Severe Acute Malnourished Children Research Articles

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

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

Prevalence and Associated Factors of Hypoglycemia among Severe Acute Malnourished Children who admitted in East Gojjam Zone Public Hospitals from 2018 to 2021, Northwest Ethiopia, 2022. Multi-center Retrospective Cross Sectional Study

Background: Globally, severe acute malnutrition (SAM) remains a major killer of children under 5 years of age. The highest magnitude is seen in sub-Saharan Africa, including Ethiopia. Hypoglycemia is the most common complication of severe acute malnutrition (SAM) and the most life-threatening condition in pediatric society. This study aimed to assess the prevalence of hypoglycemia and its associated factors among under-five children with severe acute malnutrition. Methods: A cross-sectional retrospective study was conducted among 378 randomly selected samples who were admitted to public hospitals in the East Gojjam zone from 2018 to 2021. Data was extracted from the medical records of the children and entered into SPSS version 26, Variables with a p – value < 0.25 in the Bivariate analysis were candidates for multivariable logistic regression and those with a p – value < 0.05 in the multivariable analysis were considered as having a statistically significant association with hypoglycemia among severe acute malnutrition. Results: Out of 378 respondents, 50 (13.2%) had hypoglycemia with severe acute malnutrition patients. Children admitted between the ages of 0-6 months were 2.93 (AOR = 1.57-6.25, p = 0.000), shocks were 4.6 (AOR = 1.25-17.42, p = 0.034), and fully immunized children were (AOR: 2.61 (1.01- 6.77, p = 0.048) was significantly associated with hypoglycemia with severe acute malnutrition. Conclusion and recommendation: The prevalence of hypoglycemia with severe acute malnutrition was 13.2%. We also recommend a longitudinal study should be done among children who develop hypoglycemia with severe acute malnutrition to determine the long-term consequences, especially the neurodevelopmental sequelae associated with this condition.

Integrated child development service (ICDS) coverage among severe acute malnourished (SAM) children in India: A multilevel analysis based on national family health survey-5.

Severe acute malnutrition (SAM) can be fatal for children, and potentially limit their cognitive and physical growth. The last three National Family Health Survey (NFHS) in India shows an increase in the prevalence of SAM among under-five children. Given the specific mandates under ICDS (Integrated Child Development Service) for SAM children, it is important to validate the coverage efficiency of ICDS on SAM children. This paper examines a possible association between the coverage efficiency of ICDS on SAM children. The study further aims to identify the determinants of ICDS service utilization among SAM children. We used data from the fifth round of the National Family Health Survey. Descriptive statistics was used to estimate the SAM coverage under ICDS. Multilevel Logistic Regression was used to identify the determinants of ICDS service utilization among SAM children. The burden of SAM is higher among older children (3+ age). Coverage of ICDS was more among younger children and the poorest households in the rural areas. Results from multilevel logistic regression showed that age had a significant relationship with the outcome variable. SAM children living in the rural areas had a significantly higher odds of being covered under ICDS service (OR 1.57; CI: (1.35, 1.82)) than their urban counterparts. Pregnant and lactating mothers who received ICDS services were significant determinants of SAM coverage under ICDS. There is no evidence that ICDS is more efficient in identifying and covering SAM children than non-SAM children. Despite special provisioning in place for SAM children, coverage of different ICDS services was similar to that of non-SAM children, and were in fact lower than non-SAM children for some categories. The study suggests that improving coverage of ICDS services among pregnant and lactating mothers would increase the coverage of ICDS services among SAM children.

An observational analysis of profile and outcome of children with malnutrition admitted at malnutrition treatment centre

ABSTRACT Introduction: Nutritional status is an important health indicator and children bear maximum burden of it. Poor nutrition during first thousand days of a child’s life can lead to stunted growth. Comorbid condition adversely affects treatment outcome of malnutrition. This study is aimed to describe the profile and treatment outcome of malnourished children. Materials and Methods: This record-based retrospective, analytical observational study was conducted from October to December 2020. Data of severe acute malnourished children who were admitted in malnutrition treatment centre during August 2017 to September 2020, collected. Totally, 264 eligible children were enrolled in the study. The data were collected through medical records of patients. Data were entered in excel spreadsheet and analysed. Results: Most of the children belonged to 6-24 months of age, almost equal proportion of male and female, and more than three-fourth of children were from rural area. The mean length of stay in hospital was 15.19 ± 6.64 days and average weight gain of children was 7.6 ± 6.7 gm/kg/day. There was significant increase in Z-score (Weight/Height) and MUAC at the time of discharge (P value <0.05). There was no significant association of treatment outcome with the presence of comorbidities (P value >0.05). Conclusion: Most vulnerable age group for malnutrition was 6 months to 2 years. Majority of children with malnutrition improve with standard treatment protocol of malnutrition. We can improve the ability of community health workers to significantly reduce child malnutrition at the primary care level and in the community by equipping them with the required knowledge, tools, and assistance.

