Severe Wasting Research Articles

Regulating the reaction pathway of nZVI to improve the decontamination performance through magnetic spatial confinement effect

Nanoscale zero-valent iron (nZVI) shows high effectiveness in the catalyzed removal of contaminants in wastewater treatment. However, the uncontrolled interfacial electron transfer behavior and formation of surface iron oxide (FeOx) layer led to severe electron wasting and occasionally form highly toxic intermediates. Here, we constructed magnetic mesoporous SiO2 shell on surface of nZVI to stimulate a magnetic spatial confinement effect and regulate the electron transfer pattern. Therein, Fe atom facilely spread out from the nZVI core, orderly release electron to surface adsorbed H2O molecule, which is efficiently transformed into active hydrogen (H*). Meanwhile, in-situ Raman revealed that Fe atoms were involved in the formation of penetrable γ-FeOOH rather than FeOx layer, enabling the continuous inward diffusion of H2O and outward diffusion of H* . Employing the catalyzed removal of halogenated phenols as demo reaction, the presence of magnetic mesoporous SiO2 shell utilized the reaction between electrons and H2O to switch the reaction pathway from the reduction/oxidation hybrid process to hydrodehalogantion, and increased the conversion of halogenated phenols-to-phenols by 5.53 times. This study shows the forehand of improving the decontamination performance of nZVI through sophisticated designed surface coating, as well as fine regulating the environmental behavior of magnetic material via micro-magnetic field.

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.

Impact of Infant and Young Child Feeding Practices on the Nutritional Status of Children in Northern Bangladesh

Background: Proper feeding practices are essential for attaining and maintaining optimum nutrition, health, and development of infants and children. Exclusive breastfeeding during the first six months of life and continued breastfeeding for two years, together with age-appropriate, nutritionally adequate complementary feeding initiated after six months of age, are optimum Infant and Young Child Feeding (IYCF) practices. However, often many aspects of infant and young child feeding practices are not optimum, with serious consequences for the child.
 Objective: To determine the impact of Infant and Young Child Feeding (IYCF) practices on the nutritional status of children. Materials and Method: This Cross-sectional descriptive type of study was conducted among 314 children from 6 months to 24 months of age at the Pediatric Outpatient Department and EPI center of Rajshahi Medical College Hospital during the period of January 2017 to December 2018. Collected data were analyzed by using 'SPSS version 16.
 Result: Among 314 children exclusive breastfeeding (EBF) rate was 68.2% for the first six months, and timely started complementary feeding was 58.5% of cases. In 214 exclusive breastfed infants, only 4.7% and 1.4% of children were moderate to severely wasted and stunted, respectively. On the other hand, among 97 infants who were not exclusively breastfed, the percentage of moderate to severe wasting and stunting was 11.4% and 13.4%, respectively. Among the 175 timely started complementary feeding children, only 12% and 6% were moderate to severely underweight and wasted, respectively, no one was stunted, but among the inappropriately started complementary children, 20.2%, 12.5%, and 12.8% were moderately to severely underweight, wasted and stunted respectively.
 Conclusion: Most of the children who were given exclusive breastfeeding in the first six months and started complementary food at an appropriate time after six months had normal nutritional status. Both moderate to severe stunting and wasting were common in those children who were non-exclusively breastfed and started complementary feeding either early or late.
 TAJ 2022; 35: No-2: 83-91

Comparative Assessment of Nutritional Status of School Children Aged 6-8 Years in Selected Urban and Rural Schools of Belagavi – A Pilot Study

