Severe Acute Malnutrition In Children Research Articles

Determinants of severe acute malnutrition among children less than five years visiting health centers in Leqa Dulacha District, East Wallaga Zone, Oromia Region, Ethiopia: A case control study.

In underdeveloped nations like Ethiopia, severe acute malnutrition (SAM) is one of the most pressing public health issues. Despite efforts to pinpoint the causes of SAM, the impact of parents' drug usage on their children's nutritional status remains unclear and unresolved. The purpose of this research was to determine the risk factors for SAM in children under five who were attending medical facilities in the Leqa Dulacha district. A health facility-based case-control study was carried out from March 1 to July 30, 2022, with 256 children under the age of five. Random sampling was used to identify study participants in a methodical manner. Mothers and other child caretakers were interviewed using a structured questionnaire and anthropometric measurements were performed using standardized, calibrated equipment. Epi-data version 3.1 was used to code and enter the data, and it was then exported to IBM SPSS for analysis. An analysis of multivariable binary logistic regression was conducted, and the measure of association employed was the adjusted odds ratio (AOR), with a 95% confidence interval (CI). A total of 96.5% of respondents responded. SAM in children was significantly correlated with the following factors: parent alcohol consumption [AOR = 3.142; 95% CI = (1.104, 8.945)]; child illness in the previous 15 days [AOR = 4.122; 95% CI = (1.686, 10.07)]; poor dietary diversity [AOR = 3.044; 95% CI = (1.189, 7.788)]; household food insecurity [AOR = 4.024; 95% CI = (1.544, 10.490)]; and parent chewing chat [AOR = 3.484; 95% CI = (1.329, 9.134)]. A number of factors have been linked to SAM in children, including the use of health services, the child's illness within the previous 15 days, food security, child feeding practices, and parent substance use. Therefore, it is important to emphasize the value of health education programs on child feeding habits, particularly the significance of dietary diversity, and to work together to modify the way that parents raise their children.

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.

Chronic Pathologies Associated with Severe Acute Malnutrition in Children Hospitalised at the Ureni Reference Health Centre in Commune V

Introduction: The objective was to study chronic pathologies associated with severe acute malnutrition in children aged 6 to 59 months hospitalized at URENI. Methodology: This was a retrospective, descriptive and analytical study running from January 1 to December 31, 2017. Results: During the study period 352 children were hospitalized for severe acute malnutrition at the URENI of the CSREF CV. Among them, 18 presented a chronic pathology, i.e. a frequency of 5.11%. The male gender was predominant, i.e. 61.1% with a sex ratio of 1.57. The 12-24 month age group represented 50% of cases. Thirty-three percent of children had a history of neonatal resuscitation and 16.7% were formerly premature babies. Marasmus was of the severe acute malnutrition type the most represented, i.e. 77.8% of the cases. The association of malnutrition with HIV infection and Cerebral Palsy (CP) were accounted for 27.8% each. More than half of the patients (55.6%) stayed between 15 - 21 days in the structure. Conclusion: HIV infection and cerebral palsy constitute the chronic pathologies most associated with severe acute malnutrition in children at the Csref of commune V.

IJCM_97A: Clinico-epidemiological profile and outcome of Severe Acute Malnutrition children admitted to the nutritional rehabilitation centre of a tertiary care hospital in Kalaburagi, Karnataka: a retrospective study

