Mean Mid-upper Arm Circumference Research Articles

Nutritional Assessment Based on Mid-upper Arm Circumference Among Tribal Preschool Children of Three Distinct Ecological Zones of India

Undernutrition among infants and children retards the physical and cognitive growth and increases susceptibility to infections and diseases. Educational attainment and productivity of children get adversely affected by undernutrition, NFHS (2019–2020) and IIPS (2021) found the prevalence of undernutrition indicators to be high among the under-five children of the nation and tribal children to be in a more vulnerable condition. Mean mid-upper arm circumference (MUAC) is a quick, simple and precise screening tool to use in large-scale community-based nutritional programme. The present study aimed to assess the prevalence of undernutrition based on MUAC among three tribes of three distinct ecological zones of India, namely Bhil Tribe (Desert ecology), Dhodia tribe (Coastal ecology) and Kinnaura tribe (Himalayan ecology). The present cross-sectional study consists of 985 tribal children (509 boys and 476 girls) belonging to the age group 0–1 through 5+ years (below six years). Z-score was computed using WHO (2006) recommended age and sex-specific cutoff points for MUAC and the prevalence of undernutrition was assessed for children of below five years of age. MUAC has been found to have significant age difference among all communities ( p < .001). Prevalence of undernutrition was found to be the highest among the Bhil tribe, the one residing in the desert ecology (41.03%) followed by Dhodia (18.06%) and Kinnaura tribe (12.16%). Among Bhil and Kinnaura children, prevalence of undernutrition was higher among the girls, while the Kinnaura boys manifested higher prevalence of undernutrition in comparison to their counterpart. Significant ( p < .01) sex difference in undernutrition prevalence was found only in case of Bhil tribe (boys: 33.33%, girls: 48.02%). The prevalence of undernutrition significantly differs among the tribes of three distinct ecological zones ( p < .001). The nutritional status of the tribal children, particularly that of the Bhil children, was unsatisfactory. To improve the nutritional wellbeing of the tribal population of the nation, studies at regular intervals focusing on the causes responsible for nutritional status are needed.

Outcome of Severe Acute Malnutrition in Children Aged 6-59 Months Before and After the Institution of the Malnutrition Treatment Centre in the Regional Hospital Limbe, Southwest Region of Cameroon

Background: Malnutrition occurs when nutrient and energy intake do not meet, or exceed an individual’s requirements to maintain growth, immunity, and organ function. In 2020, among children 0-59 months worldwide, 21.3% (144 million) were stunted and 6.9% (47 million) were wasted. The Malnutrition Treatment Centre’s (MTC) establishment in the Regional Hospital Limbe in 2019 brought major changes in management such as free and continuous supply of therapeutic food and basic drugs, the expertise of a nutritionist and closer follow up of patients after discharge. The aim of this research was to evaluate the outcome of children with severe acute malnutrition aged 6-59 months treated at the MTC differed from those treated before the MTC’s creation. Methodology: An analytic cross sectional retrospective study was conducted from February to March 2022. The study period was from March 2016 to February 2019 (before the MTC) and March 2019 to February 2022 (after the MTC). A predesigned data extraction form was used to obtain sociodemographic data of the children and their parents, clinical findings on admission and hospital outcome. The data was entered into CDC Epi info 2.4 and analysed using SPSS. A p-value of <0.05 was considered statistically significant. Results: Out of 129 files included in the study, 35 were pre-MTC and 94 after its creation. The hospital prevalence of SAM increased from 4% to 7% after the MTC’s creation. The mean MUAC (mid-upper arm circumference) was 11.1 ± 0.98 cm. Marasmus was the most common form of SAM (90.7%). The most common admission symptoms were fever (74.4%), diarrhoea (47.2%) and vomiting (32.6%). The most common comorbidities were malaria (29.5%), gastrointestinal infection (20.9%), sepsis (18.6%) and pulmonary infection (14%). There was an increase in the recovery rate (from 71.4% to 76.6%) and the rate of weight gain (from 3.5 g/kg/day to 8.7 g/kg/day). There was also a reduction in the death rate (from 14.3% to 9.6%) and length of in-hospital admission (from 10.24 ±5.4 days to 7.3 ±3.6 days) Conclusion: The MTC led to an increase in the influx of patients with SAM at the RHL, marasmus was the most common form of SAM. There was an increase in the rate of weight gain, a decreased mortality rate and decreased length of hospital stay, thus revealing the pertinent relevance of the MTC in the management of SAM.

