Prevalence Of Severe Acute Malnutrition Research Articles

A comprehensive analysis of food insecurity in the drought-prone rural areas of Tigray.

The number of globally food-insecure people is increasing since 2017. Sub-Saharan Africa has the highest proportion of severely food-insecure people in the world. Tigray region of Ethiopia is one of the food-insecure regions, which, over the past many decades has been affected by recurrent food insecurities. In the drought-prone rural areas of Tigray, many people are living under the condition of chronic hunger. Proper food security studies are vital for proper intervention mechanisms. Yet, previous food security studies have rarely addressed the four pillars of food security: availability, access, utilization, and stability. In this study, all components are duly considered to assess the food insecurity status in the drought-prone rural areas of Tigray, Ethiopia. Of the 34 rural districts in Tigray, 363 households from three drought-prone rural districts were studied. Household Food Insecurity Access Scale and Food Insecurity Experience Scale were adapted to measure the food availability, access to food, and stability components of food security; and, Household Dietary Diversity Score (HDDS), Food Consumption Score (FCS), mid-upper arm circumference, and Bitot's spot were used to analyze the food utilization aspect. Findings show that 68% of the studied community frequently ate less food than they felt they needed and 82.1% of the households have experienced hunger because of lack of food. The study rural districts were unconnected to road networks; hence, 87.9% of the elderly and 20.4% of the women and girls had no access to food markets. Regarding the food utilization, 81.5% of the studied households had poor FCS; and the average HDDS and FCS for the study areas were 2.47 and 18.9, respectively. The prevalence of Global acute malnutrition, severe acute malnutrition (SAM), and moderate acute malnutrition (MAM) for 6-59months of age children in the study areas were 50.3, 4.2, and 46.1%, respectively. More notably, the prevalence of SAM for children from the food-insecure households was 21.2%. The prevalence of MAM for pregnant and lactating women (PLW) in the study areas was 59.5. Further, the prevalence of Bitot's spot among 6-59months of age children was 1.9%. On the other hand, all the rural households had anxiety about their future food demands. The rural households living in the studied areas were critically food-insecure. All the measurements implied that the food insecurity situation in the study areas was unacceptably worrisome and life-threatening. This calls for an instant action to avert the occurrence of famine and starvation in the drought-prone rural areas of Tigray region. Thus, interventions should primarily target the vulnerable rural people and need to be planned based on attaining food availability first rather than concurrently addressing all components of food security. Further, due emphasis should be given to diversifying livelihood strategies of the vulnerable villagers.

A comparison of mid-upper arm circumference and weight-for-height Z score of world health organization growth standards in detecting moderate and severe acute malnutrition in children aged 6-60 months

Background: World health organization (WHO) had defined severe acute malnutrition (SAM) and moderate acute malnutrition (MAM) by weight for height Z score (WHZ) and mid upper arm circumference (MUAC) criteria. Several studies indicate discrepancies in the prevalence of malnutrition on using either WHZ or MUAC. The prevalence of SAM was nearly same when using either criterion and only 40% children showed overlapping by using both the criteria. Present study was taken to identify the overlapping of cases by applying both the WHO criteria in children aged 6-60 months. It also identifies the optimal screening cut off values of MUAC if used as a sole criterion. Method: It was a hospital based descriptive cross-sectional study done on 640 cases who were assessed for MAM /SAM by using anthropometric WHO criteria. Results: From 67 SAM cases who were identified by WHZ, only17 cases had SAM on using MUAC too. The sensitivity of MUAC was 25.4% and specificity of 92.0%. From 94 MAM cases, 19 cases showed overlapping by using both the WHO criteria. At MUAC of <13.5 cm, the sensitivity increased to 86.6% for SAM and 81.6% for MAM cases at the cost of decreased specificity which was at around 36% for both the types of malnutrition. Conclusions: The number of malnourished cases, identified by using either of WHO criteria were nearly same but both these criteria detect different subgroups of malnourished children in most cases. A MUAC of <13.5 cm may be used as a sole-criteria in the community by the health workers to detect acute malnutrition.

