IGF1 levels in children with severe acute malnutrition after nutritional recovery: A good predictor for children’s long-term health status

Abstract Objectives Routine amoxicillin for children with uncomplicated severe acute malnutrition raises concerns of increasing antibiotic resistance. We performed an ancillary study nested within a double-blind, placebo-controlled trial in Niger testing the role of routine 7 day amoxicillin therapy in nutritional recovery of children 6 to 59 months of age with uncomplicated severe acute malnutrition. Methods We screened 472 children for rectal carriage of ESBL-producing Enterobacteriaceae (ESBL-E) as well as their household siblings under 5 years old, at baseline and Week 1 (W1) and Week 4 (W4) after start of therapy, and characterized strains by WGS. ClinicalTrials.gov: NCT01613547. Results Carriage in index children at baseline was similar in the amoxicillin and the placebo groups (33.8% versus 27.9%, P = 0.17). However, acquisition of ESBL-E in index children at W1 was higher in the amoxicillin group than in the placebo group (53.7% versus 32.2%, adjusted risk ratio = 2.29, P = 0.001). Among 209 index and sibling households possibly exposed to ESBL-E transmission, 16 (7.7%) had paired strains differing by ≤10 SNPs, suggesting a high probability of transmission. This was more frequent in households from the amoxicillin group than from the placebo group [11.5% (12/104) versus 3.8% (4/105), P = 0.04]. Conclusions Among children exposed to amoxicillin, ESBL-E colonization was more frequent and the risk of transmission to siblings higher. Routine amoxicillin should be carefully balanced with the risks associated with ESBL-E colonization.

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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

BMC Public Health ◽

10.1186/s12889-015-2593-5 ◽

2015 ◽

Vol 15 (1) ◽

Cited By ~ 27

Author(s):

Delelegn Yilma Gebremichael

Keyword(s):

Cohort Study ◽

Retrospective Cohort Study ◽

Recovery Time ◽

Retrospective Cohort ◽

Severe Acute Malnutrition ◽

Acute Malnutrition ◽

Southern Ethiopia ◽

Survival Status ◽

Nutritional Recovery

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Recovery time from severe acute malnutrition and associated factors among under-5 children in Yekatit 12 Hospital, Addis Ababa, Ethiopia: a retrospective cohort study

Epidemiology and Health ◽

10.4178/epih.e2020003 ◽

2020 ◽

Vol 42 ◽

pp. e2020003 ◽

Cited By ~ 2

Author(s):

Mekonen Adimasu ◽

Girum Sebsibie ◽

Fikrtemariam Abebe ◽

Getaneh Baye ◽

Kerebih Abere

Keyword(s):

Cohort Study ◽

Weight Gain ◽

Retrospective Cohort Study ◽

Recovery Time ◽

Retrospective Cohort ◽

Severe Acute Malnutrition ◽

Acute Malnutrition ◽

Daily Weight Gain ◽

Nutritional Recovery ◽

Length Of Hospitalization

OBJECTIVES: Recovery time from severe acute malnutrition (SAM) is often a neglected topic despite its clinical impact. Although a few studies have examined nutritional recovery time, the length of hospitalization in those studies varied greatly. Therefore, the aim of this study was to determine the recovery time from SAM and to identify predictors of length of hospitalization among under-5 children.METHODS: A retrospective cohort study was conducted among 423 under-5 children with SAM who had been admitted to Yekatit 12 Hospital. Kaplan-Meier analysis was used to estimate time to nutritional recovery, and Cox proportional hazard regression analysis was performed to determine independent predictors.RESULTS: The nutritional recovery rate was 81.3%, and the median recovery time was 15.00 days (95% confidence interval [CI], 13.61 to 16.39). Age, daily weight gain per kilogram of body weight, vaccination status, and the existence of at least 1 comorbidity (e.g., pneumonia, stunting, shock, and deworming) were found to be significant independent predictors of nutritional recovery time. The adjusted hazard ratio (aHR) for nutritional recovery decreased by 1.9% for every 1-month increase in child age (aHR, 0.98; 95% CI, 0.97 to 0.99).CONCLUSIONS: The overall nutritional recovery time in this study was within the Sphere standards. However, approximately 13.0% of children stayed in the hospital for more than 28.00 days, which is an unacceptably large proportion. Daily weight gain of ≥8 g/kg, full vaccination, and deworming with albendazole or mebendazole reduced nutritional recovery time. Conversely, older age, pneumonia, stunting, and shock increased nutritional recovery time.