Small Fish Big Impact: Improving Nutrition during Pregnancy and Lactation, and Empowerment for Marginalized Women.

Undernutrition and micronutrient deficiencies such as anemia are considered significant public health challenges in Bangladesh, which enhancing fish consumption is a well-established food-based intervention to address these. This paper documents the establishment of community-based fish chutney production and reports the impact of its consumption on mid-upper arm circumference (MUAC) and hemoglobin (Hb) levels among targeted 150 pregnant and lactating women (PLW) in rural Bangladesh. A fish chutney was developed using locally available ingredients followed by a series of laboratory tests, including nutrient composition, shelf-life and food safety. A community-based fish chutney production process was designed to: (1) supply locally available ingredients for processing; (2) establish two fish drying sites; (3) initiate a community-based production site; and (4) distribute fish chutney to PLW for one year by six women nutrition field facilitators. Then a pre- and post-intervention study was designed for a selected 150 PLW to receive 30 g of fish chutney daily for 12 months. Differences in mean MUAC and Hb levels pre- and post-consumption were analyzed using one-way analysis of variance. Consumption of 30 g of fish-chutney resulted in significant increases of the mean values of Hb levels and MUAC among the targeted PLW.

Disparities with global standards about growth references of mid-upper arm circumference-for-age for Pakistani children aged 6-60 months.

Growth reference values about mid-upper arm circumference (MUAC) are vital for assessing children's nutritional status. However, Pakistan lacks these reference values and growth charts. This study aims to develop these for children aged 6-60 months and compare them with global standards. The data were acquired from the 2018 National Nutrition Survey of Pakistan, which was conducted by the United Nations Children's Fund (UNICEF) during 2018-2019. The final study cohort comprised 57 285 children, with 51% being boys. Percentile values and charts for MUAC-for-age were developed using generalised additive models for location, scale and shape with the Box-Cox power exponential distribution. The mean MUAC was 14.21 cm (±2.07 cm) and 14.13 cm (±2.12 cm) for the boys and girls, respectively. At 60 months of age, the P3 and P97 percentiles for girls were slightly higher than those for boys. The median percentiles of Pakistani children were smaller than the World Health Organisation 2007 standards and with international references. We observed disparities in MUAC-for-age growth references among Pakistani children compared to global standards, highlighting regional, age and gender variations. This underscores the need for developing countries like Pakistan to establish their growth references.

Effect of nutrition counseling on nutritional status and gestational weight gain of pregnant adolescents in West Arsi, Central Ethiopia: a cluster randomized controlled trial

When pregnancy occurs in adolescence, the growth and development of the mother and fetus may be impaired due to strong competition for nutrients between the still-growing adolescent and the fetus. Pregnant adolescents constitute an underserved population; they lack adequate nutritional knowledge. Therefore, this study investigated the effect of nutritional behavior change communication (NBCC) through alliance for development (AFD) on the nutritional status and gestational weight gain (GWG) of pregnant adolescents. A two-arm parallel cluster randomized controlled community trial was conducted in the West Arsi Zone, central Ethiopia, from August 2022 to July 2023. The nutritional status of the pregnant adolescent was assessed using mid-upper arm circumference. Weight was measured at baseline and at the end of the intervention. A total of 207 and 219 pregnant adolescents participated in the intervention and control clusters, respectively. The intervention started before 16 weeks of gestation, and the intervention group attended four NBCC sessions. The NBCC was based on the health belief model (HBM) and was given at the participants’ homes with their husbands. The NBCC intervention was delivered by AFDs and community-level health actors. Pregnant adolescents in the control group received routine nutrition education from the health care system. A linear mixed-effects model and difference in difference (DID) were used to measure the intervention effect after adjusting for potential confounders. After the implementation of the trial, the mean mid-upper arm circumference (MUAC) in the intervention arm significantly increased from baseline (p ≤ 0.001), 23.19 ± 2.1 to 25.06 ± 2.9 among intervention group and 23.49 ± 2.1 to 23.56 ± 2.0 among control group and the mean difference in the MUAC (DID) was 1.89 ± 2 cm (p ≤ 0.001); the mean GWG in the intervention arm significantly increased from baseline; 51.54 ± 4.7 to 60.98 ± 4.6 among intervention group and 52.86 ± 5.27 to 58 ± 5.3 among control group; the mean GWG in the intervention group was 9.4 kg, and that in the control group was 5.14 kg, and the difference in difference was 4.23 kg and this was statically significant p ≤ 0.001). This study demonstrated that the use of the HBM for NBCC delivered through the AFD was effective at improving the nutritional status and GWG of pregnant adolescents. These results imply the need for the design of model-based nutritional counseling guidelines.Clinical trial registration: PACTR202203696996305, Pan African Clinical Trials Registry, date of first registration: 16/03/2022.

