scholarly journals Providing care for children with severe acute malnutrition in India: new evidence from Jharkhand

2012 ◽  
Vol 17 (1) ◽  
pp. 206-211 ◽  
Author(s):  
Víctor M Aguayo ◽  
Sangita Jacob ◽  
Nina Badgaiyan ◽  
Praveen Chandra ◽  
Ajit Kumar ◽  
...  
Keyword(s):  
Severe Acute Malnutrition ◽  
Average Length ◽  
Survival Rates ◽  
Acute Malnutrition ◽  
Average Weight ◽  
High Survival ◽  
Initial Weight ◽  
Average Length Of Stay ◽  
Programme Outcomes ◽  
New Evidence

AbstractObjectiveTo assess the effectiveness of facility-based care for children with severe acute malnutrition (SAM) in malnutrition treatment centres (MTC).DesignEarly detection and treatment of SAM using locally adapted protocols; assessment of programme outcomes, including survival, default, discharge and recovery rates.SettingAll forty-eight MTC in Jharkhand, India.SubjectsChildren (n 3595) with SAM admitted to MTC (1 July 2009–30 June 2011).ResultsOf children admitted, 55·0 % were girls, 77·7 % were 6–23 months old and 68·6 % belonged to scheduled tribes or castes; 34·4 % had oedema or medical complications. Of the 3418 programme exits, the proportion of children who died was 0·6 % (n 20), the proportion of children who defaulted was 18·4 % (n 628) and the proportion of children discharged was 81·0 % (n 2770). Children's average weight gain was 9·6 (sd 8·4) g/kg body weight per d and their average length of stay was 16·0 (sd 5·7) d. Among the 2770 children who were discharged from the programme, 39·4 % (n 1090) gained 15 % or more of their initial weight while 60·6 % (n 1680) gained less than 15 % of their initial weight.ConclusionsMTC provide live-saving care for children with SAM as demonstrated by high survival rates. However, the protocols and therapeutic foods currently used need to improve to ensure the recovery of all discharged children. MTC should be reserved for children with complicated SAM; children with uncomplicated SAM should be admitted to a community-based programme for the management of SAM, at a lesser risk to children and a lesser cost to families and the health system.

scholarly journals Performance and costing of nutrition intervention measures on admitted children in malnutrition treatment center: a case study from Jharkhand, India

2020 ◽  
Vol 7 (10) ◽  
pp. 4048
Author(s):  
Rajesh Kumar Sinha ◽  
Asha Kiran ◽  
Vivek Kashyap ◽  
Praveen Kumar
Keyword(s):  
Severe Acute Malnutrition ◽  
Average Length ◽  
Nutrition Intervention ◽  
Acute Malnutrition ◽  
Treatment Center ◽  
Medical Complication ◽  
Average Weight ◽  
Post Discharge ◽  
Target Weight ◽  
Intervention Measures

Background: Children with severe acute malnutrition (SAM) having medical complications require immediate care at malnutrition treatment centers (MTC). Thus, it becomes important to assess the effect and treatment cost of such children in these facilities. Hence, the present study was done with these aims in two MTCs in Jharkhand, India.Methods: A retrospective record review was done of the children admitted to these two MTCs between 1st April 2017 and 31st March 2018. A predesigned proforma was used to collect child related information. The data collected was entered in Microsoft excel sheet and analysed.Results: Majority of the admitted children (90.6%) were in 6-23 months age group. 358 (51.5%) children were females. Only, 194 (27.9%) children admitted were SAM had any medical complication. 690 (99.3%) children were discharged of whom 499 (72.3%) were discharged after achieving the target weight. The average weight gain during their stay was 8.1±2.4 g/kg/day and average length of stay was 16.7±3.2 days. Post discharge follow up rates were found to be low and only 130 (18.8%) children completed all three follow ups. Average cost per SAM child treated was Rs. 18,599 (US$ 272) and per SAM child cured was Rs. 25,904 (US$ 379).Conclusions: MTCs are effective in managing medically complicated SAM children. However, improvements are necessary to ensure that more such children should be treated at facility level, complimented with a community based programme for managing uncomplicated SAM children to improve coverage and ensure continuum of care.