Background: Severe acute malnutrition is the major cause for under- five morbidity and mortality. According to NFHS 5 (2019-20), 7.7% of malnourished children under 5 years in India were severely wasted and in Karnataka it is 8.4 %. There is paucity of data on risk factors and clinical outcomes related to SAM children in North Karnataka, hence the present study was conducted. Objectives: 1. To assess the clinico-epidemiological profile of SAM children. 2. To determine the risk factors of SAM children admitted in NRC. 3. To study outcomes of SAM children admitted in NRC. Methodology: Study setting: Nutritional Rehabilitation Centre of Gulbarga Institute of Medical Sciences, a Tertiary care hospital in Kalaburagi. Study design: A retrospective record- based cross-sectional study Study population: All children under 5 years of age admitted with SAM in the NRC at GIMS, Kalaburagi. Study duration: December 2022- November 2023 Sample size: As per data from Medical Records Department, total number of SAM children admitted in NRC is 180 between December 2022 to November 2023. DATA COLLECTION METHOD: In all the admitted patients, a detailed history including socio demographic, clinical presentation, birth order, immunization and duration of stay in NRC, physical examination findings and investigations were collected from available records. Anthropometric measurements like weight, length /height, MUAC and weight for height were collected and analysed using WHO growth charts. The outcomes included whether the children completed duration of stay at NRC were cured with weight gain, no weight gain or succumbed to malnutrition. Inclusion criteria: All children under 5 years who were admitted and fulfilled the criteria of SAM by WHO. Exclusion Criteria: 1. Case sheets of admitted SAM children with incomplete data. STATISTICAL ANALYSIS: Data were entered in Microsoft excel sheet and analyzed using SPSS version 20. Results: Among 150 SAM children analysed,77 (51.7%) males and 73(48.3%) females had weight for height below - 3SD. Conclusion: Hospital-based management of SAM children in NRC with adherence to updated WHO standard guidelines has helped in reducing mortality and morbidity among undernourished children.

Cost-effectiveness of severe acute malnutrition treatment delivered by community health workers in the district of Mayahi, Niger

BackgroundA non-randomized controlled trial, conducted from June 2018 to March 2019 in two rural communes in the health district of Mayahi in Niger, showed that including community health workers (CHWs) in the treatment of severe acute malnutrition (SAM) resulted in a better recovery rate (77.2% vs. 72.1%) compared with the standard treatment provided solely at the health centers. The present study aims to assess the cost and cost-effectiveness of the CHWs led treatment of uncomplicated SAM in children 6–59 months compared to the standard national protocol.MethodsTo account for all relevant costs, the cost analysis included activity-based costing and bottom-up approaches from a societal perspective and on a within-trial time horizon. The cost-effectiveness analysis was conducted through a decision analysis network built with OpenMarkov and evaluated under two approaches: (1) with recovery rate and cost per child admitted for treatment as measures of effectiveness and cost, respectively; and (2) assessing the total number of children recovered and the total cost incurred. In addition, a multivariate probabilistic sensitivity analysis was carried out to evaluate the effect of uncertainty around the base case input data.ResultsFor the base case data, the average cost per child recovered was 116.52 USD in the standard treatment and 107.22 USD in the CHWs-led treatment. Based on the first approach, the CHWs-led treatment was more cost-effective than the standard treatment with an average cost per child admitted for treatment of 82.81 USD vs. 84.01 USD. Based on the second approach, the incremental cost-effectiveness ratio of the transition from the standard to the CHWs-led treatment amounted to 98.01 USD per additional SAM case recovered.ConclusionsIn the district of Mayahi in Niger, the CHWs-led SAM treatment was found to be cost-effective when compared to the standard protocol and provided additional advantages such as the reduction of costs for households.Trial registration: ISRCTN with ID 31143316. https://doi.org/10.1186/ISRCTN31143316

Growth monitoring and nutritional outcome of severe acute malnutrition children in the presence and absence of edema: a facility based retrospective study