Assessment of growth monitoring among children younger than 5 years at early childhood development centres in Nelson Mandela Bay, South Africa

AbstractIntroductionEarly childhood development (ECD) centres are important community hubs in South Africa and act as sites for community detection of childhood nutrition problems. This study aimed to assess the ability of trained ECD practitioners with optimal support to correctly classify the nutritional status of infants and young children at ECD centres in the Nelson Mandela Bay.MethodsA descriptive, cross‐sectional study was used to collect data from 1645 infants and children at 88 ECD centres. Anthropometric measurements were taken by trained fieldworkers and growth monitoring and promotion infrastructure was audited at ECD centres.ResultsOf the sample, 4.4% (n = 72) were underweight by weight for age Z‐score (WAZ < −2) and 0.8% (n = 13) were severely underweight (WAZ < −3). Results showed that 13.1% (n = 214) were stunted by height for age Z‐score (HAZ < −2) and 4.5% (n = 74) were severely stunted (HAZ < −3). The prevalence of moderate acute malnutrition was 1.2% and severe acute malnutrition was 0.5%, while the prevalence of overweight was 9.2% and the prevalence of obesity was 4%. A significant level of agreement between the correct interpretation and the ECD practitioners' interpretation was observed across all the anthropometric indicators investigated. The true positive wasting cases had a mean mid‐upper arm circumference (MUAC) of 14.6 cm, which may explain the high false negative rate found in terms of children identified with wasting, where ECD practitioners fail to use the weight for height Z‐score (WHZ) interpretation for screening.ConclusionBy using ECD centres as hub to screen for malnutrition, it may contribute to the early identification of failure to thrive among young children. Although it was concerning that trained ECD practitioners are missing some children with an unacceptably high false negative rate, it may have been due to the fact that wasting in older children cannot be identified with MUAC alone and that accurate WFH plotting is needed. Onsite mentorship by governmental health workers may provide ECD practitioners with more confidence to screen children for growth failure based on regular WFH measurements. Moreover, ECD practitioners will be more confident to monitor the Road to Health booklets for missed vaccinations, vitamin A and deworming opportunities.

Family MUAC supported by a two-way SMS platform for identifying children with wasting: the Mama Aweza randomised controlled trial

Effective methods of preventing and identifying childhood wasting are required to achieve global child health goals. Family mid-upper arm circumference (MUAC) programs train caregivers to screen their child for wasting with MUAC tapes. We assessed the effectiveness of a two-way short message service (SMS) platform (referred to as the Maternally Administered Malnutrition Monitoring System [MAMMS]) in western Kenya. In this individual-level randomised controlled trial in two rural countries in western Kenya, children (aged 5-12 months) were randomly allocated (1:1) to receive either standard care (SOC) or MAMMS. Randomisation method was permuted-block randomisation with a block size of 10. Eligible participants were children attending maternal child health clinics in the two counties whom had a MUAC between 12.5 and 14.0cm. The MAMMS group received two MUAC tapes and weekly SMS reminders to screen their child's MUAC. The SOC group received routine community health volunteer services and additional quarterly visits from the study team. The primary analysis used a cox proportional hazards model to compare SOC and MAMMS time-to-diagnosis of wasting (MUAC <12.5cm) confirmed by a health professional during 6-months follow-up. Secondary outcomes were days from enrolment to treatment initiation among children with wasting, proportion of all children with wasting who were identified by the two approaches (treatment coverage), mean MUAC at treatment initiation, and duration of wasting treatment. This trial was registered on ClinicalTrials.gov, NCT03967015. Between August 1, 2019 and January 31, 2022, 1200 children were enrolled, among whom the incidence of confirmed wasting was 37% lower in the MAMMS group (hazard ratio: 0.63, 95% CI: 0.42-0.94, p=0.022). Among children with wasting, the median number of days-to-diagnosis was similar between study groups (MAMMS: 63 days [interquartile range (IQR): 23-92], SOC: 58 days [IQR: 22-94]). Treatment coverage in the MAMMS group was 83.3% (95% CI: 39.9-100.0) while coverage in the SOC group was 55.6% (95% CI: 22.3-88.9%, p=0.300). Treatment duration and mean MUAC at treatment initiation were similar between groups. Family MUAC supported by SMS was associated with a 37% reduction in wasting among young children. Empowering caregivers to monitor their child's nutritional status at home may prevent a substantial proportion of moderate wasting. Thrasher Research Foundation and Pamela and Evan Fowler.

