Moderate Acute Malnutrition In Children Research Articles

Facilitators and barriers to implementing complex community-based interventions for addressing acute malnutrition in low- and lower-middle income countries: A scoping review.

Background: Community-based nutrition interventions have been established as the standard of care for identifying and treating acute malnutrition among children 6-59 months in low- and lower-middle-income countries. However, limited research has examined the factors that influence the implementation of the community-based component of interventions that address severe acute malnutrition and moderate acute malnutrition among children. Aim: The objective of this review was to identify and describe the facilitators and barriers in implementing complex community-based nutrition interventions to address acute malnutrition among children in low- and lower-middle-income countries. Methods: This review used a systematic search strategy to identify existing peer-reviewed literature from three databases on complex community-based interventions (defined as including active surveillance, treatment, and education in community settings) to address severe acute malnutrition and moderate acute malnutrition in children. Results: In total, 1771 sources were retrieved from peer-reviewed databases, with 38 sources included in the review, covering 26 different interventions. Through an iterative deductive and inductive analysis approach, three main domains (household and interpersonal, sociocultural and geographical; operational and administrative) and eight mechanisms were classified, which were central to the successful implementation of complex community-based interventions to address acute child malnutrition. Conclusion: Overall, this review highlights the importance of addressing contextual and geographical challenges to support participant access and program operations. There is a need to critically examine program design and structure to promote intervention adherence and effectiveness. In addition, there is an opportunity to direct resources towards community health workers to facilitate long-term community trust and engagement.

Artificial intelligence for the practical assessment of nutritional status in emergencies

AbstractThis paper describes a novel method for detecting child malnutrition based on artificial intelligence and facial photography. Estimates of severe and moderate acute malnutrition in children are critical for rapid emergency responses. However, the two traditional measurement methods, mid‐upper arm circumference (MUAC) and weight‐for‐height (WFH), are impractical in conflict and catastrophic disaster situations. They require well‐trained enumerators, cumbersome equipment, and close supervision. The Method for Extremely Rapid Observation of Nutritional Status (MERON) addresses the problem, using simple facial photographs. Facial features are extracted to predict Body Mass Index (BMI) in adults and Weight for Height Z Score (WFHZ) in children under five. MERON correctly predicts adult BMI classification with 78% accuracy. A variant of the model, trained on a sample of 3167 children in Kenya, successfully classified 60% of cases. On most measures, MERON was easier and more culturally acceptable to use than the traditional measurement methods. If MERON were to be trained and validated on a larger sample, with more extreme cases, it would provide a practical solution to a recurrent humanitarian problem.

Factors Associated With Failure to Respond to Treatment for Moderate Acute Malnutrition in Sierra Leone

ObjectivesTo assess factors associated with failure to respond to treatment for moderate acute malnutrition (MAM) while enrolled in a supplementary feeding program (SFP) in Pujehun District, Sierra Leone. MethodsThis was a secondary analysis of a cluster-randomized trial. The main study examined the cost-effectiveness of four specialized nutritious foods (SNFs) for treating MAM in children 6–59 months. Each SNF (Corn Soy Blend Plus, Corn Soy Whey Blend, Super Cereal Plus with Amylase, and Ready to Use Supplementary Food) was provided to caregivers in 14-day isocaloric rations for 12 weeks or until reaching an outcome. Outcomes were: Recovery (mid-upper arm circumference [MUAC]≥12.5cm), Failure (11.5 > MUAC < 12.5 after 12 weeks of treatment), severe acute malnutrition [SAM] (MUAC ≤ 11.5), Default (3 consecutive missed visits), or Death. Beneficiary caregivers provided standard demographic information at enrollment. Height, weight, and MUAC were taken every 14 days during a clinical visit as was information on illness (incidence of diarrhea, fever, cough, and vomit). Multinomial logistic regression assessed demographic and illnesses’ influence on the relative risk of Failure or developing SAM compared to Recovery. ResultsOf enrolled children (N = 2682), 1675 (63%) recovered, 498 (19%) worsened to SAM, and 259 (10%) failed to respond. In the 2 weeks prior to enrollment, more children who recovered experienced fever (30%), cough (23%), diarrhea (9%), or vomit (7%) than children who did not recover. By exit, a larger % of children who developed SAM reported fever (30%), cough (27%), diarrhea (16%), or vomit (10%) in the 2 preceding weeks than children who failed or recovered. In both adjusted and unadjusted models, children who entered the program with higher MUACs or reported any illness in the 2 weeks preceding enrollment were at significantly lower risk of worsening to SAM or failing to recover. Children who were transferred from a SAM treatment program were at significantly greater risk of worsening to SAM and failing to respond as were children with any illness in the 2 weeks preceding exit. ConclusionsUnderlying infections or illness may explain why some children with MAM fail to recover. Illness at enrollment may signal a transitory condition remedied with treatment. Funding SourcesBureau for Humanitarian Assistance, U.S. Agency for International Development.

