Therapeutic Feeding Research Articles

NUTRITIONAL AND METABOLIC CORRECTION IN THE INTENSIVE THERAPY OF PERITONITIS

Introduction. The current concept of the metabolic and nutritional support of patients with peritonitis considers the early enteral administration of corrective solutions, special pharmaconutrients, and feeding formulas as a component of the pathogenetic treatment that contributes to recovery of the intestinal morphofunctional status, to resolution of intestinal failure (IF), to correction of metabolic disturbances, and to adequate provision of the body’s energy-plastic needs. Objective: to improve treatment results in patients with peritonitis due to early enteral feeding of special formulas in order to resolve IF and to correction of nutritional and metabolic disorders. Subjects and methods. A unicenter randomized study was conducted in 54 patients with generalized purulent peritonitis. In Group 1 (a comparison group; n = 25), enteral therapy for IF encompassed intestinal lavage, enterosorption, stepwise intraintestinal administration of glucose saline solution (3–4 days) and then the standard formula Nutrient Standard (1.0 kcal/ml) (5–6 days). In Group 2 (a study group; n = 29), the multi-elemental (oligopeptide) formula Nutrient Elemental was used in the first step and switched to the metabolic formula Nutrient Hepa in the second step, and then to the standard balanced nutrition formula Nutrient Standard. Hemodynamic parameters, oxygen budget, volemia, metabolism, immune system, gastrointestinal function, levels of enzymes, and hormonal status were studied. Results. In Group 2 patients, the processes of absorption of glucose saline ingredients started to recover on days 2–3 and those of digestion of the semi-elemental formula Nutrient Elemental did on days 3–4. The early enteral feeding of the semi-elemental formula in combination with a formula with a high content of branched amino acids and the lowest level of aromatic amino acids, and the presence of serum proteins facilitated the resolution of IF within a shorter time period than in Group 1 patients and could also adequately meet the body’s energy and plastic needs. Conclusion. Active small bowel decompression, intestinal lavage, enterosorption in combination with artificial therapeutic feeding that has been properly selected and performed in accordance with the given technology with the obligatory and early inclusion of a semi-elemental nutrition formula are shown to be powerful therapeutic factors that contribute to the resolution of IF and thus to the improvement of the results of peritonitis treatment.

Analysis of Hospital Records on Treatment Outcome of Severe Acute Malnutrition: The Case of Gondar University Tertiary Hospital

Introduction: Globally severe acute malnutrition affects most children aged under five years old. Particularly those who are living in the developing world and in the extreme poverty regions were affected more. Objective: To assess treatment outcome and associated factors of severe acute malnutrition among under five children in Gondar University tertiary Hospital. Methods: A cross sectional analysis of two years record was done in Gondar University tertiary Hospital among under five years old children with severe acute malnutrition who were registered between September 2010 and August 2012. Data was collected from 298 patient charts and registration book by using data extraction format which was prepared based on the world health organization standardized manual. Data were entered in to EPI info version 3.5.3 and analyzed by using SPSS for window version 20. Result: The finding of this study indicated that 68.5% of children were cured and discharged, 19.8% were defaulters and 11.7% were died. Severely wasted and severely stunted patients were 57.3% and 44.6% respectively. Children with acute gastroenteritis and HIV co morbidities were nearly three and ten times more likely to die respectively compared with their counter parts. Conclusion and recommendation: All treatment outcomes are below the acceptable range of global SPHERE standards. The hospital should monitor and evaluate therapeutic feeding program to improve treatment outcome and give emphasis for cases with co morbidities especially acute gastroenteritis and HIV.

Predictors of nutritional recovery time and survival status among children with severe acute malnutrition who have been managed in therapeutic feeding centers, Southern Ethiopia: retrospective cohort study.