Relapse of severe acute malnutrition among children discharged from outpatient therapeutic program in western Ethiopia

BackgroundChildren with severe acute malnutrition (SAM) without complication are treated in the outpatient therapeutic program (OTP) and the program has been reported to be effective. However, relapse post-discharge from the program is poorly defined, and scarcely evaluated across programs and research. The objective of this study is to assess the prevalence of SAM among children post-discharge from the OTP and to identify factors associated with SAM relapse in Gambella Region, Western Ethiopia.MethodsWe conducted a facility-based cross-sectional study among 208 children aged 6–59 months who have been discharged from the OTP as cured. Baseline data were collected from caregivers using structured questionnaire. Child anthropometry and oedema was measured. The association between SAM relapse and the risk factors were assessed using bivariate and multivariable logistic regression models.ResultsThe prevalence of SAM relapse was 10.1% (95% CI: 5.8–14.0%). The odds of SAM relapse was significantly higher in children with mothers who had no exposure to education and promotion about infant and young child feeding (IYCF) practices (OR = 5.7; 95% CI: 1.3–12.6), children who were not fully immunized for their age (OR = 8.0; 95% CI: 3.8–23.4), and children with mid-upper arm circumference (MUAC) at discharge of < 12.5 cm (OR = 4.4; 95% CI: 2.1–12.8) than their counterparts.ConclusionsTo reduce SAM relapse, the OTP programs should avoid premature discharge and consider provision of supplementary food for children with low MUAC at discharge. Further, the OTP discharge criteria should consider both the anthropometric indicators – weight-for-height/length z-score (WHZ) and MUAC – and the absence of bilateral pitting oedema irrespective of the anthropometric indicator that is used during admission. Promotion of nutrition education and improving child immunization services and coverage would help reduce SAM relapse.

Associated Comorbidities in Children under 5 Years with Severe Acute Malnutrition Attending Magumeri General Hospital: Retrospective Hospital-Based Study

Malnutrition is a global health challenge essentially because of its role as a preventable cause of several morbidities and mortality around the globe, especially in children under 5 years. Associated comorbidities and types of morbidity common in children admitted with severe acute malnutrition in Magumeri General Hospital were investigated. This was a retrospective quantitative hospital-based study. Hospital records, ward admission and discharge registers, and patient cards were reviewed focusing on demographic, clinical, and mortality data extracted on all children under 5 years admitted to the Hospital. Data during the period of December 2018 to March 2020 was collected and analyzed using Microsoft Excel 2013 and SPSS version 17.0. 367 children under 5 years with complicated SAM were identified from the reviewed total hospital admissions of 537. 217 cases were male (59.1%) while 150 were female (40.9%). Marasmus was the most common type of severe acute malnutrition (75.2%) while diarrhea, respiratory tract infection, and malaria were the top three comorbidities, majority of the cases were managed successfully with 79.6 % reported to have fully recovered and were discharged, while 17 (4.1%) died. Magumeri is a locality disproportional affected by various insecurities due to the Boko Haram insurgency, resulting in the high prevalence of severe acute malnutrition among children under 5 years, representing 68.3% of total hospital admissions in the same age group, while 81.2 % had at least more than one comorbidity with a significant association between prolonged hospital stay and treatment (p &lt; 0.001). Keywords: Admission, Magumeri, Morbidity, Severe acute malnutrition, and Under 5 children.

Prevalence of severe acute malnutrition among 6-59 months children from community-based SAM management program in Dungarpur district of southern Rajasthan: diving deeper through study of block-wise prevalence

Background: Acute malnutrition (severe and moderate) is a major public health problem in India and especially Rajasthan. National family health surveys now provide prevalence of SAM children till district level but there’s an undenying need for data at even more granular, like block level, to assess the field reality in more depth. The present study tries to demystify the same at block level by studying data collected from a community-based SAM management program i.e., AMMA (acute malnutrition management action) program in Dungarpur. Methods: As part of AMMA program, block wise data from 20 districts of Rajasthan was collected monthly during implementation and its dedicated MIS was used as the source of this data. The data includes information of all children screened in the age-group of 6-59 months in Dungarpur district which was subsequently analyzed and studied till block level. The SAM prevalence is assessed, using Mid Upper Arm Circumference (MUAC) of 6-59 months children. &lt;12.5 cm of MUAC was considered as acute malnutrition while &lt;11.5 cm of MUAC was considered as SAM as per WHO standards. Results: A total of 1,13,547 children were screened (84.91%) in the study period. A total of 4829 children (4.25%) were found with Acute Malnutrition, out of which 4622 were identified with moderately acute malnutrition (MAM) and 207 are identified with SAM. Out of total 207 children with SAM, 118 were girls (57%) while 89 (43%) were boys. The prevalence of SAM children in the district came out as 0.18% whereas state prevalence is 0.9%. Among blocks the SAM prevalence varied from as low as 0.02% in Dowda and Chikhali to as high as 0.63% in Jothari block. Conclusions: Prevalence of SAM in Dungarpur district is low at 0.18% but block-wise analysis helped in further disaggregating the burden. To identify all children with acute malnutrition in the district there’s an urgent need to do screening based on WFH Z-score instead of complete reliance on MUAC tape.