Do Nutritional Status Parameters such as Body Mass Index &amp; Mid Upperarm Circumference Need to be Taken into Account when Estimating Dental Age? A Cross-sectional study with Tooth Count as Variable

Context: Age estimation is playing a very important role in the criminal justice system and also in the forensic human identifi cation process. Over the past several decades, the scientifi c community has done extensive work on age estimation from biological markers of growth, the dental structure being one among them. The routine dental age estimation methods usually apply the mineralization and/or the eruption parameters of the developing dentition. Certain factors like the nutritional status and the socio-economic status of the individual also may infl uence dental development and eruption. Aim: The objective of the study was to assess the link between the nutritional status and the dentition status of children and adolescents in the age range of 12 to 18 years. Settings and Design: This is a cross-sectional population based, descriptive study. Materials and Methods: The body mass index (BMI) and the mid-upper arm circumference (MUAC) values were measured to assess the nutritional status of the children with a mean age of 14.35 years (± 1.36). The oral examination was done to count the number of teeth present. The tooth count was compared with the BMI and the MUAC values of the children. Results: The mean BMI of the study population was 17.36 Kg/m2 ± 3.40 and the mean MUAC value was 21.53cm ± 2.93. There was a strong positive correlation between BMI and MUAC and a signifi cant diff erence in the deciduous tooth count among the BMI categories. (2 =12.161, df 3, p&lt;0.05). Conclusion: There is no signifi cant association between BMI and deciduous tooth count in the study sample. Key Messages: The BMI and MUAC values are markers of nutritional status in growing children. Though nutritional status has a link with the tooth development, the present study could not establish a signifi cant association between BMI and deciduous tooth count in children in the age range of 12 to 18 years.

Correlation between electronic wrist blood pressure with auscultatory blood pressure in children.

The increasing prevalence of obesity in children and adolescents has turned hypertension into an important public health issue. In the current literature, auscultatory blood pressure measurement is recommended for the diagnosis of hypertension. The number of studies comparing electronic blood pressure measurement and auscultatory blood pressure measurement is limited. This study aimed to compare auscultatory blood pressure measurement with electronic blood pressure measurement in the children population group aged 5-15 years. A total of 72 patients aged between 5-15 years without chronic disease were included in the study. Anthropometric measurements (height, weight, body mass index, wrist circumference, mid-upper arm circumference) were performed. Systolic blood pressure (SBP), diastolic blood pressure (DBP), and mean arterial pressure (MAP) were first measured electronically from the wrist using an Omron Rs7 Intelli It HEM-6232T device, and then auscultatory measurements were performed. Each type of measurement was performed 3 times intermittently. The mean wrist circumference was 14.43±0.22 cm and the mean mid-upper arm circumference was 21.43±0.55 cm. Mean SBP, DBP and MAP measured electronically on the wrist were 104.1±1.5, 65.6±1.3 and 78.1±1.3 mmHg, respectively, and mean SBP, DBP and MAP measured via auscultation were 99.3±1, 61.4±0.7 and 73.6±0.7 mmHg, respectively. Electronically-measured wrist MAP had significantly moderate correlations with mid-upper arm and wrist circumference (r:0.547, r:0.559, p<0.01). Since the differences were less than 4 mmHg in both systolic and diastolic pressures between electronic wrist blood pressure (EWBP) measurement and auscultatory measurement, it appears that electronic measurement may be important in first line of blood pressure screening. Since it is easy and practical to use in the early period, it may be an alternative approach to auscultatory measurement among non-critical pediatric patients.

Effects of intensive nutrition education and counseling on nutritional status of pregnant women in East Shoa Zone, Ethiopia.