Prevalence of Severe Anemia among Severe Acute Malnourished Children in the 6-59 Months Age Group at the CRENI of the Aguié District Hospital

Anemia among children remains a critical public health issue whether in industrialized or developing countries. The objective of this study is to determine the prevalence of severe anemia among children in the 6-59 months age group hospitalized at the CRENI of the Aguié district hospital. This is a retrospective and descriptive study over a 12-month period on 240 severely malnourished children hospitalized with severe anemia. Our study showed that 240 children had severe anemia, that is to say a prevalence of 10.30%, which was more frequent among children under 24 months of age. Severe anemia was associated with malaria in 74.16% and occurred more in the last quarter of the year, that is to say 81%. We had a successful treatment rate of 92.5% and 7.5% of deaths. There is a pressing need to strengthen the community approach on nutritional advice and early attendance at healthcare facilities to avoid worsening of diseases among children.

Effect of Vitamin D Supplementation in Children with Severe Acute Malnutrition

Background: Malnutrition accounts for about 35% of under-five mortality, of which 4.4% is specifically because of severe wasting. Prevalence of vitamin D deficiency in malnourished children ranges from 31% to 61%. Addition of high dose vitamin D supplementation in children with severe acute malnutrition would be effective in elevating serum vitamin D concentration and thus improve weight gain. The association of vitamin D and malnutrition is well recognized but data are scarce. Objectives: To see the effect of vitamin D in the treatment of severe acute malnourished children. Methods: This prospective randomized controlled trial study was conducted among children 6 months to 5 years old with a diagnosis of SAM in the pediatric ward of Dhaka Shishu (Children) Hospital in Bangladesh from July 2018 to January 2020.Sample was collected through simple random sampling then randomized into two groups by lottery method. Finally, 50 patients were included in the study, among them 25 patients received 6 lac IU vitamin D orally in day 1 in addition to the standard treatment of SAM and the other 25 patients received only the standard treatment of SAM. Demographic data and other related information regarding clinical feature, laboratory feature, outcome variables were recorded and anthropometric measurement and Z-scoring was done to assess malnutrition. Collected data was checked manually and analyzed by computer-based program SPSS for Windows (version 20.0). Outcomes were: Length of hospital stay and average weight gain between the two groups. Comparison of parameters among the group were done by unpaired t-test and chi-square test. Results: There were no statistically significant difference in length of hospital stay (16.24 ±3.29 versus 15.34±2.64) days, p=0.291 but there was statistically significant difference in average weight gain (9.08±2.99 versus 7.52±2.06) gm/kg/day, p=0.037 and wasting (weight for height z score) improved significantly on follow ups (p=0.241 on first, p=0.039 on 2nd, p=0.009 on 3rd and p=<0.001 on 4th follow up). Conclusions: Vitamin D supplementation causes significant weight gain in children with severe acute malnutrition.

Predictors of mortality among severe acute malnourished children. A multi-center prospective follow-up study

Severe acute malnutrition (SAM) is a public health problem in developing countries including Ethiopia, because of the high risk of death, most severely malnourished children are managed in hospitals. Hence, the aim of this study was to assess the predictors of mortality among severely malnourished children admitted in Gedeo zone hospitals, Southern Ethiopia. Multicenter institution-based prospective follow-up study was conducted among 568 severely malnourished children with age <5 years in Gedeo zone hospitals from December 2018 to April 2020. Survival analysis with Cox proportional hazard model was conducted to determine factors associated with mortality rate. Variables with a p-value <0.05 in multivariate regression were considered statistically significant. From a total of 568 children admitted with SAM; 54(9.5%), 306(53.9%), 179(31.5%) and 29(5.1%) died, recovered, transferred out and defaulted respectively. Over the study period, the rate of mortality was eight per 1000 person-days. Comorbidity after admission (Adjusted hazard ratio (AHR)=2.96; 95% CI 1.35, 6.47), being HIV reactive (AHR=1.31; 95% CI 1.12, 1.72), hospital stay for more than one week (AHR=1.78; 95% CI 1.03, 3.12), no formal education of the mother (AHR 2.25; 95% CI 1.24, 4.08) and Nasogastric (NG) tube (AHR=1.87; 95% CI: 1.562-2.37) given were the significant predictors of mortality. Maternal/caregiver educational status, co-morbidity after admission, being HIV reactive, vaccination status, hospital stay for more than one week and NG tube given were found as significant determinant factors of mortality rate. Hence, the government of Ethiopia and stakeholders should implement strong interventions focusing on these predictors.