Survival Analysis of Patients with Severe Acute Malnutrition Admitted at the In-patient Therapeutic Care of the Bicol Regional Training and Teaching Hospital

Background. Severe acute malnutrition (SAM) in children under five years remains a major global health concern. It carries a burden to the overall health of a child, contributes to mortality, and adds financial strain to the family and the hospital. The Philippine Integrated Management of Acute Malnutrition was established to address acute malnutrition in Filipino children.Objective. This study aimed to determine the factors affecting survival of patients admitted at Bicol Regional Training and Teaching Hospital (BRTTH) In-patient Therapeutic Care (ITC).Methods. This is a retrospective cohort study design utilizing survival analysis. Accrual period was from January 1, 2018 to December 31, 2018. Follow-up ended on March 31, 2019. There were 154 admissions and excluded 17missing charts. Survival analysis was done utilizing STATA 14.Results. The prevalence of SAM requiring ITC admission was 3.0 percent. Majority belonged to 6-59 months of age (63%), with equal predilection for both sexes (1:1) and 71% came from the home province, Albay. Most of patients’ caretakers had middle educational attainment. Sixty-eight percent (68%) were new patients, 16% readmitted, 15% transferred from the Out-patient Therapeutic Care (OTC) and &lt;1% relapsed. The top three most common complications and co-morbidities include: pneumonia, low electrolytes, and fever. Sixty-three percent (63%) of patients at the ITC had a desirable treatment outcome, of which, 8% were cured and 55% transferred to OTC. Undesirable outcomes accounted for 37% of the cases which included non-cured, defaulter, and died at 12%, 8%, and 17%, respectively. The risk of dying was higher in SAM patients with parents having middle and low educational attainment as compared to those with high educational attainment (2-5 folds to 100-200 folds). SAM patients presenting with hypovolemic shock were likely to die by 1.5-19 times (1.5-19x) as compared to those without. SAM patients with malignancy were more likely to die 4-44 folds as compared to patients without malignancy.Conclusion and Recommendations. Educational attainment of parents, malignancy, and hypovolemic shock were significant predictors of mortality. We recommend prompt intervention by educating families, strengthen policies targeting socio-economic determinants, capacitate medical staff, refine current clinical practice guidelines and treatment pathways to reduce the number of children who die from severe acute malnutrition.

Factors Influencing Malnutrition Among Under 5 Year Children of District Gwadar, A Cross-Sectional Community Based Study

Malnutrition is one of the major causes in low and middle-income families’ children’s deaths under the age of 5 years. Nine times as many children with severe acute malnutrition (SAM) will pass away than healthy youngsters. In Pakistan, 17.7% of children under five are wasted, and 4 out of 10 infants under five are stunted. With almost 1/3 children (28.9%) underweight, the double burden of malnutrition is increasing. Objectives: To assess and identify the factors influencing malnutrition among under five years children of district Gwadar. Methods: A community-based cross-sectional research was carried out in randomly chosen clusters in several union councils in the Pakistani district of Gwadar. Mothers and other caregivers of children under five were interviewed as part of the house-to-house survey, using a practical sample approach. Results: The children age mean was 11.56 ± 12.4 months and the mean age of mothers was 27.29 ± 6.31 years. Overall stunting prevalence of severe acute malnutrition (SAM) cases was 21.2% and moderate acute malnutrition (MAM) cases were 46.2%. Conclusions: According to the study's results, under the age of five the malnutrition was widespread. The three types of nutritional outcomes were all strongly correlated with household income. Particularly in Baluchistan's underdeveloped regions, more labor and studies are needed

Malnutrition among hospitalized children 12–59 months of age in Abyan and Lahj Governorates / Yemen

BackgroundThe analysis of acute malnutrition in 2018 for the Integrated Phase Classification of Food Security in Yemen shows that high malnutrition rates are present in Abyan governorate (23%) and Lahj governorate (21%). This analysis was community based addressed all children and mostly due to problems related to food intake. The role of diseases was not yet addressed in Yemen. The aim of this study is to assess acute and chronic malnutrition among hospitalized children at 12–59 months of age in Lahj and Abyan governorates in Yemen.MethodologyA cross-sectional, multi-center study is designed. The assessment of the nutritional status was measured by standardized anthropometry of 951 sick children at 12–59 months of age.ResultsThe prevalence of Global acute malnutrition (GAM) among the sick children seeking care in health facilities in Lahj and Abyan is 21%. More specifically; the prevalence of moderate acute malnutrition (MAM) is 15.1% while the prevalence of severe acute malnutrition (SAM) is 6.2%. The prevalence of acute malnutrition (wasting) among the studied sick children in lahj is 23.4% while in Abyan is 19.3%. The prevalence of MAM in Lahj is 17.7% and the prevalence of SAM is 5.7%. The prevalence of acute malnutrition (wasting) in Abyan is 12.6% while the prevalence of SAM in Abyan is 6.7%. The prevalence of acute malnutrition among male children (25.2%) is significantly higher than among female children (17.5%). The prevalence of the chronic malnutrition (Stunting) in the studied sick children is 41.3%; the prevalence of stunting in Lahj is 41% while in Abyan is 41.7%.ConclusionsHigh acute and chronic malnutrition rates were identified among sick children seeking care in health facilities in lahj and Abyan, and higher than the SPHERE indicators of malnutrition. Boys are more exposed than girls to acute and chronic malnutrition.