scholarly journals Assessment of the Nutritional Status of Children on Arvs in the Prevention of Mother Transmission (PMTCT) Child Centers in the Ruashi Health Zone in Lubumbashi in Dr Congo

2021 ◽  
Vol 5 (2) ◽  
Keyword(s):  
Nutritional Status ◽  
Severe Acute Malnutrition ◽  
Minimum Weight ◽  
Treatment Compliance ◽  
Acute Malnutrition ◽  
Average Weight ◽  
People Living With Hiv ◽  
Health Zone ◽  
Nutritional Status Of Children ◽  
Hiv Aids

Introduction: HIV infection causes and promotes enormous nutritional deficits in children. The objective of this work was to analyze the nutritional status of children infected with HIV placed on antiretrovirals in the Ruashi Health Zone in Lubumbashi. Methods: We carried out a cross-sectional descriptive study which focused on 51 children aged 3 months to 17 years selected in 8 care structures for People Living with HIV AIDS, from January to June 2016. Data was collected by documentary review and the usual descriptive statistics and anthropometric indicators were used. Result: The prevalence of overall malnutrition was 31.37% (n = 51) including 7.84% moderate malnutrition. The average weight is 19.25 kg with a minimum weight of 4.5 kg and a maximum of 49 kg. The overall prevalence of anemia (hemoglobin <11g / dl) was 9.8%. Wasting affected 3.92% of children and 7.84% were victims of chronic malnutrition. The prevalence of acute malnutrition was 25.48%, of which 3.92% was severe acute malnutrition. Immune deficiency (CD4 <350) in 5.88% of cases, undetectable viral load at 88.37% and treatment compliance at 92.16% Conclusion: HIV / AIDS affects the state of health of children in Ruashi with 31.37% overall malnutrition and 7.84% stunted growth. Good nutritional and therapeutic support for children is necessary.

scholarly journals Impact of effective counselling on management of moderate acute malnutrition in a community

2020 ◽  
Vol 7 (2) ◽  
pp. 321
Author(s):  
Vikas Arya ◽  
Ajay Gaur ◽  
Neetu S. Agarwal ◽  
Harsha Chouhan
Keyword(s):  
Severe Acute Malnutrition ◽  
Acute Malnutrition ◽  
P Value ◽  
Case Group ◽  
Average Weight ◽  
Group Counselling ◽  
Target Weight ◽  
Dietary Counselling ◽  
Trained Counsellor ◽  
Moderate Acute Malnutrition

Background: Moderate Acute Malnutrition (MAM) is defined as Weight for Height between -2SD to -3SD, and/or Mid Upper Arm Circumference (MUAC) 11.5 cm to 12.5 cm. Effect of not treating MAM has a significant impact on Severe Acute Malnutrition (SAM) burden. Management of MAM is possible through supplementary feeding or Community centre counselling.Methods: Present study was a prospective case control study done in 2013-14 in 200 children in adjacent communities. Community in which intervention (dietary counselling) was planned, it was labelled as case group. For dietary counselling ‘structured group counselling’ method was selected in which at a time parents of six MAM children were involved. Counselling was done by a trained counsellor using all techniques proposed by IYCF. Counselling sessions were scheduled at 0, 1, 3 and 6 months.Results: 60% children of case group moved to improved or well- nourished nutritional status (p-value 0.00001). Amongst improved group, weight for height improvement is statistically significant (p-value 0.001), average weight attained is 2-3 kg in 6 months with average weight gain of 1.5-3 grams/kg/day. MUAC improvement was also found to be statistically significant (p-value 0.003), there was 47% improvement in case group with average MUAC gain is 0.6 cm to 1 cm in 6 months (0.13 cm/month). Also, there is early rise in weight for height then MUAC. Average duration to achieve target weight for height is 4.3 months in case group as compare to 5.3 months in control group.Conclusions: Structured and integrated group counselling using all counselling skills by a trained counsellor should be an integral part of managing MAM in community. Weight for height should be primary indicator in early phase of response as compare to MUAC in measuring impact of counselling.

scholarly journals A study of effectiveness of nutritional interventions on children with severe acute malnutrition admitted in nutrition rehabilitation centers of Bhopal, Madhya Pradesh