Nutritional status is defined as an individual's health condition as it is influenced by the intake and utilization of nutrients. Maternal malnutrition is widespread throughout the world, with Sub-Saharan Africa and Asia bearing the brunt of the burden. The objective of this study was to evaluate the effect of intensive nutrition education and counseling on nutritional status during pregnancy. The study was a one-year, two-arm parallel design cluster randomized controlled trial conducted in the East Shoa zone, Ethiopia, from January 1, 2021, to February 30, 2022. A total of 374 participants were enrolled in the intervention (n = 185) and control (n = 189) groups. End-line data were collected from 163 women, from each group. The intervention package provided three counseling sessions by trained midwives, three-page take-home brochures prepared in local languages, and the delivery of 18 weekly serial short text messages. The women in the control group received routine nutrition education from the health facilities. After adjusting for potential confounders, a linear mixed-effects model was employed to assess the intervention effect. After the intervention, the mean mid-upper arm circumference in the intervention group increased by 1.8% (23.08 vs. 23.44, p < 0.01). Similarly, the proportion of undernutrition in the intervention group was 11% (25 vs. 36%, p = 0.02) lower compared to the control arm. At the end of the trial, women in the intervention arm had significantly better nutritional status than women in the control group (β = 0.47, p < 0.01). The findings showed that intensive nutrition education and counseling using the health belief model was effective in improving nutritional status and reducing undernutrition among pregnant women. As a result, nutrition education and counseling using HBM constructs, as well as regular reminder messages, should be provided to pregnant women as part of the routine antenatal care service.

Serum Magnesium Level in Protein-Energy Malnourished Children

Background: Protein energy malnutrition (PEM) is mainly due to inadequate intake of food both in quantity and quality. Serum magnesium level can be detected to identify magnesium deficiency in malnourished children. Low magnesium level in these children is associated with illness and death. Objective: To determine the serum magnesium level in protein energy malnourished children who are under the age of 5 years. Study Design: Prospective Cross Sectional study. Setting: The Pediatric department, civil hospital, Karachi. Study period: From July to December 2021. Material and Methods: Total 245 patients of both genders with moderate and severe malnutrition were included. Venous samples were sent to laboratory and a centrifuge machine was used to separate the serum, which was maintained at a temperature of 20°C for serum magnesium test. Atomic Absorption Spectrophotometer was used to measure serum magnesium levels. Descriptive statistics were applied. Frequency and percentage was calculated. Stratification was done using chi square test and p-value ≤0.05 was considered as significant. Results: Total 156 male and 89 female patients were included in the study. Mean age was 26.63±15.17 months. Mean duration of malnutrition was 11.74±4.86 months. Mean mid upper arm circumference (MUAC) was 11.66±0.76 cm. Serum magnesium level was 1.78±0.22 mg/dl. Overall 180 (73.5%) have moderate PEM. Conclusion: Study showed low serum concentration of magnesium in children with PEM. Keywords: Serum Magnesium Level, Protein Energy Malnutrition, Children Under 5 Years.

Evaluation of Nutritional Characteristics Reveals Similar Prevalence of Malnutrition in Patients with Ulcerative Colitis and Crohn's Disease.

Inflammatory bowel disease (IBD) is associated with an increased risk of malnutrition and sarcopenia. To evaluate the nutritional status of patients with IBD and determine the threshold values of different parameters of nutritional assessment to identify malnutrition. This was a single-centre cross-sectional analysis of adult patients with IBD [ulcerative colitis (UC) and Crohn's disease (CD)] who underwent anthropometry [body mass index (BMI), mid upper arm circumference (MUAC) and triceps-fold thickness (TSF)], body composition analysis and assessment for sarcopenia [hand-grip strength and skeletal muscle index (SMI) at L3 vertebral level)]. Age- and gender-matched healthy adults served as controls. Malnutrition was defined according to the European Society of Clinical Nutrition and Metabolism (ESPEN) criteria. A total of 406 patients [336 (82.76%) UC and 70 (17.24%) CD; mean age 40.56 ± 13.67years; 215 (52.95%) males] with IBD and 100 healthy controls (mean age 38.69 ± 10.90years; 56 (56%) males) were enrolled. The mean BMI, MUAC, TSF thickness, fat and lean mass, hand-grip strength, and SMI at L3 vertebral level were lower in patients with IBD compared to controls. The prevalence of malnutrition was similar in UC and CD [24.40% (n = 82) and 28.57% (n = 20), respectively (p = 0.46)]. Thresholds for fat mass in females (15.8kg) and visceral fat index in males (0.26) were both sensitive and specific to detect malnutrition. The cutoff values of MUAC and TSF thickness to identify malnutrition were 23.25cm and 25.25cm, and 16.50mm and 8.50mm, in females and males, respectively. Malnutrition and sarcopenia were common in patients with IBD, with the prevalence being similar in patients with both UC and CD.