Nutrition status and morbidity of Ethiopian children after recovery from severe acute malnutrition: Prospective matched cohort study.

After recovery, children with severe acute malnutrition (SAM) remain vulnerable to sub-optimal growth and malnutrition relapse. Although there is an increased interest in understanding these problems, data are scarce, and contextual factors can cause variability. We prospectively followed a cohort of Ethiopian children (215 post-SAM cases and 215 non-wasted controls), monthly for one year. The post-SAM cases were: age 6-59 months at admission into the community management of acute malnutrition (CMAM) program and being successfully discharged from CMAM (MUAC>11.0cm, weight gain of 20%, absence of oedema and clinically stable for two consecutive weeks). The controls were apparently healthy children from same village who had no history of an episode of AM and were matched 1:1 to a post-SAM child by age and sex. The primary outcomes were: cumulative incidence of acute malnutrition; growth trajectory; cumulative incidence of reported common morbidities, and cumulative proportion and incidence of deaths. The burden of common morbidities was higher among post-SAM than controls; post-SAM children had more frequent illness episodes (Incidence Rate Ratio of any illness 1.39, 95% CI: 1.14, 1.71; p<0.001). The prevalence of SAM was consistently higher among post-SAM cases than the control group, having a 14 times higher risk of developing SAM (Incidence Rate Ratio: 14.1; 95% CI: 3.5, 122.5; p<0.001). The divergence in weight and growth trajectory remained the same during the study period. Our results advocate for the design of post-discharge interventions that aim to prevent the reoccurrence of acute malnutrition, reduce morbidity and promote catch-up growth. Research is needed to define the appropriate package of post-discharge interventions.

Nutritional, antioxidant and organoleptic properties of therapeutic-complementary-food formulated from locally available food materials for severe acute malnutrition management

BackgroundThe prevalence of severe acute malnutrition among children (< 5 years) due to low energy-protein density of local complementary foods and poor feeding practices is a great concern in developing countries, Nigeria inclusive. Hence, the aimed of this study was to formulate and evaluate the chemical composition, functional, antioxidant and organoleptic properties of low-cost complementary foods from locally accessible food material using household technologies. Using UNCEF guidelines, three complementary foods were formulated and their nutritional characteristics were compared with local complementary food (100% sorghum) and ready-to-using therapeutic food.ResultsProtein (g/100 g) and energy values (kcal./100 g) of formulated complementary foods varied from 16.16 to 16.93 and 418.08 to 474.13, respectively, and were significantly (p < 0.05) higher than OG (7.72; 378.71) (a 100% sorghum flour), but lower than P0 (539.8) (a read-to-eat therapeutic food). Mineral elements (mg/100 g) in the food samples were K (4175–6350.5), Ca (341.5–949), Fe (23.5–50.5) Zn (28–38.5), P (3855.6–4501), and Na (343.5–950.5), and were significantly lower than in P0, but higher in K, Fe and Zn than for OG. Sodium/Potassium and Calcium/Phosphorous molar ratios of the complementary foods ranged from 0.16 to 0.92 and 0.07 to 0.16 and were lower than P0 (0.64, 0.19) and OG (1.71, 0.2), respectively. Total essential amino acids (g/100 g protein) of the food samples varied from 23.53 to 25.94, and were comparable to OG (28.40) and P0 (32.74). Predicted biological value and essential amino acid index of P2 sample (53.53%, 59.85%) had the highest values, while P1 (46.0%, 52.94%) had the lowest, and these values were comparatively lower than P0 (67.53%, 72.69%), OG (55.91%, 62.03%), and recommended value (> 70%). Functional properties varied from 0.61 to 0.83, 124.2 to 176.2, 102.2 to 257.19, 0 to 1 and 164.7 to 373.3 for bulk density, oil absorption capacity, water absorption capacity, least gelation and swelling capacity, respectively. Antioxidant activity of formulated complementary foods ranged from 2.07 to 3.24%, 8.61 to 9.87 mg/g, 21.6 to 40.95% and 62.42 to 87.0% for DPPH, FRAP, Fe-chelation and OH-free radicals, respectively, and were significantly (p < 0.05) higher than in OG and PO. Sample P1 was significantly (p < 0.05) rated highest in appearance, aroma, taste, texture and overall acceptability above P2 and P3.ConclusionThe formulated complementary foods had enough nutrient and energy values to meet the requirements for infants as recommended for complementary foods and for amelioration of severe acute malnutrition in children. Nutritional and sensory evaluation revealed that addition of full fat milk to the P1 sample significantly improved its nutrient composition and organoleptic quality and contributed to its high acceptance compared to other formulations. Therefore, this complementary food is potentially suitable for use as complementary food and diet to manage severe acute malnutrition in Nigeria and other developing countries. However, there is a need for biological evaluation.