Background One of the biggest health issues of poor nations is malnutrition. A school survey is beneficial because it is easy to conduct and enables to detect the presence of disease among large number of students of a particular age group.Aim To assess and compare nutritional status of school children in urban and rural schools.Methods In Belagavi district a prospective qualitative study was carried out including 60 children each from urban and rural schools aged 6 to 8 years. The nutritional status of children was determined using the anthropometric parameters such as weight for height weight for age and height for age based on Waterlowrsquos and Gomezs classifications of malnutrition.Results The study included 120 students 60 from rural area and 60 from metropolitan area. Mild wasting was found in 18 urban and 20 rural students moderate wasting was noted in eight urban and 20 rural students while severe wasting was observed in three rural students and normal weight for height was noted in 34 urban and 17 rural students. Mild stunting was observed in 17 urban and 18 rural children moderate stunting in two urban and four rural severe stunting was noted in one child from rural school. Normal height for age according to Waterlowrsquos classification was observed in 41 urban and 37 rural students. According to Gomezs classification mild malnutrition was identified in 17 urban students and 33 rural students moderate malnutrition was found in five urban and six rural students and severe malnutrition was found in one rural student. On comparison of nutritional status of urban and rural children stunting was observed in 19 urban and 23 rural children whereas wasting was identified in 26 urban and 40 rural children. Furthermore malnutrition affected both urban children 22 and rural children 43.Conclusion According to the present study children attending rural schools in Belagavi showed malnutrition more frequently compared to those attending urban schools. The present study will aid in determining the causes of malnutrition and the most effective ways to prevent it in both urban and rural settings.nbsp

Trends of the prevalence of malnutrition in India and Himachal Pradesh, a comparative assessment

Introduction: Malnutrition poses a significant threat to child health, with approximately 45% of under-five child deaths attributed to malnutrition, predominantly affecting low- and middle-income countries. This study delves into the trends of malnutrition in India and Himachal Pradesh, examining the interplay between infection and malnutrition and the escalating concern of overweight in developing countries. Objective:To compare malnutrition rates among under-5 children in Himachal Pradesh and India, utilizing data from the National Family Health Survey rounds (NFHS-3, NFHS-4, and NFHS-5). Additionally, the research seeks to identify districts in Himachal Pradesh with the poorest malnutrition indicators. Materials and Methods: A narrative description methodology is employed, utilizing NFHS fact sheets for India and Himachal Pradesh. The comparative analysis focuses on under-5 malnutrition indicators, including stunting, wasting, severe wasting,underweight, and overweight, with percentage distribution graphs for visual representation. Results: Wasting prevalence in Himachal Pradesh decreased from 19% in 2005 to 13.7% in 2015 but rose to 17.4% in 2019, with Kangra district showing a significant increase. Severe wasting increased in both India and Himachal Pradesh. Stunting decreased in India but increased in Himachal Pradesh, notably in Bilaspur district. Underweight declined in India but increased in Himachal Pradesh, primarily in Bilaspur district. Overweight showed an increasing trend in both India and Himachal Pradesh. Conclusion: Malnutrition,encompassing undernutrition and overnutrition, is escalating in India and Himachal Pradesh. While India exhibits declining trends in undernutrition, severe wasting is on the rise. Himachal Pradesh initially showed improvement but experienced a recent upturn in malnutrition indicators. Both regions face alarming rates of stunting and wasting, categorizing them as "very high" by United Nations International Children's Emergency Fund (UNICEF) standards. Despite various programs, efforts to alleviate child malnutrition have faltered.

Assessment of Nutritional Status of Patients on the Maintenance Hemodialysis at Tertiary Care Hospital using Malnutrition Inflammatory Score

Objective: To determine the frequency of protein energy wasting among end stage renal disease patients on maintenance hemodialysis.
 Study Design: Cross-sectional analytical study.
 Place and Duration of Study: Department of Nephrology, Pak Emirates Military Hospital, Rawalpindi Pakistan, from May 2019 to Mar 2020.
 Methodology: Two hundered patients diagnosed with end-stage renal disease on maintenance hemodialysis were included in the study. Protein-energy wasting was assessed using the Malnutrition inflammatory score comprising four x components: medical history, physical examination, laboratory parameters and body mass index. Malnutrition inflammatory score was used to categorize protein-energy wasting.
 Results: Out of 200 patients with ESRD on maintenance hemodialysis, 73(36.5%) patients had mild, 120(60.0 %) patients had moderate, and 7(3.5%) patients had severe protein-energy wasting. The advanced age group, multiple comorbid (diabetes mellitus, hypertension, ischemic heart disease), and duration of hemodialysis (> 2 years) had a statistically significant association with the protein energy wasting (p-value < 0.05). Protein-energy wasting was also more prevalent in patients with low monthly income (p-value 0.04).
 Conclusion: Protein-energy wasting is common among patients with end stage renal disease on maintenance hemodialysis.Old age group, multiple comorbid, and duration of hemodialysis are important risk factors.