Composite Flour from Indonesian Local Food Resources to Develop Cereal/Tuber Nut/Bean-Based Ready-to-Use Supplementary Foods for Prevention and Rehabilitation of Moderate Acute Malnutrition in Children.

Undernourishment is a threat to human health. The prevalence of undernourishment remains alarming, especially among children under five years old in many countries, including Indonesia. Nowadays, the handling of undernourishment has shifted to treatment outside the hospital, utilizing local nutrient-rich foods. At the national level, the utilization of local food resources is a part of the promotion of dietary diversification and the bioeconomy. Ready-to-use supplementary food (RUSF) refers to supplementary foods aimed at improving the nutrition of moderate acute malnutrition (MAM) children under five years old. RUSF biscuit recipes were made using local food resources available in Banten province, Indonesia. To optimize the nutritional profile of the developed RUSF, taro/talas banten were mixed with ground-nut/peanut (Arachis hypogaea L.) and mungbean (Vigna radiata) as protein and lipid sources and red rice (Oryza longistaminata) and maize (Zea mays) as carbohydrate sources, and enriched by the local banana Nangka (Musa textilia). Two formulations were selected for the pilot testing, namely the taro-peanut and taro-peanut/mungbean RUSF biscuits, made from taro Banten, cereal, peanut and/or mungbean, and local banana. The RUSF biscuit showed promising results, presenting a high level of acceptance and a macronutrient composition that meets the standards for MAM children. However, the RUSF biscuits should be fortified with micronutrient premix to fulfill the dietary requirement for the MAM children. The results of this study provide further development opportunities.

Environmental, Metabolic, and Inflammatory Factors Converge in the Pathogenesis of Moderate Acute Malnutrition in Children: An Observational Cohort Study.

ABSTRACTAcute malnutrition affects more than 50 million children worldwide. These children are at an increased risk of morbidity and mortality from infectious disease. However, the pathogenesis of acute malnutrition and mechanisms underlying the increased risk and poor outcomes from infection are not well understood. Our objective was to identify differences in inflammation and inflammatory responses between children with moderate acute malnutrition (MAM) and healthy controls (HCs), and search for environmental, pathophysiological, and metabolic factors that may influence this response. Sixteen children with MAM and 16 HCs aged 18–36 months were studied in Nairobi, Kenya. None of the children had symptoms of an infectious disease (fever, diarrhea, or cough) in the 2 weeks before enrollment and sample collection. Demographic and health data were provided by their primary caregivers. Blood samples were collected to measure various biomarkers and the response to an inflammatory stimulus. Children with MAM were more frequently from households with contaminated water, crowding, and unstable income sources. They also had increases in basal inflammation, circulating bacterial lipopolysaccharide (LPS), markers of intestinal damage, and an exaggerated whole blood inflammatory response to LPS. Metabolic changes in children with MAM led to increased plasma levels of long-chain fatty acids, which were found to contribute to the pro-inflammatory state. These exploratory findings suggest convergence of multiple factors to promote dysregulated inflammatory responses and prompt several mechanistic hypotheses that can be pursued to better understand the pathogenesis of MAM.

Preparation of Ready to Use Supplementary Food for Treating Moderate Acute Malnutrition in Children Aged 6 to 59 Months

&lt;p&gt;Children with moderate malnutrition have a high risk of mortality and MAM is associated with a high number of nutrition-related deaths. If some of these children suffering from MAM do not receive adequate support, they may progress towards severe acute malnutrition (SAM), which is a life-threatening condition. Therefore, the management of MAM should be a public health priority&lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p&gt;A well-balanced diet was prepared based on the recommendation of WHO for the treatment of moderate acute malnourished children aged 6 -59 months. According to the formulae, nine products of RUSF were prepared using cereals, legumes, seeds, oil, sugar, and vitamin and mineral premix. Three products of RUSF MSPe, PBPe, and ISPe were found to be better among the nine products by the mothers after sensory evaluation.&lt;/p&gt;&lt;p&gt;Based on sensory evaluation in children, RUSF MSPe was found to be the best among the three products. The product was analyzed for proximate composition, mineral, vitamin, digestibility of protein. The protein, fat, carbohydrate, dietary fiber, total ash, vitamin C, Vitamin A, iron, calcium and zinc of 100 g of the product were found to be 15.9g, 33.7g, 44.3g, 6.6g, 2.2g, 54.6 mg, 855 µg, 14.1 mg, 66.6 g and 12.4 µg respectively. The diet can supply 544.5 Kcal/100 g. The energy contributed by the protein, fat, and carbohydrate was found to be 11.68%, 55.7%, and 32.62% of total Kcals respectively. The protein digestibility adjusted to the chemical index PDCASS was 0.95.&lt;/p&gt;Hence, the prepared RUSF is in accordance with the specification given by WHO which could be effective in the treatment of moderate acute malnourished children after the clinical trial.