Recovery rate of severe acute malnourished children aged 6-59 months enrolled in outpatient therapeutic program at health posts of Central Gondar zone, Ethiopia.

Background: Inadequate intake of food is one of the causes of malnutrition and has significant impact on the deaths of children in low-income countries. Community-based management of acute malnutrition was endorsed as a strategy to alleviate such burdens of child morbidity and mortality associated with malnutrition. Despite outpatient therapeutic program has decentralized to health post level, there is still a lack of adequate evidence regarding the recovery rates from outpatient therapeutic program at health post level in Ethiopia. In addition, the previous body of articles did not show the local situations, particularly the recovery rates of severe acute malnutrition children from outpatient therapeutic program in the central Gondar zone, Ethiopia. Aim: This study aimed to assess recovery rate and associated factors among severe acute malnourished children enrolled to outpatient therapeutic program at health posts of Central Gondar zone, Ethiopia. Methods: This study was a facility-based retrospective cross-sectional study conducted on 349 children who had managed for severe acute malnutrition in outpatient therapeutic program in Central Gondar zone from March to May 2021. A structured and pre-tested data extraction checklist adapted from literatures was used to collect the data. The children were selected using consecutive sampling from 39 health posts. Data were entered, cleaned, coded and analyzed using Stata version 14 software. Binary logistic regression was fitted to identify factors associated with recovery rate from outpatient therapeutic program. Adjusted odds ratio with 95% confidence interval and p-value <0.05 were used to declare the variables statistically significant with the recovery rate from outpatient therapeutic program. Results: The successful recovery rate for severe acute malnourished children admitted to outpatient therapeutic program was 74.2% (95% CI: 69.3, 78.6). False recovery, death, default, non-responder and medical transfer out rates were 12.6%, 8.6%, 2.9%, 0.9% and 0.9%, respectively. In addition, the average weight gain of children was 4.4 g/kg/day for the length of stays, and the average length of stay was also 6.7 (±1.3SD) weeks. Breastfeeding status (AOR = 1.72; 95% CI: 1.05, 2.83), antibiotics (amoxicillin) provision (AOR = 2.14; 95% CI: 1.07, 4.25) and vitamin A supplementation (AOR = 1.93; 95% CI: 1.13, 3.30) were positively associated with the recovery rate of severe acute malnourished children admitted to outpatient therapeutic program. Conclusion: In this study, we found that the recovery, death and default rates were in the acceptable ranges of sphere standards. Therefore, health extension workers shall manage to shape service providers of outpatient therapeutic program with severe acute malnutrition management protocol. Special attention was also needed to build capacity of health extension workers to alleviate knowledge gaps on children enrolled to and discharge from outpatient therapeutic program at health posts. Dietary counselling is essentially required to improve maternal diets, which can affect the nutritional status of breastmilk.

The synergistic interaction of systemic inflammation, dysbiosis and antimicrobial resistance promotes growth restriction in children with acute severe malnutrition: An emphasis on Escherichia coli

A healthy development is denied to millions of children worldwide as harsh life conditions manifest themselves in an altered inflammation-prone microbiome crosstalk environment. Keynote of this tragedy is that insufficient nutritious amino acid blocks lipids-intake to sustain diverse microbiota, and promotes the generalist strategy followed by Escherichia coli -besides other proteobacteria- of shifting gut metabolism, subverting the site specificity of first immune reaction. Furthermore, it could be hypothesized that selective success lies in their ability to induce inflammation, since this phenomenon also fuels horizontal gene transfer (HGT). In this review, we dilucidate how immune mechanisms of environmental enteric dysfunction affect overgrowth restriction, infectious morbidity rate, and acquired lifelong risks among severe acute malnourished children. Also, despite acknowledging complexities of antimicrobial resistant enrichment, we explore and speculate over the links between virulence regulation and HGT as an indissociable part in the quest for new inflammatory niches by open genome bacteria, particularly when both collide in the most vulnerable.