Relationship Between Mid-upper Arm Circumference (MUAC) and Body Mass Index (BMI) in Children Aged 6 - 12 Years: A Cross-sectional Study

Background: Obesity has become one of the most important health problems worldwide. Body mass index (BMI) is a clinical assessment of overweight and obesity in children, although mid-upper arm circumference (MUAC) assessment is more straightforward, especially for parents. Objectives: This study aimed to investigate the relationship between MUAC and BMI in children aged 6 - 12 years. Methods: This cross-sectional study was performed on 455 elementary school children aged 6 - 12, including 278 girls and 177 boys with a mean age of 8.8 ± 1.8 years selected using the census method. Our researcher was trained for anthropometric data collection. Data were analyzed by SPSS version 25 software using Mann-Whitney, Kolmogorov-Smirnov, and Kruskal-Wallis tests. Results: The mean age was 9.19 ± 1.8 years, the mean height was 135 ± 12 cm, the mean weight was 31.85 ± 11 kg, the mean MUAC was 21 ± 3.1 cm, and the mean BMI was 17 ± 3.6 kg/m2. There was a significant correlation between MUAC and BMI in both sexes, but it was stronger in girls than in boys (P-value &lt; 0.05). The MUAC cutoff point was 23.75 cm (77% sensitivity and 80% specificity) and 24.75 cm (93% sensitivity and 88% specificity) for overweigh and obesity in girls, respectively. Also, it was 23.25 cm (88% sensitivity and 83% specificity) and 25.25 cm (87% sensitivity and 90% specificity) for overweigh and obesity in boys, respectively. Conclusions: We recommend MUAC as a predictor of early diagnosis of overweight and obesity.

Effectiveness of Ready-to-Use Therapeutic Food Among Children With Protein-Calorie Malnutrition.

BackgroundMalnutrition develops when there is an inadequacy of one or more than one macronutrient for optimum body functioning. This study was designed to determine the effectiveness of ready-to-use therapeutic food (RUTF) in children with protein-calorie malnutrition (PCM) in terms of weight gain and mid-upper arm circumference (MUAC) improvement.MethodologyThis prospective observational study was done at The Department of Pediatrics, National Institute of Child Health, Karachi, Pakistan from 1st January 2021 to 31st December 2021. A total of 159 children of either gender between six and 59 months of age and diagnosed with PCM were included. All children participating in the study were asked to come back for a follow-up every two weeks until they are 12 weeks old. Outcomes were measured in terms of comparison of weight gain and MUAC at baseline and after 12 weeks of RUTF.ResultsOf the 159 children, 94 (59.1%) were female. The mean age was 16.8±9.2 months, and 88 (55.3%) children were aged between six to 12 months. The mean body weight was 6.8±9.7 kg. The mean MUAC was calculated to be 116±9.1 mm. There were 121 (76.1%) children who had severe acute malnutrition. One hundred and thirty-one children completed the planned 12-week of follow-up using RUTF in this study, so they were included in the final analysis. Body weight increased significantly from baseline to 12-weeks after RUTF (6.8±1.7 kg vs. 7.6±1.2kg, p<0.0001). Likewise, MUAC also increased from baseline to 12 weeks after RUTF (116.0±9.1 mm vs. 127.2±8.2 mm, p<0.0001).ConclusionThe RUTF was found to significantly improve weight gain and MUAC among children aged between six to 60 months with PCM during a period of 12-weeks. Early diagnosis and timely intervention can improve outcomes among children with PCM. Community-based interventions can be aimed to improve the nutritional status of children in a developing country like Pakistan.

Identifying modifiable risk factors for mortality in children aged 1–59 months admitted with WHO-defined severe pneumonia: a single-centre observational cohort study from rural Malawi

ObjectiveAlthough HIV infection, severe malnutrition and hypoxaemia are associated with high mortality in children with WHO-defined severe pneumonia in sub-Saharan Africa, many do not have these conditions and yet mortality...

Assessment of Body Composition among the Sabar Preschool Children of Purulia districts, West Bengal, India

There is scanty information on body composition characteristics among preschool children from underprivileged communities of India. Therefore, the present cross-sectional study was designed to assess the body composition characteristics among Sabar preschool children aged 1-5 years. The present study was conducted at six different villages of three blocks under Purulia district, West Bengal, India. The subjects were randomly selected from house-to-house visit from studied villages. Significant age variations were noticed in mean height, weight, and Body mass index (BMI) among both sexes. Boys showed significant age variation in mean triceps skinfold thickness (TRISKF), whereas the girls showed significant age variation in mean Mid-upper arm circumference. Maximum significant age variation was observed in mean height (Boys: F = 52.36, P &lt; 0.001; Girls: F = 49.78, P &lt; 0.001), and minimum significant age variation was noticed in mean TRISKF among boys (F = 3.78, P &lt; 0.05) and in mean BMI (F = 5.13, P &lt; 0.05). Age-combined mean values of percent body fat (PBF) and fat mass (FM) were significantly higher among girls (20.39% and 2.36 kg) than boys (16.17% and1.84 kg). The Pearson correlation coefficients (r) showed that body composition measurers were significantly correlated with the majority of variables among these children. In conclusion, the results revealed that PBF, FM, and fat-free mass were good indicators to measure the degree of fat deposition, which could be used as a nutritional indicator in terms of leanness.