Effects of Dietary Diversity on Growth Outcomes of Children Aged 6 to 23 Months in India: Evidence from National Family and Health Survey.

Low dietary diversity significantly interplays with children's growth failure. However, evidence of its crucial role in children's health remains inconclusive in developing countries such as India. This study attempts to find the association between dietary diversity and growth outcomes among children aged between 6 and 23 months in India using the fourth round of the National Family Health Survey (NFHS), 2015-2016. A total of 67,278 mother-child pairs of children between the ages of 6-23 months and mothers aged 15-49 years were included in this study. Pearson's chi-square significance test and multivariable logistic regression were used to determine the association between dietary diversity and child growth outcomes (stunted, wasted, and underweight). The study found that the prevalence of stunting and severe stunting among children aged between 6 and 23 months were 35.9% and 16.2%; 23.8% and 8.5% represented wasting, and severe wasting; and more than 32%, 10% were underweight and severely underweight respectively. This present study found that having an inadequate minimum dietary diversity (<4 food groups) significantly increases the risk of being stunted (adjusted odds ratio (AOR) = 1.29; 95% confidence interval (CI); 1.21-1.38), wasted (AOR = 1.29; 95% CI; 1.21-1.38), and underweight (AOR = 1.47; 95% CI; 1.39-1.56). Further, it was noted that children who did not intake dairy products, eggs, and other fruits and vegetables were more likely to be stunted, wasted, and underweight and more likely to be severely stunted, wasted, and underweight. Therefore, additional nutrition-specific interventions are urgently needed to strengthen and enhance existing feeding interventions aimed at improving infant and young child feeding (IYCF) practices, including complementary feeding practices among children aged between 6 and 23 months in India. The Government should focus such interventions more on states or regions where the prevalence of adequate minimum dietary diversity (MDD) and malnutrition is high.

Magnetic resonance quantification of skeletal muscle lipid infiltration in a humanized mouse model of Duchenne muscular dystrophy.

Rodent models of Duchenne muscular dystrophy (DMD) often do not recapitulate the severity of muscle wasting and resultant fibro-fatty infiltration observed in DMD patients. Having recently documented severe muscle wasting and fatty deposition in two preclinical models of muscular dystrophy (Dysferlin-null and mdx mice) through apolipoprotein E (ApoE) gene deletion without and with cholesterol-, triglyceride-rich Western diet supplementation, we sought to determine whether magnetic resonance imaging and spectroscopy (MRI and MRS, respectively) could be used to detect, characterize, and compare lipid deposition in mdx-ApoE knockout with mdx mice in a diet-dependent manner. MRI revealed that both mdx and mdx-ApoE mice exhibited elevated proton relaxation time constants (T2 ) in their lower hindlimbs irrespective of diet, indicating both chronic muscle damage and fatty tissue deposition. The mdx-ApoE mice on a Western diet (mdx-ApoEW ) presented with greatest fatty tissue infiltration in the posterior compartment of the hindlimb compared with other groups, as detected by MRI/MRS. High-resolution magic angle spinning confirmed elevated lipid deposition in the posterior compartments of mdx-ApoEW mice in vivo and ex vivo, respectively. In conclusion, the mdx-ApoEW model recapitulates some of the extreme fatty tissue deposition observed clinically in DMD muscle but typically absent in mdx mice. This preclinical model will help facilitate the development of new imaging modalities directly relevant to the image contrast generated in DMD, and help to refine MR-based biomarkers and their relationship to tissue structure and disease progression.