Factors associated with moderate acute malnutrition among 6–59 months children in the Lake Tchad region: A case-control study

Introduction In Lake Chad, a region located on the Sahelian strip, malnutrition is recurrent and constitute a real public health problem. Of children aged 6 to 59 months, 14.7% suffered of global acute malnutrition and 12.6% (95% CI: 10.7%–14.8%) of moderate acute malnutrition (MAM) with a mortality rate of 0.98/10,000 children per day (Smart, 2014). Government, international and non-governmental organizations, adopt policies, deploy resources to fight against malnutrition in Chad and especially in this Region, but the crisis persists [1] . Studies have documented the factors of malnutrition and recognized inadequate nutrition and diseases as immediate causes. Added to this are the underlying causes such as situations of food insecurity, inadequate dietary practices, etc. [2] . However, all these factors occur alone or in aggregate according to specific contexts [Food and Agriculture Organization–World Health Organization (WHO), 1992]. Apart from general descriptive surveys such as Multiple Indicator Cluster Survey (Mics), Food Security Assessment (Ensa), few studies have studied and/or documented specific factors of malnutrition in this region. Therefore, this study aimed to study the factors associated with MAM in children from 6–59 months in the Lake Chad region. Methods This study was conducted from March to April 2015 in six Nutritional Units of Sanitary Districts of Bol and Ngouri, in the Lake Chad Region. This was a matched case-control study for sex and age with a sample of 252 pairs of children aged 6 to 59 months. Anthropometric data of the children were measured. “Cases” were defined for any child, girl or boy whose weight-for-height was between −3 and −2 Z-scores, and without edema (WHO standard included in the 2014 version of the National Management Protocol of Malnutrition in Chad). “Controls” were diagnosed unharmed of malnutrition (acute malnutrition, stunting, overweight or obesity). They live in the social environment as close as possible to the cases (same neighborhood or village). In this work, we studied sociodemographic factors, obstetric factors, dietary and health factors (breastfeeding, dietary diversity score according to the seven food groups - WHO standard, morbidity of the child, nutritional status of the mother), the factors related to the health system, water, hygiene and sanitation. A conditional logistic regression model was used to calculate association measures (adjusted odds ratios: ORa) and their 95% confidence intervals. Results This results focused on the 252 pairs of children included in the study. Our analyzes showed that the odds of malnutrition were four times higher when children's diets were not diversified (consumed food belonging to less than four of the seven food groups) than when it was (ORa = 4.03 [1.86–8.73], P Conclusion This work allowed us to explore and identify the factors associated with MAM in the Lake Chad Region. The results confirm some of our specific hypotheses that, children whose diet was not diversified, those with recent diarrhea and children whose mothers had a Muac less than 210 mm were the most affected by moderate acute malnutrition.

Stability of Sorgum, Peanut Blende (Spb) Food Supplement under Ambient Conditions for Treatment of Moderate Acute Malnutrition in Children 6-59 Months

Shelf life is the recommended maximum time for which the defined quality of specified characteristics of the goods or products remains acceptable under expected (or specified) conditions of handling, storage and distribution and or display. Stability assessment of a local food supplement consisting of a premix of milled sorghum, ground nut paste, honey and cow ghee (SPB) was conducted from November 2014to January 2015. The study investigate the length of stay of SPB at ambient conditions with desirable sensory quality attributes of taste, color and texture. This was a cross sectional study design with a sensory evaluation questionnaire using a 5-point hedonic scale. Control sample was labeled as (A) and experimental (B). Sample A was freshly prepared once every week while sample B was kept constant. 24 participants with similar demographic characteristics were randomly selected to evaluated the sensory attributes of the porridges made from each sample. Only the investigator was aware of the treatment given to the participants. Sensory scores for all attributes were greater than four on a five-point hedonic scale. There were no significant differences (P&gt;0.05) in all the five attributes between the two samples in the first 5 weeks of evaluation. A significant difference was observed in color during the week 9 (P&lt;0.02), aroma in week 6 (P &lt; 0.01) and taste in week 7 (P&lt; 0.01). There was no significant difference in the texture of the samples throughout the time of the study. Taste and aroma recorded the lowest scores at 3.0 and 3.7 respectively after 9 weeks. Texture did not change during study time. Honey has anti-microbial properties and its inclusion improves water-binding capacity which prolong shelf life. The length of stay of SPB at room temperature with desirable sensory quality attributes of taste, color and texture was 8 weeks. This storage time could further be increased by use of antioxidants.

