrition in Dessie, Kombolcha, and Haik towns, Northeast Ethiopia.

Undernutrition is a major health concern in many developing countries, and is one of the main health problems affecting children in Ethiopia. Although many children experience multiple relapses following the management of severe acute malnutrition, it is scarcely studied in Ethiopia. A community-based cross-sectional study was conducted in Dessie, Kombolcha, and Haik towns among 6-59-month-old children enrolled and discharged from community-based acute malnutrition management (CMAM). The total sample size was 318 children, and data were collected from April 15, 2021, to May 14, 2021. The data were entered into EPI data version 4.4.1 before being exported and analyzed with SPSS version 25 software. A multivariate logistic regression analysis was performed, and a 95% confidence interval and p-value <0.05 were used to identify significantly associated variables. Additionally, the weight-for-height z-score (WHZ) was generated using the WHO Anthro 3.2.2 software. The overall acute malnutrition relapse after discharge from CMAM was 35.2% (6.6% relapsed to severe acute malnutrition and 28.6% relapsed to moderate acute malnutrition). The following variables were significantly associated with the relapse of acute malnutrition: child age (AOR: 3.08, 95% CI; 1.76, 5.39), diarrhea after discharge (AOR: 2.93, 95%CI; 1.51, 5.69), have not immunized (AOR: 3.05, 95% CI; 1.14, 8.23), MUAC at discharge (AOR: 3.16, 95% CI; 1.56, 6.40), and poorest and poor wealth index (AOR: 3.65, 95% CI; 1.45, 9.18) and (AOR: 2.73, 95% CI; 1.13, 6.59), respectively. Over one-third of children treated with the CMAM program reverted to SAM or MAM. The age of the child, diarrhea after discharge, lack of immunization, MUAC at discharge (<13 cm), and poor and poorest wealth index were significantly associated with acute malnutrition relapse. Therefore, adequate health education and counseling services are essential for mothers to improve child immunization coverage and maintain adequate hygiene to prevent diarrhea. In addition, further experimental research is needed to investigate the effect of MUAC at discharge on the risk of acute malnutrition relapse.

Soya-maize-sorghum ready-to-use therapeutic food (SMS-RUTF) for the management of severe acute malnutrition among children: A systematic review and meta-analysis

In managing severe acute malnutrition (SAM) among children, the World Health Organization has endorsed the use of ready-to-use therapeutic foods (RUTF), especially the peanut and milk-based (PM-RUTF), which has been proven for its efficacy. Unfortunately, the distribution of PM-RUTF is challenged by high financial cost and reliance on imports for milk and peanuts. Researchers explore the Soy-Maize-Sorghum (SMS)-RUTF as the alternative, in which the formulation has two types; milk-free soya-maize-sorghum (FSMS)-RUTF and low milk content SMS (MSMS)-RUTF. The aim of this study was to evaluate the efficacy, safety, and acceptance of SMS-RUTFs in the management of SAM among children as compared with PM-RUTF. Eligible studies were searched through PubMed, Scopus, and Embase up to July 14, 2023. Studies reporting the effects of SMS-RUTF, FSMS-RUTF, or MSMS-RUTF intake on SAM with PM-RUTF as the control were considered eligible. The included randomized controlled trials were then assessed for the risk of bias using Cochrane Risk of Bias 2.0. Odds Ratio (OR) and mean difference (MD) were calculated using a random-effects meta-analysis. The analysis focused on investigating the recovery, mortality, weight gain, and hemoglobin levels. Five randomized controlled trials involving a total of 5,513 children were incorporated in this review. Of which, four studies were included in the statistical analysis. Those receiving SMS-RUTF was 0.77 times less likely to recover from SAM as compared to control (95% CI: 0.66–0.90, p&lt;0.01). The SMS-RUTF group had 1 kg lower weight gain as compared to control (95% CI: -1.25–0.75, p&lt;0.01). However, the SMS-RUTF group had significantly higher increase of hemoglobin level than control (MD: 0.80 g/dL [95% CI: 0.68–0.93], p&lt;0.01). Adverse effects were observed similar in both SMS-RUFT and control groups. SMS-RUFT received low acceptance from the participants suspected to be caused by poor packaging. In conclusion, SMS-RUTF is less effective than PM-RUTF in managing SAM among children but can be used to improve anemia as indicated by increased hemoglobin levels.

Epidemio-Clinical Profile and Factors Associated with Performance Indicators of Integrated Management of Severe Acute Malnutrition in Children Aged 6 - 59 Months Hospitalized at the Kalaban Coro Reference Health Center

Epidemio-Clinical Profile and Factors Associated with Performance Indicators of Integrated Management of Severe Acute Malnutrition in Children Aged 6 - 59 Months Hospitalized at the Kalaban Coro Reference Health Center

Non-Puerperal Adoptive Breastfeeding as Lactational Rescue in the Rohingya Refugee Camp: 2 Case Studies.