Background: Severe acute malnutrition (SAM) is the leading cause of death in children. SAM affects approximately 20 million preschool children, mainly in Africa and South Asia. Children with severe acute malnutrition and severe edema (+++) have an increased risk of death compared with children with severe acute malnutrition and no edema. This study evaluated the nutritional outcome of SAM patients in the presence and absence of edema. Methods: This retrospective study was conducted in malnutrition treatment centre, JK Lon Hospital attached with Govt Medical College, Kota from January 2021 to December 2022 on children of age 6 months to 59 months, with clinical diagnosis of severe acute malnutrition. Ethics committee approval was not required as the study was a retrospective observational study. Patients were divided into three categories, viz. recovered, defaulted and non-responders. Results: A total of 270 patients were selected for this study on the basis of date made available through past records. Of the total patients studied, 32.2% (87) had bilateral edema while the rest (183) were non edematous. From edematous arm, 79.9% children recovered, 9.1% defaulted, and 11% were non-respondents. Conversely, of those without oedema 55.7% recovered, 7.0% defaulted, and 37.3% were non-respondents. Conclusions: Severe acute malnutrition is a preventable and treatable cause of childhood morbidity and mortality. The determinants of SAM include illiteracy, low socio-economic status, malnourished mother, low birth weight, ignorance about specific nutritional requirements of infants and young children, repeated infections, etc. In this study, we documented that the edematous children in the study area had a better likelihood of recovery as compared to those with severe wasting.

Factors affecting treatment outcomes of outpatient therapeutic program for treatment of severe acute malnutrition in under-fives: A review

This study aims to scrutinize the factors influencing treatment outcomes in Outpatient therapeutic programs (OTPs) targeting Severe Acute Malnutrition (SAM) in children under five. SAM in children under five is a pressing global health issue, necessitating effective treatment to mitigate its high mortality and morbidity risks. OTPs have been pivotal in addressing SAM in resource-constrained settings, offering ready-to-use therapeutic foods (RUTF) and medical care. However, the success of OTPs is dependent upon various factors, including the child's age and nutritional status and the quality of care provided. Understanding these factors and their influence on treatment outcomes is paramount for enhancing OTP effectiveness and alleviating the SAM burden among young children. A thorough search was conducted across Cochrane, Elsevier, and PubMed databases to identify relevant publications between 2016 to 2024. Twenty-four studies were initially retrieved, with thirteen meeting the inclusion criteria for data synthesis. Analysis of the selected studies revealed pivotal factors affecting treatment outcomes in OTPs for SAM. These factors include socio-demographic characteristics, clinical features and caregiver-related factors. Notably, factors such as age, nutritional status, comorbidities, program adherence and caregiver knowledge, emerged as significant determinants of treatment success. This review underscores the multifaceted nature of factors influencing treatment outcomes in OTPs for SAM among children under five. Understanding these determinants is crucial for optimizing program effectiveness and enhancing child health outcomes in resource-limited settings. Interventions addressing these factors will improve the impact of SAM treatment programs. Further research focusing on tailored interventions are recommended to refine SAM treatment strategies.

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

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

Community perception and utilization of services for the severe wasted children aged 6-59 months in the Forcibly Displaced Myanmar Nationals and their nearest host communities in Bangladesh: a qualitative exploration.

There is a paucity of data on community perception and utilization of services for wasted children in Forcibly Displaced Myanmar Nationals (FDMN) and their nearest host communities. We conducted a qualitative study to explore community perceptions and understand the utilization of services for severely wasted children among the FDMN and their nearest host communities in Teknaf, Cox's Bazar. We carried out 13 focus group discussions and 17 in-depth interviews with the caregivers of the children of 6-59 months, and 8 key informant interviews. Caregivers' perceived causes of severe wasting of their children included caregivers' inattention, unhygienic practices, and inappropriate feeding practices. However, the context and settings of the FDMN camps shaped perceptions of the FDMN communities. Caregivers in both the FDMN and host communities sought care from healthcare providers for their children with severe acute malnutrition (SAM) when they were noticed and encouraged by their neighbors or community outreach workers, and when their SAM children suffered from diseases such as diarrhea and fever. Some caregivers perceived ready-to-use therapeutic food (RUTF) as a food to be shared and so they fed it to their non-SAM children. Caregivers of the children having SAM with complications, in the FDMN and host communities, were reluctant to stay in stabilization centers or complex respectively, due to their households' chores and husbands' unwillingness to grant them to stay. The findings of this study are expected to be used to design interventions using locally produced RUTF for the management of SAM children in the FDMN, as well as to inform the health sector working on SAM child management in the host communities.