BackgroundMalnutrition remains to be one of the most common causes of morbidity and mortality among children in developing countries. The prevalence of wasting in Ethiopia remained about 10 % for the past ten years. Mortality rate of children with severe acute malnutrition treated in inpatient set ups has remained unacceptably high.MethodsA retrospective cohort study was conducted in Southern Ethiopia. The study population were children with severe acute malnutrition aged from 6 to 59 months who have been managed at Karat and Fasha stabilization centers between September 30, 2013, and Sep. 29, 2014. The total sample size was 420 and pretested questionnaire was used. Kaplan Meier analysis was used to estimate time to nutritional recovery and Cox proportional-hazard regression analysis was carried out to determine independent predictors.ResultsNutritional recovery rate was 3.61 per 100 person day observations. Median nutritional recovery time was 22 and 29 days for edematous malnourished and severely wasted children respectively. The independent predictors of nutritional recovery rate were: stabilization center (AHR = 1.4, 95 % CI: 1.1–1.7), malnutrition status (AHR = 1.8, 95 % CI: 1.3–2.4), weight (AHR = 1.5, 95 % CI: 1.2–1.9), mid- upper arm circumference (AHR = 1.4, 95 % CI: 1.1–1.9), inpatient complications (AHR = 2.2, 95 % CI: 1.4–3.5) and did not lose edema within four days of inpatient treatment (AHR = 2.3, 95 % CI: 1.1–4.8).ConclusionsThe findings of this study confirm the probability of surviving gets slimmer with inpatient complications and staying longer in stabilization centers. So, to prevent complications and enhance recovery rate due emphasis should be given in improving early detection and treatment of severely malnourished children in Ethiopia.

Comparison of Clinical Characteristics and Treatment Outcomes of Children Selected for Treatment of Severe Acute Malnutrition Using Mid Upper Arm Circumference and/or Weight-for-Height Z-Score

ObjectivesDebate for a greater role of mid-upper arm circumference (MUAC) measures in nutritional programming continues, but a shift from therapeutic feeding programs admitting children using MUAC and/or weight-for-height Z (WHZ) to a new model admitting children using MUAC only remains complicated by limited information regarding the clinical profile and response to treatment of children selected by MUAC vs. WHZ. To broaden our understanding of how children identified for therapeutic feeding by MUAC and/or WHZ may differ, we aimed to investigate differences between children identified for therapeutic feeding by MUAC and/or WHZ in terms of demographic, anthropometric, clinical, and laboratory and treatment response characteristics.MethodsUsing secondary data from a randomized trial in rural Niger among children with uncomplicated severe acute malnutrition, we compared children that would be admitted to a therapeutic feeding program that used a single anthropometric criterion of MUAC< 115 mm vs. children that are admitted under current admission criteria (WHZ< -3 and/or MUAC< 115 mm) but would be excluded from a program that used a single MUAC< 115 mm admission criterion. We assessed differences between groups using multivariate regression, employing linear regression for continuous outcomes and log-binomial regression for dichotomous outcomes.ResultsWe found no difference in terms of clinical and laboratory characteristics and discharge outcomes evaluated between children that would be included in a MUAC< 115 mm therapeutic feeding program vs. children that are currently eligible for therapeutic feeding but would be excluded from a MUAC-only program.ConclusionsA single anthropometric admission criterion of MUAC < 115 mm did not differentiate well between children in terms of clinical or laboratory measures or program outcomes in this context. If nutritional programming is to use a single MUAC-based criterion for admission to treatment, further research and program experience can help to identify the most appropriate criterion in a broad range of contexts to target children in most urgent need of treatment.