Moderate acute malnutrition: uncovering the known and unknown for more effective prevention and treatment.

With a fast-approaching post-Millennium Development Goal era, there is an urgent need to boost global investment in efforts to reduce child malnutrition. Critical to the management of moderate malnutrition, and therefore to the new Sustainable Development Goals, is addressing severe acute malnutrition (SAM) and moderate acute malnutrition (MAM). Despite the considerable difference in the approximate number of children affected by MAM (33 million) compared with SAM (19 million), there is currently no standardized approach to the management of MAM. In partnership with Valid International, the World Food Programme, and the Micronutrient Initiative, the International Atomic Energy Agency hosted the International Symposium on Understanding Moderate Malnutrition in Children for Effective Interventions in Vienna, Austria, 26-29 May 2014. This symposium focused on the management (prevention and treatment) of MAM in children. The symposium convened over 350 participants from 63 countries, the majority of whom represented governments responding to moderate malnutrition in their populations, nearly 70 national and international organizations from the United Nations and nongovernmental sectors, and universities from around the world, as well as donor governments and private-sector entities. The symposium was structured around nine sessions over a 3-day period, progressing from a global analysis of the scale of the problem to recent research findings relevant to designing effective interventions. This Supplement contains a series of papers that summarize the symposium sessions and other fundamental aspects important to improving the management of moderate malnutrition in children.

Treatment of severe and moderate acute malnutrition in low- and middle-income settings: a systematic review, meta-analysis and Delphi process.

BackgroundGlobally, moderate acute malnutrition (MAM) and severe acute malnutrition (SAM) affect approximately 52 million children under five. This systematic review evaluates the effectiveness of interventions for SAM including the World Health Organization (WHO) protocol for inpatient management and community-based management with ready-to-use-therapeutic food (RUTF), as well as interventions for MAM in children under five years in low- and middle-income countries.MethodsWe systematically searched the literature and included 14 studies in the meta-analysis. Study quality was assessed using CHERG adaptation of GRADE criteria. A Delphi process was undertaken to complement the systematic review in estimating case fatality and recovery rates that were necessary for modelling in the Lives Saved Tool (LiST).ResultsCase fatality rates for inpatient treatment of SAM using the WHO protocol ranged from 3.4% to 35%. For community-based treatment of SAM, children given RUTF were 51% more likely to achieve nutritional recovery than the standard care group. For the treatment of MAM, children in the RUSF group were significantly more likely to recover and less likely to be non-responders than in the CSB group. In both meta-analyses, weight gain in the intervention group was higher, and although statistically significant, these differences were small. Overall limitations in our analysis include considerable heterogeneity in many outcomes and an inability to evaluate intervention effects separate from commodity effect. The Delphi process indicated that adherence to standardized protocols for the treatment of SAM and MAM should have a marked positive impact on mortality and recovery rates; yet, true consensus was not achieved.ConclusionsGaps in our ability to estimate effectiveness of overall treatment approaches for SAM and MAM persist. In addition to further impact studies conducted in a wider range of settings, more high quality program evaluations need to be conducted and the results disseminated.

Systematic Review and Meta‐Analysis of Food‐Based Interventions on Recovery from Moderate Acute Malnutrition in Young Children

Background and ObjectiveThe rationale of this systematic review was to examine the comparative effectiveness of lipid‐based nutrient supplements (LNS) versus fortified blended foods (FBF) in treatment of moderate acute malnutrition (MAM).Data sourcesAll published articles identified though MEDLINE® and Cochrane Central Register of Controlled Trials, from inception to July 2012.Study selectionReviewers independently selected eligible comparative studies of children under 5 with MAM. Interventions were broadly categorized as FBF or LNS.Data extractionArticle information was extracted using a standardized protocol into predesigned forms and reviewed for accuracy.Results34 out of 12,453 screened articles were accepted. Interventions ranged 8 to 16 wks. Meta‐analysis of 5 studies showed a 10% lesser recovery rate from MAM in children treated with FBF as compared with LNS (RR=0.9, 95% CI 0.8,1.01; 79.6% LNS vs 77.5% FBF). This indicates that for every 48 children that are treated with FBF rather than LNS, one child will not recover from moderate malnutrition.ConclusionsLNS is associated with a higher rate of recovery from MAM when compared with FBF. The studies on children with MAM are heterogeneous leading to dilution of comparative effect. The clinical relevance of outcomes as well as cost‐effectiveness need to be taken into consideration when interpreting the results.