Prevalence of Tuberculosis in Severe Acute Malnutrition: A Prospective Observational Study

Introduction: Tuberculosis (TB) and malnutrition are important causes of morbidity and mortality in children in the developing world. This study was done to determine the prevalence of tuberculosis in severe acute malnutrition (SAM) cases and to observe different presentations of SAM. Method: This prospective observational study was carried out in the Department of Paediatrics and Adolescent Medicine at a tertiary care center in Nepal for a duration of one year from December 2018 to November 2019. All cases of SAM meeting the inclusion criteria were evaluated with Mantoux test, chest X-ray, gastric aspirate / sputum analysis and gene-Xpert for diagnosis of TB. Other relevant investigations for diagnosis of TB were also sent as per the clinical scenario. Data were entered and analyzed using Microsoft excel. Descriptive statistics was used for analysis of data. Results: Total 107 SAM cases were analyzed. The hospital prevalence of wasting and severe wasting was 11.98% and 0.73% respectively. The prevalence of TB in SAM was 4.67%, commonest being pulmonary TB (60%). Among TB cases, 40% were without any systemic complaints. Only 19.6% cases presented with nutritional complaint. Conclusions: This study found that a significant percentage of cases with SAM had TB and hence adds on the importance of screening for TB (Pulmonary TB) in every case of SAM, irrespective of symptoms.

Prevalence and determinants of wasting of under-5 children in Bangladesh: Quantile regression approach.

Wasting is perhaps one of the signs of malnutrition that has been linked to the deaths of children suffering from malnutrition. As a result, understanding its correlations and drivers is critical. Using quantile regression analysis, this research aims to contribute to the discussion on under-5 malnutrition by analyzing the predictors of wasting in Bangladesh. The dataset was extracted from the 2017-18 Bangladesh demographic and health survey (BDHS) data. The weight-for-height (WHZ) z-score based anthropometric indicator was used in the study as the target variable. The weighted sample constitutes 8,334 children of under-5 years. However, after cleaning the missing values, the analysis is based on 8,321 children. Sequential quantile regression was used for finding the contributing factors. The findings of this study depict that the prevalence of wasting in children is about 8 percent and only approximately one percent of children are severely wasted in Bangladesh. Age, mother's BMI, and parental educational qualification, are all major factors of the WHZ score of a child. The coefficient of the female child increased from 0.1 to 0.2 quantiles before dropping to 0.75 quantile. For a child aged up to three years, the coefficients have a declining tendency up to the 0.5 quantile, then an increasing trend. Children who come from the richest households had 16.3%, 3.6%, and 15.7% higher WHZ scores respectively than children come from the poorest households suggesting that the risk of severe wasting in children under the age of five was lower in children from the wealthiest families than in children from the poorest families. The long-term malnutrition indicator (wasting) will be influenced by the presence of various childhood infections and vaccinations. Furthermore, a family's economic position is a key determinant in influencing a child's WHZ score. It is concluded that socioeconomic characteristics are correlated with the wasting status of a child. Maternal characteristics also played an important role to reduce the burden of malnutrition. Thus, maternal nutritional awareness might reduce the risk of malnutrition in children. Moreover, the findings disclose that to enrich the nutritional status of children along with achieving Sustainable Development Goal (SDG)-3 by 2030, a collaborative approach should necessarily be taken by the government of Bangladesh, and non-governmental organizations (NGOs) at the community level in Bangladesh.

Duchenne muscular dystrophy involves the myocardium and causes arrhythmia: Case report

Patients with muscular dystrophy have mutations in the gene that can lead to severe muscle wasting, respiratory issues or heart failure between ages 30 and 40. Currently, there is no effective treatment for DMD-induced heart failure. We report a patient with recurrent unexplained fever and muscle soreness was definitely diagnosed with DMD. An analysis of the patient's genetics revealed a nonsense mutation (C.1207G > T). His DMD was treated with hormones. Also, the patient's fever is under control because of hormone therapy. However, as the disease progresses, the heart structure and function gradually change, and eventually malignant arrhythmias occur. We report a rare case of DMD involving the heart causing heart failure and malignant arrhythmia. Currently, no complete treatment is available for these patients, but our treatment regimen may benefit our patient and improve his outcomes.