Recovery Rate and Determinants in Treatment of Children with Severe Acute Malnutrition using Outpatient Therapeutic Feeding Program in Kamba District, South West Ethiopia

Introduction: Globally approximately one million children die every year from severe acute malnutrition. It is reported that severe acute malnutrition(SAM) is the commonest reason for paediatric hospital admission in many poor countries; 25 to 30% of children with severe malnutrition die during hospital admissions. Objective: To assess the success rate of OTP in treatment of children with SAM and identify its determinants at Kamba district, South West Ethiopia. Method: Institution based retrospective longitudinal study was carried out on children who were treated on the OTP. A total sample of 711 was selected from 4 health centers and 12 satellite health posts. A structured and pretested data abstraction form were prepared and used for data collection. The data were cleaned, coded and entered into Epi-INFO, analyzed by SPSS. The results were estimated using Kaplan-Meier survival curves, log-rank test and Cox-regression. Result: The recovery rate was 67.7% and the median recovery time was 7.14 weeks (IQR 5.28-8.14). Children treated at a health centers have 1.36 times higher recovery rate than children treated at health post (AHR = 1.495, 95% CI = 1.188, 1.881). Controlling for other factors; the probability of a child to recover from SAM under OTP is 1.25 times higher among children aged greater than two years old than those children aged less than or equal to two years old (AHR = 1.255, 95% CI = 1.012, 1.556). Conclusion and Recommendation: The recovery rate was lower than the international standard. Type of health facility providing the OTP services and age of the child had significant association (at 0.05 P-value) with survival time among children who recovered from SAM under OTP. Special focus should be given to young children and decentralization of OTP service from health centers to health posts should be carried out with great caution.

Factors Contributing to Lower than Expected Recovery Rates of HIV Negative Children on the Therapeutic Feeding Program

The study sought to find out factors contributing to lower than expected recovery rates of HIV negative children on the therapeutic feeding program. Qualitative design was employed. Twenty (20) caregivers were interviewed at Gweru District Health Offices in Zimbabwe. Findings indicated that socio-economic factors, level of education and caring practices of the caregiver and the cultural practices to a larger extent contributed to the lower than expected recovery rates of HIV negative children on the therapeutic feeding program. Epi Info, used as database software showed that the exposure variables had an association with the outcome (recovery). Stunted children had 89% less chances of recovering, breast feeding children had 83% more chances of recovering unlike those not breast fed. Socio demographic factors had more impact on the recovery of the child. The Zimbabwean government should spend more money on quality nutritional programs to improve the state of malnutrition. More nutrition campaign is inevitable in an effort to promote health.

How do the new WHO discharge criteria for the treatment of severe acute malnutrition affect the performance of therapeutic feeding programmes? New evidence from India.

Background/Objectives:To assesses how the introduction of new WHO discharge criteria for the treatment of severe acute malnutrition (SAM) may affect the performance of therapeutic feeding programmes in India.Subjects/Methods:The analysis concerns 6041 children admitted to Nutrition Rehabilitation Centers (NRCs) in Jharkhand, Madhya Pradesh and Uttar Pradesh between 1 July 2009 and 31 December 2011.Results:A total of 217 children (3.6%) had bilateral pitting oedema, 1803 (29.8%) had severe wasting with medical complications, 4021 (66.6%) had uncomplicated severe wasting and 4810 (79.7%) were in the age group 6–23 months old. The programme has high survival (>99%), default (⩾15%) and discharge (>75%) rates. The use of weight gain ⩾15% as recovery criteria (old criteria) translates into recovery rates in NRCs that range from 33.6% for children admitted with weight-for-height z-score (WHZ) ⩽−3 to 35.2% for children admitted with mid-upper-arm circumference (MUAC) <115 mm. The use of WHZ ⩾−2 as recovery criteria reduces recovery rates by ~2-fold (17.5%) while the use of MUAC ⩾125 mm as recovery criteria reduces recovery rates by 3.5-fold (10%). The new criteria tends to keep longer in the programme children who are younger and/or have poorer anthropometry at admission (that is, more vulnerable).Conclusions:The new WHO discharge criteria reduce the recovery rates currently reported by programmes for the treatment of children with SAM in India. However, their introduction in the programme practice will increase programme impact—particularly if accompanied by a general improvement in the strategy and protocols currently used—as they prioritize the most vulnerable children.