Non-puerperal adoptive lactation sometimes requires long preparation and substantial expense for pharmacological intervention to be successful, which are not feasible in refugee camps. Here we report two case studies of non-puerperal adoptive breastfeeding of two infants in the Rohingya Refugee Camp of Cox's Bazar, Bangladesh. Two non-pregnant, non-breastfeeding caregivers with previous experience of breastfeeding brought two adopted infants-one a 12-day-old female with severe acute malnutrition, and the other a 2-day-old male with normal anthropometric measurements-to a nutritional stabilization center for feeding. After counseling, both families opted for adoptive lactation. Both infants were treated with a modified Action Against Hunger protocol of in-patient management of severe acute malnutrition using the supplementary suckling technique, a procedure to feed the baby with supplementary feed. Diluted F100 was used as the supplementary feed; the energy and protein gained from it were just enough to maintain body physiology and were not responsible for any weight gain. When the infants gained weight, indicating that the caregivers were producing milk, we reduced the supplementary feed as per protocol guidelines. The caregivers were prescribed domperidone and counseled on their ability to breastfeed the infants. The cases required 35 days and 20 days, respectively, for the full establishment of breastfeeding. This is the first report of successful adoptive breastfeeding in a refugee camp. With proper counseling and motivation of the caregiver, induced lactation can be started without a preparatory period and with very low-cost intervention.

Evaluation of The Integrated Protocol for The Management of Severe Malnutrition in Children at The National Hospital of Nouakchott-Mauritania

Malnutrition is a worldwide concern with worrisome outcomes that affect substantially the lifestyle of infants. The main aim is to investigate the efficacy of the IMSAM protocol over malnourished Mauritanian children during hospitalization. A cohort of 230 participants, including 126 boys and 104 girls collected from rural and urban areas with an average age of 15.52 ± 7.727 months were enrolled. The study is carried out in the Pediatric Service of the National Hospital Center of Nouakchott, Mauritania on children who have undergone the national protocol for the Integrated Management of Severe Acute Malnutrition (IMSAM). In addition, the medical and nutritional treatment, and body measurements were appreciated as well as the anthropometric parameters. The findings exhibit during nutritional-based intervention significant differences between the mean of weight during the pre- and post-intervention (P &lt; 0.001). Moreover, through a regression test, we found a negatively predicted weight gain (P &lt; 0.05) by the variables Z-score of weight to height (P / T) Edema after Nutritional Support and final health status. Last, but by no means least, the IMSAM-based intervention with rational management might make inroads into mitigating adverse outcomes of malnutrition through maximizing social skills.

Evaluation of Micronutrients and Pro-Inflammatory Cytokines Levels in Nutritionally Deprived Children—A Tertiary Care Hospital-Based Study

Background: Severe acute malnutrition (SAM) is a significant public health problem in developing countries, including India, where a significant proportion of children suffer from malnutrition. Objective: This research aims to investigate the factors contributing to severe acute malnutrition (SAM). Additionally, the study seeks to explore the relationship between micronutrient levels and pro-inflammatory cytokines in SAM children with and without clinical complications. Furthermore, the effectiveness of antibiotic treatment in SAM children without complications is evaluated. Methods: The study involved three groups comprising 66 subjects each: a healthy control group, SAM children with complications, and SAM children without complications. Blood samples were collected, and various analyses were conducted, including biochemical, hematological, micronutrient, and pro-inflammatory marker quantification. The data were analyzed using SPSS version 22.0. Results: The results indicate that the levels of IL-6, CRP, and TNF-α were significantly higher in the SAM group with complications compared to both the control group and the SAM group without complications. Zinc and copper levels were significantly lower in both SAM groups compared to the control group, and a negative correlation was observed between zinc levels and inflammatory markers. The study also assessed the efficacy of antibiotic treatment in SAM children without complications by comparing their weight, height, weight-for-height, and weight-for-age at baseline and after a 15-day follow-up period. Significant improvements in these parameters were observed in both the group receiving antibiotic treatment and the group not receiving antibiotic treatment. Conclusion: The findings suggest that a combination of antibiotic treatment and nutritional support can lead to significant clinical improvements in SAM children without complications. This study has important implications for the management and treatment of SAM in India and other developing countries.

Assessment of Philippine Integrated Management of Acute Malnutrition (PIMAM) Program Implementation and Challenges in Maguindanao Hospitals, Philippines

This study aimed to evaluate the implementation of the Philippine Integrated Management of Acute Malnutrition (PIMAM) Program in Maguindanao Provincial Hospital (MPH), Dinaig Municipal Hospital (DMH), and South Upi Municipal Hospital (SUMH), Philippines. Employing a descriptive-evaluative design, data were gathered from 107 respondents comprising top management and hospital staff, selected via purposive sampling. A survey questionnaire was utilized as the primary data collection tool, supplemented by secondary data obtained from hospitals' PIMAM-ITP coordinators regarding the status of patients upon discharge from the Inpatient Therapeutic Program (ITP). Data were analyzed using mean and percentage. Results indicated high levels of implementation of PIMAM-ITP across the hospitals concerning guidelines, facilities, materials, screening, treatment, and discharge procedures. Notably, 74% of discharged patients from ITP hospitals were classified as "successfully treated," with the remaining categorized as defaulter (16%), deceased (8%), medically transferred (2%), or non-respondent (0%). The program demonstrated effectiveness in systematically addressing acute malnutrition. However, challenges persisted, particularly concerning caregiver compliance and funding allocation for training on the National Guidelines for the Management of Severe Acute Malnutrition among personnel involved in program implementation.