HAEMATOLOGICAL PARAMETERS AND THYROID PROFILE IN SEVERELY MALNOURISHED CHILDREN: A CROSS SECTIONAL STUDY

INTRODUCTION: ). SAM and India has the highest prevalence of severe acute malnutrition (SAM) anaemia have an interplay association, the latter being the commonest comorbid medical problem. But now literature suggests that SAM is also associated with marked changes in secretion and metabolism of thyroid hormone as well as in the structure. METHOD AND MATERIAL: A cross-sectional study was conducted in 60 children between the age group of 6 months to 5 years fullling the criteria of SAM over a period of 2 months admitted at NRC, ABVGMC and District Hospital Vidisha. Detailed history of the child was obtained; complications were noted and managed accordingly. Blood sample was collected and was subjected to complete blood count, peripheral smear examination and thyroid prole. RESULTS: Out of 60 children of SAM, 11.67% had leukocytopenia and the same percent of children had leukocytosis. Thrombocytopenia was reported in 13.34% of the children and thrombocytosis was seen in 15%. TSH levels in children of age 6 month to 1 year of study population were in the normal range. Children of age 1 year to 5 years had values above normal in 7.31% and below normal in 2.43%. CONCLUSION: Megaloblastic anemia and dimorphic anemia along with high TSH level are prevalent in children with SAM along with iron deciency anemia but more specic studies are required to associate hypothyroidism with malnutrition and low serum protein.

Mapping the prevalence of severe acute malnutrition in Papua, Indonesia by using geostatistical models

BackgroundSevere acute malnutrition (SAM) is the most life-threatening form of malnutrition, and in 2019, approximately 14.3 million children under the age of 5 were considered to have SAM. The prevalence of child malnutrition is recorded through large-scale household surveys run at multi-year intervals. However, these surveys are expensive, yield estimates with high levels of aggregation, are run over large time intervals, and may show gaps in area coverage. Geospatial modelling approaches could address some of these challenges by combining geo-located survey data with geospatial data to produce mapped estimates that predict malnutrition risk in both surveyed and non-surveyed areas.MethodsA secondary analysis of cluster-level program evaluation data (n = 123 primary sampling units) was performed to map severe acute malnutrition (SAM) in Papuan children under 2 years (0–23 months) of age with a spatial resolution of 1 × 1 km in Papua, Indonesia. The approach used Bayesian geostatistical modelling techniques and publicly available geospatial data layers.ResultsIn Papua, Indonesia, SAM was predicted in geostatistical models by using six geospatial covariates related primarily to conditions of remoteness and inaccessibility. The predicted 1-km spatial resolution maps of SAM showed substantial spatial variation across the province. By combining the predicted rates of SAM with estimates of the population under 2 years of age, the prevalence of SAM in late 2018 was estimated to be around 15,000 children (95% CI 10,209–26,252). Further tests of the predicted levels suggested that in most areas of Papua, more than 5% of Papuan children under 2 years of age had SAM, while three districts likely had more than 15% of children with SAM.ConclusionsEradication of hunger and malnutrition remains a key development goal, and more spatially detailed data can guide efficient intervention strategies. The application of additional household survey datasets in geostatistical models is one way to improve the monitoring and timely estimation of populations at risk of malnutrition. Importantly, geospatial mapping can yield insights for both surveyed and non-surveyed areas and can be applied in low-income country contexts where data is scarce and data collection is expensive or regions are inaccessible.

Impact of intervention on nutritional status of under-fives in tribal blocks of Palghar District in Maharashtra, India.