Gastroenteritis Rehydration Of children with Severe Acute Malnutrition (GASTROSAM): A Phase II Randomised Controlled trial: Trial Protocol.

Children hospitalised with severe acute malnutrition (SAM) are frequently complicated (>50%) by diarrhoea ( ≥3 watery stools/day) which is accompanied by poor outcomes. Rehydration guidelines for SAM are exceptionally conservative and controversial, based upon expert opinion. The guidelines only permit use of intravenous fluids for cases with advanced shock and exclusive use of low sodium intravenous and oral rehydration solutions (ORS) for fear of fluid and/or sodium overload. Children managed in accordance to these guidelines have a very high mortality. The proposed GASTROSAM trial will reappraise current recommendations with mortality as the primary outcome. We hypothesize that liberal rehydration strategies for both intravenous and oral rehydration in SAM children with diarrhoea may reduce adverse outcomes. An open Phase II trial, with a partial factorial design, enrolling children in Uganda, Kenya, Nigeria and Niger aged 6 months to 12 years with SAM hospitalised with gastroenteritis (>3 loose stools/day) and signs of moderate and severe dehydration. In Stratum A (severe dehydration) children will be randomised (1:1:2) to WHO plan C (100mls/kg Ringers Lactate (RL) with intravenous rehydration (IV) given over 3-6 hours according to age including boluses for shock), slow rehydration (100 mls/kg RL over 8 hours (no boluses)) or WHO SAM rehydration regime (ORS only (boluses for shock (standard of care)). Stratum B incorporates all children with moderate dehydration and severe dehydration post-intravenous rehydration and compares (1:1 ratio) standard WHO ORS given for non-SAM (experimental) versus WHO SAM-recommended low-sodium ReSoMal. The primary outcome for intravenous rehydration is mortality to 96 hours and for oral rehydration a change in sodium levels at 24 hours post-randomisation. Secondary outcomes include measures assessing safety (evidence of pulmonary oedema or heart failure); change in sodium from post-iv levels for those in Stratum A; perturbations of electrolyte abnormalities (severe hyponatraemia <125 mmols/L or hypokalaemia. If the trial shows that rehydration strategies for non-malnourished children are safe and improve mortality in SAM this could prompt revisions to the current treatment recommendations or may prompt future Phase III trials.

Application of the Boruta algorithm to assess the multidimensional determinants of malnutrition among children under five years living in southern Punjab, Pakistan

BackgroundMalnutrition causes nutrient deficiencies that have both physical and clinical consequences in severe acute malnutrition children. Globally, there were 47 million wasted children under the age of five in 2019. One in four were located in sub-Saharan Africa, with half being in South Asia. This study aims to apply the Boruta algorithm to identify the determinants of undernutrition among children under five living in Dera Ghazi Khan, one of the marginalized districts of densely populated Punjab Province in Pakistan.MethodsA multicenter cross-sectional study design was used to collect data from 185 children with severe acute malnutrition aged under five years visiting the OTPs centers located in Dera Ghazi Khan, Punjab, Pakistan. A purposive sampling technique was used to collect data using a pretested structured questionnaire from parents/caregivers regarding family sociodemographic characteristics, child nutrition, and biological and healthcare characteristics. Anthropometric measurements, including height, weight, and mid-upper arm circumference, were collected. The Boruta models were used to incorporate the children’s anthropometric, nutritional, and household factors to determine the important predictive variables for undernutrition using the Boruta package in R studio.ResultsThis study included 185 children, with a mean age of 15.36 ± 10.23 months and an MUAC of 10.19 ± 0.96 cm. The Boruta analysis identifies age, mid-upper arm circumference, weaning practices, and immunization status as important predictors of undernutrition. Income per month, exclusive breastfeeding, and immunization status were found to be key factors of undernutrition in children under the age of five.ConclusionThis study highlights age, mid-upper arm circumference, weaning practices, and immunization status as key determinants of weight-for-height and weight-for-age in children under five years. It also suggests that economic context may influence undernutrition. The findings can guide targeted strategies for combating undernutrition.