Spontaneously relapsing–remitting experimental autoimmune uveitis in rats allows successful therapeutic oral tolerance induction in ongoing disease

Antigen-specific tolerance induction is a desired therapy for uveitis patients. Our relapsing–remitting rat model of experimental autoimmune uveitis (EAU) induced with IRBP peptide R14 enables us to test the effect of oral tolerance on the prevention of relapsing uveitis. We investigated several peptides overlapping the sequence of R14 for prevention and different doses of R14 for therapy to determine the tolerogenic epitope and the most effective therapeutic regimen for uveitis. Lewis rats were immunized with R14-CFA to induce EAU. Oral tolerance was induced prior to immunization (prevention) or after onset of EAU to prevent relapses (therapy). Therapeutic feeding was performed with high and/or low doses of oral antigen for clonal deletion of effector and induction of regulatory T cells. Uveitis was determined clinically and histologically; mesenteric lymph node (mLN) cells of tolerized rats were tested for surface markers, cytokines and Foxp3 expression. Preventive feeding of R14 and its major epitope R16, but none of the overlapping peptides significantly suppressed EAU and also prevented relapses, irrespective of their pathogenicity. Therapeutic feeding with R14 dramatically reduced relapses, while only the consecutive feeding of high and low-dose R14 had an ameliorating effect on the first course of disease. IL-10-producing T cells from mLN decreased after oral tolerization, and with R14-stimulation in vitro the TCRαβ+/Foxp3+ population increased in the low-dose fed group. No mLN population could be clearly assigned to successful oral tolerance induction during active autoimmune uveitis.

Implementing WHO feeding guidelines for inpatient management of malnourished children.

To evaluate the efficacy of adopting WHO feeding guidelines on weight gain and case fatality rate in malnourished children. Cross-sectional, observational study. Department of Pediatrics, Dow University of Health Sciences, Karachi, from 2009 to 2010. Patients above 6 months and less than 5 years of age with severe malnutrition were included during the study period, acute complications were treated and nutritional rehabilitation by WHO feeding formulae was done. Demographic details, clinical features, reasons for weight gain and risk factors of mortality were analyzed. A total of 131 children were included. Mean age of children was 22 ± 18 months. There were 78% marasmic, 4% kwashiorkor and marasmic kwashiorkor 18% children. Resolution of edema took 8 ± 4 days, dermatosis cleared in 11 ± 3 days. Mean hospital stay was 10 ± 8 days. Case fatality rate was 13%. Mean weight gain was 5.25 ± 4.57 g/kg/day. Weight gain of > 5 gm/kg/day was associated with hospital stay of more than 7 days, acceptability and palatability of feed by the children and mothers and early clearance of infections. Implementation of WHO feeding guidelines resulted in adequate weight gain of inpatient malnourished children, however, adequate healthcare services are available at the therapeutic feeding centers.

A new way to measure mid-upper-arm circumference in african villages.

In 2011 we published a study on how to detect the threshold for malnutrition in children, simply using their own hands and without any technical tool. The fight against malnutrition can only be reached when its measurements involve every single child, almost continuously, in the affected villages. In this paper we try to show that, thanks to our method, it is possible to use mid-upper-arm-circumference as a measurement for malnutrition in children, discriminating between severe and moderate malnutrition and providing the basis for the decision on whether to admit a child to a nutritional rehabilitation unit or not. We trained 63 participants in four groups (Group 1: doctors and clinical officers; Group 2: nurses and students; as Group 3 we defined the 20 best participants and Group 4 consisted of 10 more intensely trained participants) to measure the circumference of 9 different artificial arms (between 9 and 13 cm) using their own fingers and hands. The training was short and consisted of an introduction of 5 min, a first training phase of 10-15 min, a test, the critical discussion of the results, a second training phase of 5 min and a final test. We found that 95.3% of participants in the general group and 97.9% in the intensely trained group have identified the severely malnourished child; 87.3% in the general group and 91.9% in the intensely trained group have additionally identified the moderately malnourished child. Both groups haven’t admitted the well nourished child to a therapeutic feeding program retaining their resources. The third group reached without any additional training the results in the above categories. A subsequent discussion with the participants on the influence of procurement, maintenance and pricing of our tool, found our method much less vulnerable than others. We conclude that this method should be considered as a future training in the villages to detect the trend towards malnutrition early enough.