Prime Minister's Overarching Scheme for Holistic Nutrition (POSHAN) on Wheels as a Drive Towards Combating Malnutrition Among Children in Coastal Gujarat.

Background Gujarat, India, is home to severe acute malnutrition. Wasting in children is associated with a higher risk of death if not treated properly. The present study identified children under five years of age with severe acute malnutrition (SAM). It provided energy-dense nutrition supplement (EDNS) during the rising cases ofCOVID-19 to treat them as per the guidelines of the government of Gujarat in Devbhumi Dwarka District of Gujarat State, India. Methods A descriptive research design was used in the study. Children were screened by a Nutrition Assistant in the presence of an Anganwadi Worker (AWW), Auxiliary Nurse Midwife (ANM)/Community Health Officer (CHO) at Anganwadi Centre or the Child's home using weight/length Z score <-3 standard deviations (SDs) or mid-upper arm circumference (MUAC) <11.5 and identified severe acute malnourished children were provided EDNS (WHO composition) for a period of seven days initially for a starting period as per the child's body weight then followed up to eight weeks. Data was entered on the spot in a Google sheet, which nutrition assistants maintained. Data were analyzed using IBM SPSS Statistics for Windows, Version 26.0 (Released 2019; IBM Corp., Armonk, New York, United States) and Microsoft Excel 2019. Results The study revealed that 23% of children were considered in the SAM category, followed by 21% in the Bhanvad block and 24% in the Dwarka block. For the Bhanvad block, 40% of the children were treated normally with a maximum weight gain of 1 to 2 kgs (63%). Similarly, for the Dwarka block, 29% of children were treated normally with a weight gain of 1 to 2 kgs (64%). Conclusions The study identified children with SAM and provided EDNS for eight weeks. To strengthen the program, the engagement of frontline functionaries of government should be increased, which plays an active role in the community and can be a bridge to the community. As in the community-based management of acute malnutrition (CMAM) program, Accredited Social Health Activists (ASHAs) are responsible for reaching out the ready-to-use therapeutic food (RUTF) to the mothers, weighing of children is done jointly by AWWs and ASHAs on a weekly basis, as well as counselling of the mothers on care and feeding practices and hygiene, and therefore every ASHA receives an incentive of Rs. 25 per child per week to monitor the progress of the child, reach out the therapeutic food, and counsel the mother. This system should be linked with Prime Minister's Overarching Scheme for Holistic Nutrition (POSHAN) on wheels program.

Time to readmission and associated factors after post treatment discharge of severe acute malnourished under-five children in Pawe General Hospital

BackgroundRelapse or repeated episodes is the admission of a child with the diagnosis of severe acute malnutrition (SAM) after being discharged to a status of treated and cured from a stabilizing center. A child may experience more than one episode of SAM depending on the improvement of the underlying comorbidity. Thus, this study aimed to estimate the time to readmission of SAM and associated factors for under-five children in North West Ethiopia.MethodsAn institution-based retrospective cohort study was employed in 760 files of under-five children spanning from 2014/15 to 2019/20. The data extraction tool was developed from SAM treatment guidelines and medical history sheets. Epi Data version 3.2 and STATA version 14 were used for data entry and final analysis, respectively. After checking all assumptions, the multivariable Cox Proportional Hazard model was fitted to the isolated independent predictors for time to readmission. A categorical variable with p < 0.05 was considered a risk factor for the relapse of SAM.ResultThe mean (± SD) age of participant children was 27.8 (± 16.5) months with mean (± SD) time to relapse of SAM cases were 30.4(± 21.39) weeks posttreatment discharge. The overall incidence density rate of relapse was determined as 10.8% (95% CI 8.3; 12.6). The average time (± SD) for treatment recovery from the first admission of the SAM case was 28.8(± 18.7) days. Time of readmission was significantly associated with living in rural resident (AHR 5⋅3 = 95% CI, 2⋅95, 13⋅87, p = 0.021), having HIV infection (AHR6⋅8 = 95%CI; 4.1–11.9 p = 0.001), and first admission with edema (AHR = 3.5 = 95% CI; 1.92, 6.2, p = 0.018).ConclusionNearly one in every ten severely acute malnourished under-five children relapsed within a mean time to relapse 30.4(± 21.39) weeks posttreatment discharge. Time to relapse was significantly associated with being a rural resident for children, having edema during the first admission, and being HIV-infected cases. A protocol ought to be drafted for extending Supplementary Nutrition in Acute Malnutrition management program following discharge is highly needed.