Determinants of mortality during severe acute malnutrition in children under 5 years old in Mahajanga Madagascar

Determinants of mortality during severe acute malnutrition in children under 5 years old in Mahajanga Madagascar

Exploring the association between early childhood caries, malnutrition, and anemia by machine learning algorithm.

The objective of this study was to determine the prevalence of early childhood caries in children with severe acute malnutrition (SAM) and also the hierarchy of association if any with malnutrition, anemia, and other risk factors with ECC using machine learning algorithms. A hospital-based preventive and interventional study was conducted on SAM children (age = 2 to <6 years) who were admitted to the malnutrition treatment unit (MTU). An oral examination for early childhood caries status was done using the deft index. The anthropometric measurements and blood examination reports were recorded. Oral health education and preventive dental treatments were given to the admitted children. Three machine learning algorithms (Random Tree, CART, and Neural Network) were applied to assess the relationship between early childhood caries, malnutrition, anemia, and the risk factors. The Random Tree model showed that age was the most significant factor in predicting ECC with predictor importance of 98.75%, followed by maternal education (29.20%), hemoglobin level (16.67%), frequency of snack intake (9.17%), deft score (8.75%), consumption of snacks (7.1%), breastfeeding (6.25%), severe acute malnutrition (5.42%), frequency of sugar intake (3.75%), and religion at the minimum predictor importance of 2.08%. Anemia and malnutrition play a significant role in the prediction, hence in the causation of ECC. Pediatricians should also keep in mind that anemia and malnutrition have a negative impact on children's dental health. Hence, Pediatricians and Pediatric dentist should work together in treating this health problem.

Determinants of nutritional outcome among beneficiaries of Nutrition Rehabilitation Centre

Background: Under Mission Balam Sukham, children of 6 months to 5 years having severe acute malnutrition (SAM) along with complications are managed at Nutrition Rehabilitation Centre (NRC). They are admitted for 14 days with the provision of a nutritional diet and medicines. Objectives: To explore determinants of nutritional outcome of SAM children admitted at NRC Methods: A prospective cohort study was conducted comprising 63 children aged 6 months to 5 years having SAM along with complications admitted at NRC of New Civil Hospital, Surat (NCHS) for 10 months. Results: The majority of participants were boys (54%), 12-23 months of age (50.8%), and Grade III socioeconomic class (39.6%). The duration of stay ranged from 2-36 days. The average duration of stay was 12.78 + 6.49 days; 14.26 ± 5.99 days for boys and 11.10 + 6.73 for girls. 18.8% stayed at NRC for 14 days. The average weight gain was 5.46 g/kg/day. A significant improvement in weight was seen in boys (t=2.20, p&lt;0.05), working mothers (t=2.44, p&lt;0.01), exclusively breastfed children (t=3.62, p&lt;0.01) of 6-11 months, full-term children of 12-23 months (t=4.0, p&lt;0.05). The children of 12-23 months (t=2.90, p&lt;0.01) and boys (t=2.15, p&lt;0.05) showed significant improvement in underweight (WAZ). Wasting improved significantly in age below 36 months (p&lt;0.05). 20.6% could achieve the target weight. Conclusion: NRC is an effective life-saving modality for malnutrition but its outcome is associated with factors like boys, exclusive breastfeeding, and full-term.