Financial costs of Mama‐SASHA ő a project to improve health and nutrition through an integrated orange flesh sweet potato production and health service delivery model (132.6)

Mama‐SASHA project aims to improve the health status of pregnant women and nutritional status of children up to two years through an integrated orange‐flesh sweet potato (OFSP) and health service delivery strategy in Western Kenya. Nutrition education and vouchers for OFSP vines are provided during antenatal care visits, with additional nutrition education and support provided in the communities and through pregnant mothers clubs (PMCs). The purpose of this study is to analyze the financial costs of the Mama‐SASHA project. We use a microcosting approach based on project expense reports to estimate financial costs during the period 2011‐2013, allocating costs by activity and inputs by implementing organization. Project monitoring data were used to estimate project output and number of beneficiaries reached. Financial costs were incurred by two agricultural NGOs and one health NGO, totaling $344,860 (USD). Over 5,400 women participated in monthly PMCs at a cost of $63 per woman. Of 4,629 women who received vouchers, 3,281 women redeemed vouchers and planted OFSP at a cost of $105 per beneficiary. There are limited comparable cost estimates in the literature; however, this estimate falls in the range of published cost estimates for community‐based therapeutic feeding programs supported by community health workers with some referrals to health centers.

Health Sector Initiatives for Disaster Risk Management in Ethiopia: A Narrative Review

Background: Natural and man-made disasters are prevailing in Ethiopia mainly due to drought, floods, landslides, earthquake, volcanic eruptions, and disease epidemics. Few studies so far have critically reviewed about medical responses to disasters and little information exists pertaining to the initiatives being undertaken by health sector from the perspective of basic disaster management cycle. This article aimed to review emergency health responses to disasters and other related interventions which have been undertaken in the health sector. Methods: Relevant documents were identified by searches in the websites of different sectors in Ethiopian and international non-governmental organizations and United Nations agencies. Using selected keywords, articles were also searched in the data bases of Medline, CINAHL, Scopus, and Google Scholar. In addition, pertinent articles from non-indexed journals were referred to. Results: Disaster management system in Ethiopia focused on response, recovery, and rehabilitation from 1974 to 1988; while the period between 1988 and 1993 marked the transition phase towards a more comprehensive approach. Theoretically, from 1993 onwards, the disaster management system has fully integrated the mitigation, prevention, and preparedness phases into already existing response and recovery approach, particularly for drought. This policy has changed the emergency response practices and the health sector has taken some initiatives in the area of emergency health care. Hence, drought early warning system, therapeutic feeding program in hospitals, health centers and posts in drought prone areas to manage promptly acute malnutrition cases have all been put in place. In addition, public health disease emergencies have been responded to at all levels of health care system. Conclusions: Emergency health responses to drought and its ramifications such as acute malnutrition and epidemics have become more comprehensive in the context of basic disaster management phases; and impacts of drought and epidemics seem to be declining. However, the remaining challenge is to address disasters arising from other hazards such as flooding in terms of mitigation, prevention, preparedness and integrating them in the health care system. Key Words: Disaster, Emergency Health, Health System, Ethiopia

Treatment Outcomes and Associated Risk Factors of Severely Malnourished under Five Children Admitted to Therapeutic Feeding Centers of Mekelle City, Northern Ethiopia

Background: Despite presence of clinical management protocols for treating severe acute malnutrition, its case fatality rate remains high in health facilities from developing countries. Objectives: To assess treatment outcomes and associated risk factors...