There is a need to improve their nutritional status of under-five children through specific targeted interventions. The present study discusses the impact of intervention on nutritional status among under-five children in Palghar district from Maharashtra. The objective is to improve the nutritional status of under-five children by implementing multi-component health and nutrition education intervention, focusing on dietary counseling and modification keeping in view the cultural and socio-economic status of population. A prospective pre- and post-intervention study was conducted in two tribal blocks. Total 480 under-five children were included in pre- and post-intervention survey each. Exclusive breastfeeding rates improved from 48.9% to 50.5% and initiation of complementary feeding at 6 months improved from 48.3% to 72.5% in post intervention survey as compared to preintervention survey. Among other Infant and Young Child Feeding indicators, Minimum Meal Frequency increased significantly to 67.03% from 5.91% and minimum acceptable diet improved from 5.37% to 47.2% in post intervention survey. The prevalence of Severe Acute Malnutrition (SAM) reduced from 5.4% to nil whereas severe stunting and underweight significantly decreased by 17% and 8% respectively in post intervention survey. Severe anemia decreased from 16.24% to nil post intervention. The study reveals a substantial improvement in timely initiation of complementary feeds, nil cases of SAM, stunting, and underweight along with severe anemia in postintervention phase. This highlights the impact of multicomponent health and nutrition education interventions which may be adapted at a programmatic level to reduce child mortality and morbidity in India.

Mid-upper arm circumference as an indicator of nutritional status improvement in severe acute malnutrition children aged 6-59 months

Rationale: The prevalence of severe acute malnutrition (SAM) in Indonesia remains high, especially in children with pre-existing chronic disease. These children often present with conditions that could interfere with weight measurements during the rehabilitation phase, such as edema or organomegaly. Mid-upper arm circumference (MUAC) is a potential indicator of nutritional status improvement. Therefore, this study aims to investigate MUAC as an alternative parameter for nutritional improvement in children with SAM.

Prevalence of severe acute malnutrition and its effect on under-five mortality at a regional hospital in South Africa

Introduction: Severe acute malnutrition (SAM) is an important global and national public health concern. It contributes to under-five mortality but is also largely a preventable disease. Objective: This study aimed to assess the prevalence of and mortality associated with SAM. Design: A retrospective review of hospital files was conducted. Setting: Dora Nginza Hospital, Eastern Cape, South Africa was the site of the study. Subjects: The study included children from 6 to 59 months of age admitted to the paediatric ward between January 1, 2018 and December 31, 2018. Children with chronic disease were excluded. Ethics approval was granted by Walter Sisulu University (053/2019). Outcome measures: Anthropometric, co-morbid and outcomes data were retrieved and analysed. Results: A total of 1 296 children were included in the study, 93 with SAM. The prevalence of SAM was 7.2%. Children with SAM had a median age of 16 months (IQR 11–25). Gender distribution was 52 (56%) females and 41 (44%) males. The inpatient mortality rate for children with SAM was 6.5%. Children with SAM were at significantly increased risk of mortality (RR 5.97, 95% CI 3.1–11.6, p-value < 0.0005). Three factors were significantly associated with mortality: nutritional oedema, sepsis, and hypokalaemia. Conclusion: The prevalence of SAM at Dora Nginza Hospital is high, and children with SAM are at significantly increased risk of mortality. Specific risk factors for mortality include sepsis, urinary tract infection, nutritional oedema and hypokalaemia. Modifiable factors associated with SAM and SAM-related mortality need to be targeted urgently to improve outcomes.

Children's Nutritional Rehabilitation Program in Beira, Mozambique: A Retrospective Study.

ABSTRACT.Malnutrition is still a major public health issue in sub-Saharan Africa and Mozambique. The main aim of this study was to evaluate the adherence to the nutritional rehabilitation program (NRP) and its impact on the growth of malnourished children in Beira, Mozambique. The secondary aim was to verify the prevalence of HIV infection in malnourished children at the time of admission to the NRP. A retrospective observational study in Beira Central Hospital and 10 health centers in Beira, Mozambique, was conducted. All children 0 to 5 years of age with acute malnutrition admitted to the outpatient services of the NRP from March 2016 until February 2017 were included in the study. A total of 1,231 children with the following characteristics have been enrolled: 58% female; 33% severely malnourished; and 16.5% HIV-positive. Of the 198 (21.7%) children who completed the program, 177 (89.4%) recovered from malnutrition and 21 (10.6%) did not. Ten (1.1%) were hospitalized and 706 (77.2%) dropped out of the program. Among children who completed the program, the median weight-for-length and weight-for-height z-scores at admission were ≥ −3 and < −2; at discharge, these median z-scores were ≥ −1 (P < 0.001). Children with HIV infection and who were male had a higher prevalence of severe acute malnutrition (P < 0.001). Weight gain was found to be significant after 23 days (P = 0.004) of consuming supplements (ready-to-use therapeutic food). A diagnosis of the degree of malnutrition was accurate at admission for 70.5%; at discharge, this diagnosis was accurate for 67.2%. The NRP seems to be successful if correctly followed, even if it is limited by adherence problems. However, its effectiveness requires further investigation.