Comparison of biochemical and anthropometric parameters in complicated and uncomplicated severe acute malnutrition among children aged 6 to 59 months: a cross-sectional study

Aim: The frequency of severe acute malnutrition (SAM) is the highest in India. Although it should receive more attention, severe anemia is one of the comorbidities that increases mortality in children who are severely undernourished. In SAM children, the liver function test (LFT), kidney function test (KFT), and complete blood count (CBC) are deranged, but their correlation with the prognosis is not well defined. The aim was to describe the anthropometric assessment and biochemical profile of children with SAM. Methods: This cross-sectional cohort study was performed at the Departments of Paediatrics and Biochemistry at G.S.V.M. Medical College, Kanpur, and at the Department of Biotechnology at Amity University Rajasthan, Jaipur. One hundred and six patients with SAM were enrolled; 53 were grouped as complicated SAM (Group 1) (dehydration and severe dehydration) and 53 were diagnosed as non-complicated SAM (Group 2). Results: Group II had significantly higher mean values for height, weight, mid-upper arm circumference (MUAC), head circumference, and body mass index (BMI) for age percentile compared to Group I, with P-values of 0.001. Group I had a significantly lower level of hemoglobin (8.86 g/dL ± 2.21 g/dL) compared to Group II (10.0 g/dL ± 1.83 g/dL) with a P-value of 0.003. The difference in the frequency of anemia between the groups was statistically significant, with a P-value of 0.026. Anemia significantly increased the risk of complicated SAM with an odds ratio of 2.60 [95% confidence interval (CI), 1.07–6.31, P = 0.001]. Conclusions: This study suggests that there may be a significant relationship between anemia and the development of complications in high-risk children with SAM.

Critical period for better nutrition among severely acute malnourished children up to two years of age: a hospital-based case-control study, Gujarat, Western India

Background: Nutrition in the first two years of life is important for growth and development among children. To tackle undernutrition during this period, timely initiation of breastfeeding and quality of complementary feeding practices are essential. So, this study was planned to determine feeding practices associated with severe acute malnutrition children. Methods: This was hospital-based case-control study with 1:1 ratio of cases (77) and controls (77). Cases and controls were matched for age and sex. Cases were selected from Nutritional Rehabilitation Centre and controls from Immunization clinic. Mothers were interviewed about feeding practices, immunization status and illness of their child. Weight and height of children were also measured. Results: Children who received pre-lacteal feeding were associated with SAM. Most of cases (62.3%) and controls (70.1%) had received breastfeeding within 1 hour of birth. Among children of &lt;7 months age, 71.4% cases breast-fed &lt;8 times in 24 hours. Among children of 7 months to 2 years, SAM was associated with children who were not received complementary feeding (CF) at correct age, not received semi-solid/solid diet, CF not added with ghee/oil and feeding frequency &lt;5 times in day. Among cases 18.2% and only 1.3% controls had &gt;3 ARI episodes in last 6 months. Conclusions: Among identified independent risk factors (p&lt;0.05), type of CF, not adding ghee/oil in CF and feeding frequency (BF+CF) &lt;5 times were associated with SAM among 7 months to 2 years. Hospitalization history and &gt;3 ARI episodes in last 6 months were also associated with SAM.

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

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

Association between severe acute malnutrition in childhood and hematological disorders in adulthood: the Lwiro follow-up study in the Eastern Democratic Republic of the Congo

BackgroundDespite growing evidence on the short-term deleterious effects of severe acute malnutrition (SAM) in childhood on hematopoiesis, little is known about the long-term hematological effects of SAM in low-income countries (LICs). Our study explored the association between childhood SAM and hematological disorders in adults 11 to 30 years after post-SAM nutritional rehabilitation.MethodsThis follow up study investigated 97 adults (mean age 32 years) treated for SAM during childhood in eastern Democratic Republic of the Congo (DRC) between 1988 and 2007. Participants were compared to 97 aged- and sex-matched adult controls living in the same community with no history of SAM. Outcomes of interest were hematological characteristics and disorders in adulthood, assessed by various biological markers. Logistic and linear regression models were used to estimate the association between SAM in childhood and risk of hematological abnormalities.ResultsCompared to the unexposed, the exposed had higher mean white blood cells (/μl) [+ 840 (179 to 1501), p = 0.013], neutrophils [+ 504 (83 to 925), p = 0.019] and platelets (*103) [11.9 (8.1 to 17.9), p = 0.038] even after adjustment for food consumption in adulthood. No difference was observed in red blood cells (RBC), hemoglobin and erythrocytes parameters. With regard to the risk of hematological disorders, in contrast to the unexposed, exposed subjects had a risk of leukocytosis approximately three times higher [adjusted OR (95% CI): 2.98 (1.01 to 8.79), p = 0.048]. No difference was observed in terms of anemia, leukopenia, increased platelets and thrombocytopenia between the 2 groups.ConclusionAdults with a history of SAM in childhood have hematological characteristics that would be markers associated with chronic low-grade inflammatory or infectious diseases in an environment with no nutritional transition. Larger cohort studies with bone marrow analyses could provide further understanding of the impact of SAM on the overall hematological profile in adult life.