Treatment Outcome and Associated Factors among Under-Five Children with Severe Acute Malnutrition Admitted to Therapeutic Feeding Unit in Woldia Hospital, North Ethiopia

Background: Severe acute malnutrition is a major challenge to achieve the millennium development goals. It is also the least preventable causes of child deaths. Limited information is found on the factors that influences improvement of treatment outcome in the admitted children. So the study tries to identify associated factors that compromise outcome. Objectives: Assessment of treatment outcome and associated factors among under-five children with severe acute malnutrition admitted to therapeutic feeding unit at Woldia general Hospital. Method: A Hospital record based retrospective cohort study supplemented with qualitative inquiry was conducted. The study period was from January 01 to 06, 2014. Records of 324 children with severe acute undernutrition were taken as the study sample. In-depth interview was conducted with six Health professionals in the ward. Multivariate analyses were done by using logistic regression to identify predictors. Result: Among 324 admitted children, 85% with 95% CI (81%-88.7%), 6% with CI (3.8%-9.2%), 5% and 4% of the cases were cured, died, defaulters and transferred out respectively. children with edema (AOR: 0.2(0.10-0.79), HIV positive children AOR: 0.12(0.032-0.42), Children who gained Plumpy’nut AOR: 3.70( CI: 1.22- 11.23) were significant predictors for cure rate of severe acute malnutrition. Conclusion: Even though recovery and death rates were found above and below the minimum acceptable cut-off points of the sphere standards respectively, better achievement should be expected to reduce mortality rate and increase cure rate. The burden of co morbidities plus lack of training and supportive supervision in the Hospital compromise the rate of recovery. There should be a strong linkage between the Health sector and other stakeholders to minimize the level of child under-nutrition via nutrition education.

ИССЛЕДОВАНИЕ И РАЗРАБОТКА БИОТЕХНИЧЕСКОЙ СИСТЕМЫ ЛЕЧЕБНОГО ПИТАНИЯ В СТАЦИОНАРЕ (БТС-ЛПС)

Discussed the organization of clinical nutrition at the hospital. Give a general idea of biotechnological systems. Developed a method of therapeutic feeding in the hospital using biotechnical systems for medical purposes.

Long-term Swallow Function after Chemoradiotherapy for Oropharyngeal Cancer: The Influence of a Prophylactic Gastrostomy or Reactive Nasogastric Tube

AimsTwo contrasting approaches of a prophylactic gastrostomy or a nasogastric tube as needed are widely used to support patients receiving chemoradiotherapy for head and neck cancer. The influence of the type and timing of enteral feeding tube support upon long-term swallowing is uncertain. This study analysed the patients' perspective on long-term swallowing, comparing two groups of patients who received chemoradiotherapy for oropharyngeal cancer managed with the two approaches. Materials and methodsThe MD Anderson Dysphagia Inventory (MDADI) was posted to 63 consecutive patients with oropharyngeal squamous cell cancer treated with concurrent chemoradiotherapy between January 2007 and June 2009, who had not required therapeutic enteral feeding before treatment and who were disease free on follow-up at least 2 years after treatment. ResultsIn total, 56/63 patients completed questionnaires; 43 had been managed with a prophylactic gastrostomy and 13 with a policy of nasogastric tube as needed. There were no significant differences in all global, emotional, physical or functional domains of the MDADI according to enteral feeding strategy. Diet at 6 months after treatment was significantly correlated with better MDADI scores. ConclusionsIn this study, the choice of a prophylactic gastrostomy or nasogastric tube as needed did not seem to influence long-term swallowing function.