High Prevalence of Severe Acute Malnutrition in Children with Sickle Cell Anemia over 5 Years of Age in Northern Nigeria

Introduction:Two of the most common and life-threatening non-communicable diseases (NCD) among children in Nigeria are malnutrition and sickle cell anemia (SCA). SCA is one of the most common monogenic disorders, with an annual 305,000 births worldwide, 150,000 births in Nigeria, as compared to 1,700 births in the United States. Severe acute malnutrition is a previously unrecognized epidemic in children with SCA living in Sub-Saharan Africa, the impact of which usually falls on children under the age of five. Previous studies have reported poor growth and delayed maturation in children with SCA when compared to children without SCA, due to increased resting metabolic rate (proposed mechanism includes; decreased intake, hypermetabolism, increased hemolysis, red cell turnover and cardiac demand) and poor nutritional intake. The World Health Organization (WHO), UNICEF and World Bank have not established standards of care for children with severe acute malnutrition above 5 years of age. Additionally, these organizations have not acknowledged that children with SCA could be at risk for severe acute malnutrition. A recent study in Nigeria conducted in children with SCA, using the WHO-growth standards, demonstrated a high prevalence of wasting and severe wasting, as well as, stunting and severe stunting, 22.7% and 11.6%, respectively. However, WHO expected normal ranges for height and weight describes the growth of healthy children, not children with SCA. In a multi-institution cross-sectional study, we tested the hypothesis that severe acute malnutrition is more prevalent in older children (5 to 12 years old) with SCA in Nigeria when compared to an age-matched multi-institutional pediatric cohort of SCA from high-income countries.Methods:The study population in Nigeria included children with SCA between 5 to 12 years old, who were being screened for eligibility for National Institute of Health (NIH)-funded randomized controlled trial; the Primary Prevention of Stroke in Children with SCD in Sub-Saharan Africa (SPRING trial), from July 2016 to July 2017. The study population in the high-income countries (the U.S. and U.K), the comparison group, included children enrolled in the Sickle Cell Anemia Sleep and Asthma Cohort (SAC). Height, weight, age and sex were used to calculate body mass index (BMI). Anthropometric indices included weight-for-age and height-for-age, BMI-for-age, and were expressed as Z-scores to assess the nutritional status. The following definitions were used; underweight; weight-for-age Z-score below −2, stunting; height-for-age Z-score below −2, wasting; weight-for-height or BMI-for-age Z-score below −2. Severe acute malnutrition was defined as a very low BMI Z-score of below -3. These values were set from the median values of the WHO international growth reference.Result:A total of 803 in the Nigerian cohort and 153 children in the high-income countries cohort with SCA were included in the study. The median age in the Nigerian and in the high-income countries cohort was 8.2 and 10 years (range 4.9-13.8), respectively, and half were male (49.6 and 51.3%). The mean BMI in the Nigerian cohort was significantly lower when compared to high-income countries (13.7 versus 16.9 kg/m2 (p<0.001) [Figure I].Of the 803 children in the Nigerian cohort, 34.2% were underweight, 36% had height-for-age below 2, and 42.6% had BMI-for-age Z-score below −2. A total of 20% in the Nigerian cohort met the criteria of severe acute malnutrition compared to 0.7% in the cohort in high-income countries (p <0.001) [Baseline characteristics and Nutritional Status are summarized in Table I].Conclusion:We demonstrate a significant unrecognized challenge of severe acute malnutrition among older children with SCA living in Nigeria, when compared to children with SCA living in high-income countries. Severe acute malnutrition is a devastating co-morbidity in children with SCA in northern Nigeria and perhaps in other regions of Africa. Future studies are needed to elucidate the public health impact, morbidity and mortality of severe acute malnutrition in this population. Currently no formal evidence-based strategies are available to treat severe acute malnutrition in children with SCA, but are greatly needed to decrease morbidity and even potentially mortality. [Display omitted] DisclosuresRodeghier:Rodeghier consultants: Consultancy.