Evaluation of the outpatient therapeutic program for severe acute malnourished children aged 6–59 months implementation in Dehana District, Northern Ethiopia: a mixed-methods evaluation

BackgroundIn Ethiopia, about 57% of child mortality is associated with acute malnutrition in which the burden is dominant at the rural community. In that regard, the Ethiopian government has been implementing the Outpatient Therapeutic Program (OTP) for managing the uncomplicated sever acute malnutrition among children aged 6 to 59 months at community level by health extension workers. But nothing is known about the implementation status of OTP. Thus, this evaluation aims to evaluate the implementation status of OTP in Dehana district, northern Ethiopia. MethodsA facility-based cross-sectional evaluation with concurrent mixed-method was employed from 1st February to 30th April 2020. A total of 39 indicators were used to evaluate the availability, compliance and acceptability dimensions of the program implementation. A total of 422 mothers/caregivers for exit interview, 384 children’s (diagnosed with acute malnutrition) record reviews, nine key informants’ interview, and 63 observations were done in this evaluation. A multi-variable logistic regression analysis was used to identify the predictor variables associated with acceptability. Adjusted Odds Ratio (AOR) with 95% confidence interval (CI), and p-value < 0.05 were used to declare statistically significant variables. The qualitative data were tape recorded, transcribed in Amharic and translated into English and finally thematic analysis was done.ResultsThe overall implementation of OTP was 78% measured by availability (87.5%), compliance (75.3%), and acceptability (71.0%) dimensions. Trained healthcare providers, Ready to Use Therapeutic Food (RUTF), Mebendazole, and Oral Rehydration Salt (ORS) were available in all health posts, whereas vitamin A and folic acid were stocked out in some health posts. The health care providers complained that interruption of supplies, work overload and improper usage of RUTF by caregivers were the common challenges of program delivery. Rural residence (AOR = 0.18, 95% CI: 0.09–0.39), knowledge on childhood malnutrition and program services (AOR = 2.27, 95% CI: 1.04–4.97), and had malnourished children previously (AOR = 1.82, 95% CI: 1.01–3.30) were significantly associated with the acceptability of OTP program.ConclusionThe overall implementation status of OTP was judged fair. Low achievement was observed on the compliance of health care providers to the standards, and acceptability of program services. Therefore, the program needs great improvement to enhance the outcome of childhood malnutrition management.

Current scenario of ocular morbidity in severe acute childhood malnutrition in central part of India

The study aimed to assess the prevalence of ocular involvement in children 6 months to 5 years attending tertiary care centre with Severe Acute Malnutrition and to detect the associated risk factors for ocular morbidity in severe acute malnutrition.: This hospital based observational study was carried out at Gandhi Medical College, during the study period of 2 years on children diagnosed with SAM belonging to 6 months to 5 years of age. Detailed history was obtained and physical, systemic and ocular examination was done. : A total of 100 severe acute malnourished children were included. Prevalence of ocular involvement in severe acute malnourished children was 72%. Conjunctival pallor was observed in 71.5% eyes and retinal hemorrhages were most common posterior segment finding. Vitamin A deficiency signs were observed in 17 eyes (8.5%). Higher birth order and number of sibling was significantly associated with higher incidence of ocular manifestations (p&amp;#60;0.05). However, other variables showed no significant association between other variables and ocular manifestations (p&amp;#62;0.05). Training should be given to health workers at the primary health care level and health centers on counseling mothers on feeding, growth monitoring, the preventable eye blinding diseases and hygiene during the vaccination sessions and early referral of children with eye signs to hospitals. Also education of couple regarding proper nutrition of mother and child should be encouraged and couples should be insisted to have not more than two children.