Preventive small-quantity lipid-based nutrient supplements reduce severe wasting and severe stunting among young children: an individual participant data meta-analysis of randomized controlled trials

Meta-analyses show that small-quantity lipid-based nutrient supplements (SQ-LNSs) reduce child wasting and stunting. There is little information regarding effects on severe wasting or stunting. We aimed to identify the effect of SQ-LNSs on prevalence of severe wasting (weight-for-length z score < -3) and severe stunting (length-for-age z score < -3). We conducted a 2-stage meta-analysis of individual participant data from 14 randomized controlled trials of SQ-LNSs provided to children 6-24 mo of age. We generated study-specific and subgroup estimates of SQ-LNS compared with control and pooled the estimates using fixed-effects models. We used random-effects meta-regression to examine study-level effect modifiers. In sensitivity analyses, we examined whether results differed depending on study arm inclusion criteria and types of comparisons. SQ-LNS provision led to a relative reduction of 31% in severe wasting [prevalence ratio (PR): 0.69; 95% CI: 0.55, 0.86; n = 34,373] and 17% in severe stunting (PR: 0.83; 95% CI: 0.78, 0.90; n = 36,795) at endline. Results were similar in most of the sensitivity analyses but somewhat attenuated when comparisons using passive control arms were excluded (PR: 0.74; 95% CI: 0.57, 0.96; n = 26,327 for severe wasting and PR: 0.88; 95% CI: 0.81, 0.95; n = 28,742 for severe stunting). Study-level characteristics generally did not significantly modify the effects of SQ-LNSs, but results suggested greater effects of SQ-LNSs in sites with greater burdens of wasting or stunting, or with poorer water quality or sanitation. Including SQ-LNSs in preventive interventions to promote healthy child growth and development is likely to reduce rates of severe wasting and stunting. This meta-analysis was registered at www.crd.york.ac.uk/PROSPERO as CRD42019146592.

How does flooding affect the nutritional status of children in floodplain regions? A cross-sectional study from Assam, India

Flood is an annual phenomenon in Assam. This study aims to understand the after flood effects on children in the worst flood-hit districts of Assam during the last decades most devastating flood where more than 1,00,000 people were affected. A cross sectional population-based study was done covering 7512 children of 0–12 years of age in 35 worse flood-affected villages in three districts of lower Assam for nutritional risk profiling, low birth weight and morbidity pattern. Anthropometric measurements of the children were compared with standard WHO definitions for nutritional risk profiling. ANOVA was conducted to see any relationship of nutritional status between the age groups and BMI for the districts. Two-factor ANOVA to analyse the effect of ARI on the morbidity status of different districts was done. District-wise and village-wise heat maps were generated to understand different nutritional parameters for analysing which areas within each district are more affected and why. The moderate (< 2SD) and severely underweight (< 3SD) children under 5 years of age were highest in the Barpeta district (45.5% and 24.2% respectively). The moderate and severe stunting was highest in Morigaon (47.6%) and Barpeta (24.3%) respectively. The moderate and severe wasting was highest in the Morigaon district (46.1% and 20.6% respectively). All the nutritional indicators were less than the WHO standard. The age-wise and district-wise distribution of nutritional status shows variations in all three districts. Severe underweight was observed highest among 24–35 months’ children (50.9%) in Barpeta. The moderate and severe undernutrition status was found to be higher among the age group of 10–12 years of age compared to 5 to 10 years. This survey has provided a comprehensive picture of the nutritional status of the targeted children in the worst flood-affected areas. However, attention to its impact on health particularly among those exposed at very early stages in life is still lacking. This kind of rapid assessment helps to understand the health and nutritional status of the vulnerable groups in a deeper way and to plan robust region-specific interventions.