Assessment of Anthropometric Indices and Micronutrient Status of Children under Five in Orphanages of Kaduna Metropolis

Children who are orphaned are faced with an increasing risk of malnutrition, which is attributed from poor feeding practices, inadequate food supply, utilization coupled with limited access to treatment facilities. In this study, the Anthropometric indices and Micronutrient status of children under five in orphanages of Kaduna metropolis, was assessed. Some standard methods were used for the sampling, anthropometric measurements and micronutrient analysis. Results revealed that the demographic characteristics of the orphan children were mostly aged between 13 to 24 months (37.93%) with the female (52.87%) and the male (47.13%). Anthropometric measurements of the children in the orphanages revealed mean z scores for Weight for Height (WHZ/Acute Malnutrition) as -1.74±1.84, -2.59±1.65 for Weight for Age (WAZ/Underweight) and -2.32±2.23 for Height for Age (HAZ/Stunting). Prevalence of Severe Acute Malnutrition among the orphans was (36%), Severe Underweight (36.1%) and severely stunted (44.8%). Micronutrient status of the under five orphan children indicate mean concentrations of Vitamin A (26.88ug/l ± 66.54), Iron (21.78ug/l ± 12.85) and Zinc (62.65 ± 29.25 ug/dl). The orphans’ micronutrient status and anthropometric indices showed significant association between the Iron and Vitamin A concentrations, WHZ and WAZ (r = 0.681) and between WAZ and HAZ (r = 0.467). The outcome of this research will contribute to improving the nutritional status and address micronutrient deficiencies among orphans in orphanages of Kaduna Metropolis.

Progress of Severe, Moderate and Global Acute Malnutrition among Children in Bangladesh

Although Bangladesh has achieved remarkable economic growth and improved various health indicators, childhood malnutrition still is a big concern in improving child health in Bangladesh. This paper explores the prevalence and trends of severe acute malnutrition, moderate acute malnutrition and global acute malnutrition, as well as their socio-demographic factors and socio-economic differentials using the last seven rounds (1996-97, 1999-2000, 2004, 2007, 2011, 2014 and 2017-18) of Bangladesh Demographic and Health Survey, a nationally representative cross-sectional survey. Results show that the prevalence of all severe acute malnutrition, moderate acute malnutrition and global acute malnutrition has declined from 1996-97 to 2017-18 in Bangladesh: severe acute malnutrition from 6.8 per cent to 1.5 per cent; moderate acute malnutrition from 13.9 per cent to 6.9 per cent; and global acute malnutrition from 20.7 per cent to 8.4 per cent. On the other hand, the overall percentage change in the prevalence of severe, moderate and global acute malnutrition accounts for 78 per cent, 50.3 per cent and 59.4 per cent, respectively. The rate of annual decline of severe acute malnutrition is higher among rural children (7.02 per cent) and lower in those in urban areas (5.04 per cent). Child age (6-12 months), child size at birth (smaller), father’s occupation, administrative division and mother’s BMI are strongly related to severe, moderate, and global acute malnutrition. This paper also suggests that there is substantial room to upgrade the nutritional status of children aged 6-59 months in Bangladesh.

Comparison of Mid-Upper-Arm Circumference and Weight-For-Height Z-Score in Identifying Severe Acute Malnutrition among Children Aged 6-59 Months in South Gondar Zone, Ethiopia.

Children with severe acute malnutrition (SAM) are identified for admission to outpatient therapeutic programs using mid-upper-arm circumference (MUAC) or weight for height (WHZ). However, MUAC and WHZ do not identify the same children, and such observed differences might have programmatic implications of missed nutrition therapy if only MUAC is used to identify children with SAM. The objective of the study was to assess any difference in prevalence and degree of agreement between MUAC and WHZ in identifying SAM affected children. A cross-sectional study was conducted in South Gondar Zone, Ethiopia, among 17 districts, with 3 districts and 10 health centers with their clustered health posts selected randomly. A total of 2,040 children were recruited, and data were collected using a parent questionnaire then entered into EpiData and analyzed using SPSS v 20. A total of 1,980 respondents (97.1%) were interviewed, all of whom were female and rural residents. Children's mean age in months was 23.2 (SD ± 9.7), and 54% were male children. The prevalence of SAM based on MUAC <11.5 cm was 11.2% (95% CI: 9.9–12.7) and 11.0% (95% CI: 9.7–12.5) based on WHZ <−3. The agreement between MUAC and WHZ was good (k = 0.729). The proportion of children with SAM identified using both MUAC and WHZ was 61.2%. The prevalence of SAM identified using both MUAC and WHZ was comparable. A substantial degree of agreement between MUAC and WHZ was observed to diagnose SAM. Therefore, MUAC can be used as an appropriate tool in identifying children with SAM for admission into the outpatient therapeutic program (OTP) in the study area.