Anthropometric predictors of mortality in undernourished adults in the Ajiep Feeding Programme in Southern Sudan

Various nutritional assessment tools are available to assess adult undernutrition, but few are practical in poorly served areas of low-income countries. The objective was to assess the relation between midupper arm circumference (MUAC), weight, body mass index (BMI), and clinical assessment for edema in predicting mortality in adults with severe acute undernutrition. Demographic and anthropometric data that were collected in an observational study of 197 adults were analyzed. Participants were aged 18-59 y and were admitted to a therapeutic feeding center in Ajiep, Southern Sudan, during the height of the 1998 famine. Receiver operating curves were calculated and compared. The mean (±SD) age of the participants was 40.1 ±10.8 y, and the mean (±SD) MUAC, weight, and BMI (in kg/m(2)) were 16.4 ± 1.3 cm, 35.1 ± 5.2 kg, and 12.6 ± 1.5, respectively. The area under the receiver operating curve for MUAC (0.71) was higher (P = 0.01) than those of BMI (0.57) and weight (0.51). Mean age, weight, and BMI on admission did not differ between survivors and nonsurvivors (P > 0.17). MUAC and edema were independently associated with mortality. For every 1-cm increase in admission MUAC, the odds of subsequent mortality decreased by 58% (adjusted OR: 0.42; 95% CI: 0.28, 0.63; P < 0.001). In this study, which was conducted at the height of a major famine among adults with extremely severe grades of undernutrition, MUAC and edema were better indicators of short-term prognosis than was BMI. Further studies are needed to define a critical MUAC threshold for the diagnosis of acute adult undernutrition.

Infections in Children Admitted with Complicated Severe Acute Malnutrition in Niger

BackgroundAlthough malnutrition affects thousands of children throughout the Sahel each year and predisposes them to infections, there is little data on the etiology of infections in these populations. We present a clinical and biological characterization of infections in hospitalized children with complicated severe acute malnutrition (SAM) in Maradi, Niger.MethodsChildren with complicated SAM hospitalized in the intensive care unit of a therapeutic feeding center, with no antibiotics in the previous 7 days, were included. A clinical examination, blood, urine and stool cultures, and chest radiography were performed systematically on admission.ResultsAmong the 311 children included in the study, gastroenteritis was the most frequent clinical diagnosis on admission, followed by respiratory tract infections and malaria. Blood or urine culture was positive in 17% and 16% of cases, respectively, and 36% had abnormal chest radiography. Enterobacteria were sensitive to most antibiotics, except amoxicillin and cotrimoxazole. Twenty-nine (9%) children died, most frequently from sepsis. Clinical signs were poor indicators of infection and initial diagnoses correlated poorly with biologically or radiography-confirmed diagnoses.ConclusionsThese data confirm the high level of infections and poor correlation with clinical signs in children with complicated SAM, and provide antibiotic resistance profiles from an area with limited microbiological data. These results contribute unique data to the ongoing debate on the use and choice of broad-spectrum antibiotics as first-line treatment in children with complicated SAM and reinforce the call for an update of international guidelines on management of complicated SAM based on more recent data.

Relations between ethnicity and child malnutrition in rural Benin

Relations between ethnicity and child malnutrition in rural Benin. In a therapeutic feeding center in northern Benin, we found disparities between the three main ethnic groups in the proportions of children hospitalized; undernutrition seemed more frequent and severe in the Gando than in the Bariba and the Fulani groups. This survey sought to identify risk factors for malnutrition. We used a standardized questionnaire to interview women from these three groups, all with a child aged 5 years or younger. The study included 165 mothers from the three main ethnic groups, 62 of whom had weaned a child. Children from the Bariba group seemed to have access to better sanitary and nutritional conditions than those from the Gando and Fulani groups: higher quality water (from boreholes), more frequent access to latrines, higher usage of bed nets, higher likelihood of birth in a medicalized environment, early breastfeeding, and progressive and voluntary weaning. During and after weaning, children from the Fulani group received more milk-based food than the other groups. In the Fulani group, therefore, the supply of milk of animal origin may compensate for some less favorable practices related to childbirth and breastfeeding. We identified several factors, probably influenced by socioeconomic and cultural conditions, that probably affect child undernutrition. Sanitary and nutritional education programs should be conducted to target specific ethnic groups of this region.

Outpatient Treatment of Severe Acute Malnutrition

A study of an outpatient therapeutic feeding program explores patient outcomes and factors contributing to recovery from severe acute malnutrition (SAM).