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Long-term outcomes for children with disability and severe acute malnutrition in Malawi

BMJ Global Health ◽

10.1136/bmjgh-2020-002613 ◽

2020 ◽

Vol 5 (10) ◽

pp. e002613

Author(s):

Natasha Lelijveld ◽

Nora Groce ◽

Seema Patel ◽

Theresa Nnensa ◽

Emmanuel Chimwezi ◽

...

Keyword(s):

Severe Acute Malnutrition ◽

School Achievement ◽

Acute Malnutrition ◽

Health Issues ◽

Physical Strength ◽

Children With Disability ◽

Increased Risk ◽

Outcomes For Children

IntroductionSevere acute malnutrition (SAM) and disability are major global health issues. Although they can cause and influence each other, data on their co-existence are sparse. We aimed to describe the prevalence and patterns of disability among a cohort of children with SAM.MethodsA longitudinal cohort study in Malawi followed SAM survivors up to 7 years postdischarge. Clinical and anthropometric profiles were compared with sibling and community controls. Disability at original admission was identified clinically; at 7-year follow-up a standardised screening tool called ‘the Washington Group Questionnaire’ was used.Results60/938 (6.4%) of admissions to SAM treatment had clinically obvious disability at admission. Post-treatment mortality was high, with only 11/60 (18%) surviving till 7-year follow-up. SAM children with a disability at admission had 6.99 (95% CI 3.49 to 14.02; p<0.001) greater risk of dying compared with children without disability. They were also older, less likely to be HIV positive or have oedema and more severely malnourished. Long-term survivors were more stunted, had less catch-up growth, smaller head circumference, weaker hand grip strength and poorer school achievement than non-disabled survivors.The Washington Group Questionnaire confirmed disability in all who had been identified clinically, and identified many who had not been previously flagged.ConclusionDisability is common among children affected by SAM. Those with disability-associated SAM have greatly increased risk of dying even if they survive the initial episode of malnutrition. Survivors have poorer growth, physical strength and school achievement. To enable all children to survive and thrive post-SAM, it is vital to focus more on those with disabilities. SAM treatment programmes should consider using not just clinical assessment but structured assessments to better identify at-risk individuals as well as understand the population of children for which they are developing services.

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Determinants of treatment outcomes of severe acute malnutrition among under-5 children in Yekatit 12 Hospital, Addis Ababa, Ethiopia: a retrospective cohort study

10.21203/rs.3.rs-30080/v1 ◽

2020 ◽

Author(s):

Mekonen Adimasu Kebede ◽

Girum Sebsbie Teshome ◽

Fkirtemariam Abebe Fenta ◽

Melaku Bimerew Getahun

Keyword(s):

Cohort Study ◽

Treatment Outcomes ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

Severe Acute Malnutrition ◽

Vaccination Status ◽

Acute Malnutrition ◽

Nutritional Recovery ◽

Default Rates ◽

Hiv Aids

Abstract Background Devastatingly, the number of children with SAM is still growing globally. Severe acute malnutrition is the third most common contributing factor to the deaths of under-5 children worldwide. According to the World Health Organization, severe acute malnutrition causes 1 million deaths annually via increased susceptibility to death from severe infection. Ethiopia is one of the countries with highest under-5 child mortality rate, with malnutrition underlying to 28% of all children deaths. In Ethiopia, some studies reported an alarming death and default rates which indicate the need for further study to assess contributing factors to the treatment outcomes of severe acute malnutrition. Therefore, the intention of this research is to determine the treatment outcomes of severe acute malnutrition and identify predictors of nutritional recovery. Method: A retrospective cohort study was conducted among 423 under-5 children with severe acute malnutrition. Logistic regression analysis was performed and an adjusted odd ratio with 95%CI was used to determine independent predictors. Result The overall recovery, death and default rates were 81.3%, 11.1% and 7.6% respectively. Age, vaccination status, HIV/AIDS, pneumonia, diarrhea and stunting were found to be significant independent predictors of treatment outcomes. The adjusted odd ratio (AOR) for nutritional recovery increased by 14.6% for every 1-month increase in child age (AOR = 1.146; 95%CI: 1.052–1.249). Regarding vaccination status, those under-5 children who were fully vaccinated for their age were about 4 time more likely to recover than their counterparts (AOR = 4.242; 95%CI: 1.566–11.491) Conclusion In conclusion, the overall nutritional recovery and default rate in this study were in the acceptable range of international standard even though the death rate was higher. Age and full vaccination were proven to increase nutritional recovery. Conversely, the presence of HIV/AIDS, pneumonia, diarrhea and stunting were proven to decrease nutritional recovery.

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