Effectiveness of a monthly schedule of follow-up for the treatment of uncomplicated severe acute malnutrition in Sokoto, Nigeria: A cluster randomized crossover trial.

BackgroundCommunity-based management of severe acute malnutrition (SAM) involves weekly or biweekly outpatient clinic visits for clinical surveillance and distribution of therapeutic foods. Distance to outpatient clinics and high opportunity costs for caregivers can represent major barriers to access. Reducing the frequency of outpatient visits while providing training to caregivers to recognize clinical danger signs at home between outpatient visits may increase acceptability, coverage, and public health impact of SAM treatment. We investigated the effectiveness of monthly clinic visits compared to the standard weekly follow-up in the outpatient treatment of uncomplicated SAM in northwestern Nigeria.Methods and findingsWe conducted a cluster randomized crossover trial to test the noninferiority of nutritional recovery in children with uncomplicated SAM receiving monthly follow-up compared to the standard weekly schedule. From January 2018 to November 2019, 3,945 children aged 6 to 59 months were enrolled at 10 health centers (5 assigned to monthly follow-up and 5 assigned to weekly follow-up) in Sokoto, Nigeria. In total, 96% of children (n = 1,976 in the monthly follow-up group and 1,802 in the weekly follow-up group) were followed until program discharge, and 91% (n = 1,873 in the monthly follow-up group and 1,721 in the weekly follow-up group) were followed to 3 months postdischarge. The mean age at admission was 15.8 months (standard deviation [SD] 7.1), 2,097/3,945 (53.2%) were girls, and the mean midupper arm circumference (MUAC) at admission was 105.8 mm (SD 6.0). In a modified intention-to-treat analysis, the primary outcome of nutritional recovery, defined as having MUAC ≥125 mm on 2 consecutive visits, was analyzed using generalized linear models, with generalized estimating equations to account for clustering. Nutritional recovery was lower in the monthly follow-up group compared to the weekly group (1,036/1,976, 52.4% versus 1,059/1,802, 58.8%; risk difference: −6.8%), and noninferiority was not demonstrated (lower bound of the confidence interval [CI] was −11.5%, lower than the noninferiority margin of 10%). The proportion of children defaulting was lower in the monthly group than in the weekly group (109/1,976, 5.5% versus 151/1,802, 8.4%, p = 0.03). Three months postdischarge, children in the monthly group were less likely to relapse compared to those in the weekly group (58/976, 5.9% versus 78/1,005, 7.8%, p = 0.03), but cumulative mortality at 3 months postdischarge was higher in the monthly group (159/1,873, 8.5% versus 106/1,721, 6.2%, p < 0.001). Study results may depend on context-specific factors including baseline level of care and the clinical status of children presenting to health centers, and, thus, generalizability of these results may be limited.ConclusionsWhere feasible, a weekly schedule of clinic visits should be preferred to maintain effectiveness of SAM treatment. Where geographic coverage of programs is low or frequent travel to outpatient clinics is difficult or impossible, a monthly schedule of visits may provide an alternative model to deliver treatment to those in need. Modifications to the outpatient follow-up schedule, for example, weekly clinic visits until initial weight gain has been achieved followed by monthly visits, could increase the effectiveness of the model and add flexibility for program delivery.Trial registrationClinicalTrials.gov NCT03140904.