Six in ten children with epilepsy visiting the University of Gondar comprehensive specialized hospital were undernourished: a cross-sectional study

BackgroundThe burden of undernutrition among children with epilepsy in low- and middle-income countries is not well studied. This study aimed to assess the magnitude of undernutrition and associated factors among children with epilepsy at the University of Gondar Comprehensive and Specialized Hospital, Northwest Ethiopia.MethodA single-center cross-sectional study was conducted on 239 epileptic children with epilepsy visiting the University of Gondar Comprehensive Specialized Hospital pediatric neurology clinic from June 2021 to September 2021. A pre-tested, researcher-administered questionnaire and medical record review were used for data collection. We included all participants who fulfilled the inclusion criteria. We did anthropometric measurements and defined undernutrition based on the world health organization criteria. Binary and multivariable logistic regressions were employed to determine factors associated with undernutrition. The statistical association between dependent and independent variables was declared at p-value of ≤ 0.05.ResultThe mean(+/-SD) age was 9.38 ± 0.29 years, with a male to female ratio of 1.8: 1, and school-age children account for 35.6%. The overall magnitude of undernutrition was 141(59%) of which 89(63.1%) had moderate to severe stunting, 91(64.5%) moderate to severe wasting, and 39(27.7%) had both. Being male (AOR = 1.96, 95%CI, 1.05–3.69), low paternal level of education (AOR = 1.88, 95%CI, 1.01–3.50), presence of delay in motor development (AOR = 5.91,95%CI, 1.55–22.49), and gum hyperplasia (AOR = 0.32,95%CI, 0.12–0.81), were significantly associated with undernutrition.ConclusionThe magnitude of undernutrition among children with epilepsy was high. Male sex, low paternal level of education, presence of delay in motor development, and gum hyperplasia were significantly associated with undernutrition. Therefore, nutritional screening and intervention are recommended to be part of routine epileptic care.

Severe acute malnutrition outcomes for children of South African compared to foreign-born parents admitted to a rural regional hospital in South Africa: a retrospective cohort study.

Children of foreign-born parents with vulnerable legal status, limited economic rights and exclusion from national social interventions may be at higher risk for severe acute malnutrition (SAM). We evaluated the relationship between parent status (foreign-born vs. South African) and outcomes for children with SAM admitted to a rural regional hospital in the Western Cape, South Africa. A retrospective cohort study was conducted including children &lt;5 years admitted to Worcester Provincial Hospital during 2015-17 with SAM (WHO weight-for-height Z score &lt;-3, presence of nutritional oedema, mid-upper-arm-circumference of &lt;11.5 cm or visible severe wasting). Exposures, including parent status, and outcomes including in-hospital death were determined from hospital and regional dietician records. Of 95 children included, 31 (33%) were of foreign-born and 64 (67%) of South African parents. Median (interquartile range) age at admission was 12 (8-18) vs. 10 (8-13) months in children of South African vs. foreign-born parents with no difference in preterm birth, concurrent illnesses or admission duration. Age, HIV status and breastfeeding practices were no different in foreign-born compared to South African mothers. In-hospital deaths occurred in 3/64 (5%) and 6/31 (19%) children of South African vs. foreign-born parents (p = 0.01). Children of foreign-born compared to South African parents had an odds ratio of 4.88 (95% CI 1.13-21.06) for in-hospital SAM-associated mortality. In this rural setting, 33% of children admitted with SAM were of foreign-born parents and experienced in-hospital SAM-associated mortality at least four times higher than children of South African parents. This illustrates the extreme vulnerability of these children.

Intersectional Inequalities in Anthropometric Failure among Indian Children: Evidence from the National Family Health Survey (2015-2016).