Pulse of Gujarat during lockdown

Background: Coronavirus pandemic has dealt a severe blow to India's poor and socioeconomically disadvantaged group. Among a nationwide lockdown to contain the spread of the infection. This study assessed the availability of food and access to healthcare among the vulnerable population of Gujarat– pregnant women and severe acute malnourished children. Specifically, we assessed events of starvation or skipped meal, availability of healthcare services, and self-reported psychological distress during the lock down. Materials and Methods: A cross-sectional study across 252 talukas and 33 districts of Gujarat was undertaken using a structured questionnaire. A telephonic survey was carried out and positive responses were received from 161 households (HHs) with severe acute malnourished children, 328 pregnant women with severe maternal anemia, and 402 lactating women. Results: We found 79.7% of surveyed HHs received ration where major reliance was on public distribution system (51.7%). Less than half of the beneficiaries (48.6%) received take-home ration under the ICDS program. Despite efforts of the State as well as voluntary agencies, 7.3% of HHs experienced episode of hunger, mostly from Devbhumi Dwarka, and Navsari district. A third of the respondents showed signs of psychological distress associated with lockdown. Conclusion: Food insecurity may lead to malnutrition impairing the immunity of the individuals to cope with the disease. Thus, given the uncertainty around the emergency situation, preparedness measures should not only focus on the availability of healthcare commodities but also to ensure the availability of other essentials, especially to the socioeconomic disadvantaged group.

Utilization of mid-upper arm circumference as discharge tool for children in outpatient therapeutic program, Ethiopia.

Mid-upper arm circumference (MUAC) is simple to use and inexpensive in Ethiopia; both MUAC and target weight are employed, although the time to cure for MUAC is not indicated. The present study is aimed to determine cure time of MUAC for children in outpatient therapeutic program. A prospective cohort study was conducted among 414 severe acute malnourished under-five children admitted to selected health twenty-two posts from 1 February to 30 July 2021, in Oromia, Ethiopia. Data were coded, entered to Ep-data version 4.2 software, and transferred to SPSS for windows version 25 software for analysis. The Multivariate Cox Proportional Hazards model was used to fit independent determinants of time to cure. All tests were two-sided and statistical implications at P-values < 0⋅05. In the present study, the minimum week for a cure was 4 weeks, the maximum was 16 weeks and the overall time to cure severe acute malnutrition as measured by MUAC is judged to be 10 at 95% CI (9⋅65-10⋅35). Families with six or more members are 2⋅16 times more at risk, children from homes with the lowest wealth index are at 1⋅4 times more risk, and children from food insecure families were 2⋅61 times more likely to require long-term treatment for MUAC. In the present study, the time to cure severe acute malnutrition by MUAC is determined as 10 weeks. Moreover, family size, low wealth index, and household food insecurity were risks to delay in cure time MUAC.

Effectiveness of community-based treatment programs for treatment of uncomplicated severe acute malnourished children aged 6\u201359\u2009months using locally produced nutrient dense foods: protocol for a multicentric longitudinal quasi-experimental study

BackgroundSevere acute malnutrition (SAM) is a major underlying cause of mortality among children. Around one third of the world’s acutely malnourished children live in India. The WHO recommends community-based management of acute malnutrition (CMAM) for managing children with SAM. In India, different states are implementing community-based SAM treatment programme, hereinafter called CSAM, using varieties of locally produced nutrient dense food items with different nutrient compositions. The study will assess the effectiveness of these state specific CSAM interventions.MethodsThe longitudinal quasi-experimental study will be undertaken in two purposively selected blocks of one district each in the four intervention states and one comparison state. From each state, 200 SAM children identified using weight-for-length/height z-score (WHZ) < − 3 criteria will be enrolled in the study. Their anthropometric data and skinfold thickness will be taken on admission, at sixth week and at discharge by trained field investigators. Other child details, incidence of morbidity and socio-economic details will be collected on admission. To assess food consumption pattern including consumption of locally produced nutrient dense food supplements, dietary assessment, using 24-h dietary recall will be conducted on admission, at sixth week and at discharge. In addition, body composition parameters will be assessed for a sub-set of children using bio-electrical impedance analysis on admission and at discharge to analyse changes in total body water, fat-free mass, and fat mass. Post discharge, all study participants will be followed up monthly until 6 months. Atleast 10% of the sample will be checked for quality assessment.The study’s primary outcome is cure rate defined as children attaining WHZ ≥ -2. Secondary outcomes include mean weight gain, mean length of stay, body composition parameters, relapse and mortality rates. Additionally, process evaluation and cost effectiveness analysis will be conducted.DiscussionThere is a shortage of robust evidence regarding the effectiveness of locally produced nutrient dense food supplements provided as part of the CSAM intervention in India. This study will contribute to evidence on effective strategies to manage children with uncomplicated SAM in India. The study protocol has all necessary ethical approvals. Written informed consent will be obtained from caregivers of the children.Trial registrationThe study is registered with Clinical Trial Registration of India (Registration No.: CTRI/2020/09/028013) Date of registration 24/09/2020.