Anthropometric Measurements to Predict NICU Admission for Infants of Diabetic Mothers

Aim: Can NICU admission of IDM be predicted by anthropometric measurements like birth weight, lenght, head circumference (HC), mid upper arm circumference (MUAC) or triceps skin fold thickness (TSFT). Method: Eighty-six-term IDMs were analyzed prospectively. MUAC, HC and TSFT were measured within 48 hours of life. Prenatal-natal-postnatal problems; NICU admission; maternal characteristics, HbA1c were recorded. Results: Mean birth weight, gestational age were 3453.3±582.4g and 38.0±0.97weeks. 63.9% of IDMs was admitted to NICU. 56.3% hospitalized due respiratory problems; 32,7 % required endotracheal intubation. Mean MUAC, TSFT, HC and MUAC/HC ratio were 11.2±1.1 cm, 7.1±2.2 mm, 35.0±1.8 cm and 0.32±0.03 cm respectively for all. Although there was no significant relation between NICU admission and MUAC (p=0.071), TSFT and MUAC/HC were significantly higher in babies admitted to NICU (p=0.006 for TSFT, p&lt;0.001 for MUAC/HC). HC was significantly low in babies followed in NICU (P&lt;0.001). With increment of TSFT, MUAC/HC and HbA1c, NICU admission increases positively, but HC affects NICU admission negatively (OR for TSFT:1.6, OR for MUAC/HC: 2.1, OR for HbA1c: OR for HC:0,3). Mechanic ventilation requirement is affected positively by TSFT (p=0.008, OR:1.5) and affected negatively by HC (p=0.004, OR:0.6). Conclusion: This preliminary study showed; TSFT, HC and MUAC/HC ratio are helpful criterias to predict NICU admission risk for IDMs and might be helpful for risk assesment in limited settings. Bangladesh Journal of Medical Science Vol. 21(1) 2022 Page : 72-78

Anthropometric measurements of term babies delivered in a mission hospital in Southwest Nigeria.

Babies birth anthropometric measurements are useful for retrospective assessment of foetal in utero health status, anticipatory care and growth monitoring. At community level, measurements other than birth weight (BW) may help predict low BW (LBW). The aim of the study was to determine the mean anthropometric measurements of term babies, its comparability with standard values, acceptable cutoff and surrogate for LBW. A cross-sectional study involving 257 term babies delivered by booked mothers at the Sacred Heart Hospital Abeokuta and selected by systematic random sampling. BW, occipitofrontal circumference (OFC), chest circumference (CC), mid-upper arm circumference (MUAC) and crown-heel length (CHL) were measured, and data were analysed using SPSS version 21 with significant P < 0.05 and confident interval of 95%. Mean BW, CC, OFC, CHL and MUAC were 3.25 ± 0.47 kg, 33.32 ± 1.98 cm, 34.7 ± 1.93 cm, 48.16 ± 2.87 cm and 11.57 ± 1.41 cm, respectively, with no significant mean difference between male and female babies. The mean OFC was higher than the national standard, World Health Organization Multicentre Growth Reference Study (WHO-MGRS) and INTERGROWTH-21. The mean cutoff for LBW was OFC - 31.89 cm, CC - 29.56 cm, CHL- 43.33 cm and MUAC - 9.35 cm (P = 0.000) with OFC being the best surrogate of LBW at Sensitivity, Specificity and Degree of Accuracy/area under the curve of 66.7%, 97.6% and 82.1% respectively. LBW babies had lower mean anthropometric cutoff values at variance from the WHO-MGRS and INTERGROWTH-21. Mean OFC was higher than both standards reflecting the need for cautious interpretation to prevent misdiagnosis of macrocephaly. We recommend OFC as an alternative for predicting LBW when access to weighing scale is a challenge.

Comparison of standardised milk-based, standardised non-milk based and hospital-based formulations on the anthropometric indices of under-fives with moderate acute malnutrition: A randomised clinical trial.

Moderate acute malnutrition (MAM) causes impaired anthropometry, which can be reversed by supplementary feeding. The present study aimed to compare the effect of a standardised milk-based formulation (SMBF), standardised non-milk based formulation (SNMBF) and hospital-based formulation (HBF) on anthropometric indices of children aged <5years with MAM. This was a randomised clinical trial during which eligible children aged 6-59 months with MAM received SMBF, SNMBF or HBF over 4 months. They were followed up on a biweekly basis during which their weight, mid upper arm circumference (MUAC) and length/height were measured. The effect of the formulations was determined at the end of the period by the change in their anthropometric indices using 'per protocol' analysis. p<0.05 was considered statistically significant. There were 157 evaluable participants of whom 54 received the SMBF, 57 received the SNMBF and 46 received the HBF. The overall result showed a significant improvement in the mean weight and MUAC of the children. Subgroup analysis showed a significant improvement in mean weight and MUAC among children aged 6-23 months (p = 0.013) and improvement in MUAC only among those aged 24-59 months (p = 0.03). The formulations significantly improved the mean weight and MUAC of children with MAM.