Increasing body of health planning and policy research focused upon unravelling the fundamental drivers of population health and nutrition inequities, such as wealth status, educational status, caste/ethnicity, gender, place of residence, and geographical context, that often interact to produce health inequalities. However, very few studies have employed intersectional framework to explicitly demonstrate how intersecting dimensions of privilege, power, and resources form the burden of anthropometric failures of children among low-and-middle income countries including India. Data on 2,15,554 sampled children below 5 years of age from the National Family Health Survey 2015-2016 were analysed. This study employed intersectional approach to examine caste group inequalities in the anthropometric failure (i.e. moderate stunting, severe stunting, moderate underweight, severe underweight, moderate wasting, severe wasting) among children in India. Descriptive statistics and multinomial logistic regression models were fitted to investigate the heterogeneities in the burden of anthropometric failure across demographic, socioeconomic and contextual factors. Interaction effects were estimated to model the joint effects of socioeconomic position (household wealth, maternal education, urban/rural residence and geographical region) and caste groups with the likelihood of anthropometric failure among children.More than half of under-5 children suffered from anthropometric failure in India. Net of the demographic and socioeconomic characteristics, children from the disadvantageous caste groups whose mother were illiterate, belonged to economically poor households, resided in the rural areas, and coming from the central and eastern regions experienced disproportionately higher risk of anthropometric failure than their counterparts in India. Concerted policy processes must recognize the existing heterogeneities between and within population groups to improve the precision targeting of the beneficiary and enhance the efficiency of the nutritional program among under-5 children, particularly for the historically marginalized caste groups in India.

Cost-effectiveness of routine versus indicated antibiotic therapy in the management of severe wasting in children

BackgroundIn the outpatient management of severe wasting, routine antibiotic therapy is recommended for all children upon admission regardless of whether clinical signs of infection are present. Indicated antibiotic therapy, where antibiotics are provided only upon presentation of clinical signs of infection, may be considered for its potential to allow for more prudent antibiotic use and greater program coverage, reducing the risk of antibiotic resistance as well as costs and logistical burdens associated with treatment. We therefore conducted a cost-effectiveness analysis to measure the effects of indicated antibiotic therapy compared to routine antibiotic therapy in terms of incremental cost-per-life-year saved in Niger.MethodsWe used a cohort model to conduct a cost-effectiveness analysis from a healthcare system perspective to project and weigh the lifetime discounted costs and effects of indicated antibiotic therapy compared to routine antibiotic therapy in the treatment of uncomplicated severe wasting in children in Niger. We calculated incremental cost-effectiveness ratios (ICERs) in terms of treatment-related healthcare costs per discounted life-years saved (LYS), and conducted program coverage scenario and sensitivity analyses to assess model uncertainty.ResultsThe ICER for indicated antibiotic therapy compared to routine antibiotic therapy was $8.5/LYS, which is under the cost-effectiveness threshold for Niger. The probability of the indicated strategy being optimal was 76.1% when program coverage was equal to coverage associated with routine therapy but was 100% likely to be optimal in probabilistic sensitivity analysis scenarios where indicated program coverage improved 5 percentage points.ConclusionsIndicated antibiotic therapy likely represents a cost-effective strategy, particularly if indicated treatment can result in expanded coverage. With the risk of increasing antibiotic resistance worldwide, antibiotic stewardship and simplified treatment protocols for severe wasting using indicated antibiotic therapy may represent good value for money in some low risk populations.

Association between anthropometric criteria and body composition among children aged 6–59 months with severe acute malnutrition: a cross-sectional assessment from India

A multicentric study is being conducted in which children with severe acute malnutrition (SAM) aged 6–59 months are identified with only weight-for-height z-score (WHZ) < − 3 criteria. The present study aimed to assess associations of anthropometric parameters and body composition parameters, to improve treatment of SAM. We conducted a cross-section assessment using the enrolment data of children who participated in a multi-centric longitudinal controlled study from five Indian states. Fat-free mass (FFM) and fat mass (FM) were determined by bio-electrical impedance analysis (BIA). Six hundred fifty-nine children were enrolled in the study using WHZ < -3 criteria. Available data shows that WHZ, WAZ and BMIZ were significantly associated with FFMI while MUACZ was significantly associated with both FMI and FFMI. Children with both severe wasting and severe stunting had significantly lower FFMI compared to those who were only severely wasted. All forms of anthropometric deficits appear to adversely impact FFM and FM.Trial registrationThe study is registered with Clinical Trial Registration of India (Registration No.: CTRI/2020/09/028013 dated 24/09/2020).