Kidney Size Assessment in Children with Severe Acute Malnutrition Under 5 Years of Age: A Comparative Stud:

Background and Aim: Malnutrition is a common disorder worldwide. Growth of visceral organs is affected by various factors including nutrition. Kidney size is an important parameter to assess renal growth. Kidney size in malnourished children is not well studied. We compared kidney size between severe acute malnourished (SAM) and normal children. Methods: This prospective case control study was carried out at a tertiary care center in North India. Children with SAM (n=124) were enrolled as cases and 86 age and sex matched healthy children were enrolled as controls. All children were subjected to anthropometric and sonographic kidney size measurement. Various renal size parameters were compared between cases and controls. Linear correlation coefficients of kidney dimensions with anthropometric parameters were derived. P-values <0.05 were considered significant. Results: The kidney length was significantly lower in malnourished cases compared to healthy controls. There was no difference in renal width and combined kidney volume (CKV) between the two groups. However, renal depth, combined relative kidney volume, CKV/body height ratio, and CKV/BSA ratio were significantly higher in malnourished child compared to healthy controls. Kidney size parameters (kidney length, width, depth, CKV) had significant correlations with anthropometric measurements in both groups but the correlations were stronger in healthy controls compared to malnourished children. Conclusion: Malnourished children had a significantly smaller kidney length. This point should be remembered while evaluating kidney size in these children to avoid unnecessary invasive investigations.

HAEMATOLOGICAL PROFILE OF SEVERE ACUTE MALNOURISHED CHILDREN ADMITTED AT OUR INSTITUTION

Background: Severe acute malnourished children are prone to deranged pathophysiology. Their haematological profile affected mild to severe degree. Our study was done to observe the haematological profile of severe acute malnourished children admitted at P.B.M. Hospital Bikaner, Rajasthan. Material And Methods: This prospective observational study was designed for severe acute malnourished 178 children. Duration of this study was one year from 01.01.2013 to 31.12.2013. This study was done in special concern of haematological profile of severe acute malnourished children. Results: Our study showed that oedematous malnourished children had anaemia more common than non-oedematous malnourished children.Microcytic hypochromic anaemia and dimorphic anaemia were more common in non- oedematous and oedematous malnourished children. Conclusion: We concluded that Microcytic hypochromic anaemia and dimorphic anaemia is common in severe acute malnourished children. So, our primary target should be prevent malnourishment and secondary should be early diagnosis and management of sequelae by proper monitoring to avoid complications.

Malnutrition and Gut Microbiota in Children.

Malnutrition continues to threaten the lives of millions across the world, with children being hardest hit. Although inadequate access to food and infectious disease are the primary causes of childhood malnutrition, the gut microbiota may also contribute. This review considers the evidence on the role of diet in modifying the gut microbiota, and how the microbiota impacts childhood malnutrition. It is widely understood that the gut microbiota of children is influenced by diet, which, in turn, can impact child nutritional status. Additionally, diarrhoea, a major contributor to malnutrition, is induced by pathogenic elements of the gut microbiota. Diarrhoea leads to malabsorption of essential nutrients and reduced energy availability resulting in weight loss, which can lead to malnutrition. Alterations in gut microbiota of severe acute malnourished (SAM) children include increased Proteobacteria and decreased Bacteroides levels. Additionally, the gut microbiota of SAM children exhibits lower relative diversity compared with healthy children. Thus, the data indicate a link between gut microbiota and malnutrition in children, suggesting that treatment of childhood malnutrition should include measures that support a healthy gut microbiota. This could be of particular relevance in sub-Saharan Africa and Asia where prevalence of malnutrition remains a major threat to the lives of millions.

Comparative analysis of developmental profile between normal and severe acute malnourished under-five children in Pakistan: a multicentre cross-sectional study

ObjectivesThis study aims to compare the developmental profile of severe acute malnourished (SAM) and normal under-five children and to find sociodemographic determinants accountable for their developmental disabilities.SettingWe conducted a multi-centre...