Occurrence of mycotoxins, phytoestrogens and other fungal metabolites in Ready-to-Use Therapeutic Foods for severely and acutely malnourished children

Ready-to-Use Therapeutic Foods (RUTFs) are mainly legumes- or nut-based low moisture, high energy and nutrient dense ready-to-eat foods strictly designed to treat severe acute malnutrition (SAM) in children. Despite the critical application of this food in a highly vulnerable population, there is no information on the spectrum of mycotoxins in RUTFs globally. This study therefore assessed 41 RUTF samples available in northern Nigeria for multiple mycotoxins using LC-MS/MS. Sixteen mycotoxins and 31 other metabolites comprising phytoestrogenic phenols, plant toxins and metabolites from diverse fungi were detected in the RUTF samples. The mycotoxins include aflatoxin B1 (AFB1), citrinin (CIT), deoxynivalenol, enniatins, alternariol methyl ether, moniliformin, sterigmatocystin, zearalenone, and their derivatives. AFB1 was detected in 5% of the samples at concentrations below the Codex Alimentarius maximum limit of 5 μg/kg, but exceeded the stricter 0.1 μg/kg European Union limit for baby/infant foods by 4–19 times. The highest mean mycotoxin concentration (42 μg/kg) was recorded for CIT, whereas enniatin B was the most occurring (73%). For other metabolites, abscisic acid and cordycepin were the most frequently occurring (100%), while genistin, a phytoestrogenic isoflavone, had the highest mean of 15,751 μg/kg. RUTF from composite flour blends had more mycotoxins compared to those made from peanuts. This is the first study on mycotoxin occurrence in RUTFs. Further studies are needed to assess the presence of mycotoxins and other metabolites in RUTFs on a larger scale as well as the associated risks from their occurrence in view of the high vulnerability of SAM children who consume the foods.

Severe Acute Malnutrition among Children in Bale Zone Southeast Ethiopia: Treatment Outcome and its Determinant Factors

To assess the treatment outcomes of severe acute malnutrition (SAM) and its associated factors in children aged 6-59months in Bale zone, Southeast Ethiopia. A multi-institutionally-based, retrospective cross-sectional study design was conducted, based on records from September 11, 2014 to September 11, 2017. Simple random sampling was used to select the records. A pretested extraction format was used to collect information from the logbook and patient records. Treatment outcome was dichotomized into recovery and censored. Bivariate and multivariable logistic regression analyses were used to analyze the data. Odds ratios with 95% CIs were calculated to determine the association between each independent variable and treatment outcome. A total of 763 records were completed and reviewed. Of these, 711 (93.2%) were recovered from SAM. Provision of deworming treatment (aOR=6.5; 95% CI: 2.8-15.1), education given to the mother/caregiver (aOR=8.8; 95% CI: 4.2-18.4), age range 6-24months (aOR=0.37; 95% CI: 0.17-0.81), presence of anemia (aOR=0.33; 95% CI: 0.14-0.78), and use of nasogastric (NG) tube (aOR=0.42; 95% CI: (0.21-0.85) were associated with recovery from SAM. Recovery rate of SAM children in this study was in line with international standards. Deworming, maternal education status, child's age, anemia, and NG tube use were associated with recovery. Attention should be given to deworming all children, disease control, and prevention of anemia and other comorbidities.