Prevalence of malnutrition among children under five years in Babylon Government, Iraq

Background: since 2003, Iraq's fragile geopolitical situation has harmed people's health, especially children. Some factors may have an impact on a child's nutritional status. The research goal is to determine the prevalence of malnutrition among children aged 6 to 59 months in a comprehensive sample of children in Babylon. Materials and Methods: This cross-sectional study focuses on the prevalence of malnutrition in children under the age of five at primary health care centers in Al- Hilla city's urban and rural areas. From November 1st, 2021, the research will take time until March 1st, 2022. After receiving their permission, the data was obtained using an auto-self questionnaire with a series of questions and an interview with moms and children. This interview lasts 10–15 minutes for each kid and is used to determine the prevalence of malnutrition in childhood. The prevalence of severe wasting (1.3%), underweight (1.3%), stunting (6.5%), and severe stunting (5.2%) was seen in both genders. The total prevalence of malnutrition among children under the age of five was determined to be 14.3%.

Nutritional status of under five children among Rural and Urban community of East Sikkim

Context: Nutrition plays a vital role in growth and development of children. Inadequate nutrition may lead to malnutrition, growth retardation, reduced work capacity and poor mental and social development Malnutrition refers to deficiencies, excesses or imbalances in a person’s intake of energy and/or nutrients. Overall, under nutrition represents the single largest killer of under-five children, being responsible for 3.1 million child deaths each year (45% of the total 4. under 5 years' deaths)Aims & Objectives: A descriptive, comparative study was conducted with the objectives to assess the nutritional status of under five children: to compare the nutritional status of under five children among rural and urban community and to see the association between the demographic Performa for rural and urban community Methods: The study periods were one year. A total of 150 under five from rural and urban community comprise of the study population. 75 children were from each community. Non-probability purposive sampling was used. Data entry and statistical analysis was performed with the help of SPSS version 2.0. Height –for –age, weight-for-age, and weight-for-height was done using WHO z-Score and mid upper arm circumference was analyse using UNICEF mid upper arm circumference gradingResults: Finding shows that the nutritional status of under-five was found for weight for age in rural community were 62% were Normal, 25.3% were moderately undernourished, 12% were severely under nourished where as 67% were normal, 18.7% were moderately and 5.3% were under nourished. For height for age on rural community were 53% were normal 37.3% were moderately stunting and 9.3% were severe stunting and in urban community 56% were normal, 36% were moderately stunting and 8% were severe stunting. For weight for height on rural community were 53% were normal 37.3% were moderately wasting and 9.3% were severe wasting and in urban community 56% were normal, 36% were moderately wasting and 8% were severe wasting by WHO Z score. For Mid upper arm circumference 78.6% in urban and 72% in rural community were well nourished, 18.7% and 22.7% were moderately under nourished and 2.7% were in rural and 5.3% in urban community were severally acute malnourished and while comparing the nutritional status, we can conclude that the mean score for WAZ (µ=14.22), HAZ (µ=93.09) and MUAC (µ=13.44) for urban and WAZ (µ=13.38), HAZ (µ=90.55) AND MUAC (µ=13.23) for rural community respective standard deviation and with obtained t-value which is not significant. There is no significance difference between rural and urban under-five children with respect to nutritional indicator. However, the nutritional status of Under-five among urban community are certainly better then rural community in comparison with mean score. Conclusions: The major conclusion of the study drawn on the basis of the finding was that the majority of the children from both the communities were normal for their weight for age, height for age, weight for height and mid upper arm circumference, also recognized that there was a difference between nutritional status of children living in rural and urban community.