2018 ◽  
Vol 5 (6) ◽  
pp. 2590
Author(s):  
D. M. Saxena ◽  
Akshat Pathak ◽  
Ganga Ram Mahor ◽  
Ramniwas Mahor ◽  
Anil Agarwal
Keyword(s):  
Severe Acute Malnutrition ◽  
Madhya Pradesh ◽  
Acute Malnutrition ◽  
Severe Malnutrition ◽  
Average Weight ◽  
Full Potential ◽  
Health Issues ◽  
Significant Difference ◽  
Nutrition Rehabilitation

Background: The prevalence of under-nutrition among under-five children is high and varies widely. Children with severe acute malnutrition require immediate attention along with proper nutritional rehabilitation not only to decrease mortality but also to achieve full potential after recovery. Nutrition rehabilitation centres (NRCs) were started to control severe malnutrition and decrease the prevalence of severe malnourished children to less than 1% among children aged 1–5 years.Methods: The present study was conducted from July 2016 to June 2017; 500 children admitted to five different NRCs in Bhopal district of Madhya Pradesh were observed during their stay at NRCs and children were followed up during a period of 6 months after discharge from NRCs. Mothers of the children were interviewed on various health issues of children and feeding practices at the NRCs using a predesigned and pretested interview schedule.Results: The study group consisted of 252 boys and 248 girls; 51.20% were between 13 and 36 months of age. All 500 children were analysed for anthropometric indicators. A statistically significant difference was obtained between the weight of children at admission, discharge and follow up (ANOVA=106.2, p<0.001); difference of mid upper arm circumference (MUAC) at admission, discharge and follow up was also statistically significant (ANOVA=24.02, p<0.001). The average weight gain during the stay at the centers was 8.95±3.59 g/kg/day. The mothers of the children lacked adequate information on health issues and composition and preparation of nutrient rich diets for their children.Conclusions: The NRCs were effective in improving the condition of admitted children, but the effects were not well sustained following discharge due to lack of adequate parental awareness and action. 

scholarly journals Filling the Gaps for Enhancing the Effectiveness of Community-Based Programs Combining Treatment and Prevention of Child Malnutrition: Results from the Rainbow Project 2015–17 in Zambia

2018 ◽  
Vol 15 (9) ◽  
pp. 1807 ◽  
Author(s):  
Stefania Moramarco ◽  
Giulia Amerio ◽  
Jean Kasengele Chipoma ◽  
Karin Nielsen-Saines ◽  
Leonardo Palombi ◽  
...  
Keyword(s):  
Severe Acute Malnutrition ◽  
Integrated Management ◽  
International Standards ◽  
Acute Malnutrition ◽  
Child Malnutrition ◽  
Average Weight ◽  
Community Based ◽  
Predictors Of Mortality ◽  
Feeding Programs ◽  
Treatment And Prevention

Background: Child malnutrition, in all its forms, is a public health priority in Zambia. After implementations based on a previous evaluation in 2012–14 were made, the efficacy of the Rainbow Project Supplementary Feeding Programs (SFPs) for the integrated management of severe acute malnutrition (SAM), moderate acute malnutrition (MAM), and underweight was reassessed in 2015–17. Methods: The outcomes were compared with International Standards and with those of 2012–14. Cox proportional risk regression analysis was performed to identify predictors of mortality and defaulting. Results: The data for 900 under-five year-old malnourished children were analyzed. Rainbow’s 2015–17 outcomes met International Standards, for total and also when stratified for different type of malnutrition. A better performance than 2012–14 was noted in the main areas previously identified as critical: mortality rates were halved (5.6% vs. 3.1%, p = 0.01); significant improvements in average weight gain and mean length of stay were registered for recovered children (p < 0.001). HIV infection (5.5; 1.9–15.9), WAZ <–3 (4.6; 1.3–16.1), and kwashiorkor (3.5; 1.2–9.5) remained the major predictors of mortality. Secondly, training community volunteers consistently increased the awareness of a child’s HIV status (+30%; p < 0.001). Conclusion: Rainbow SFPs provide an integrated community-based approach for the treatment and prevention of child malnutrition in Zambia, with its effectiveness significantly enhanced after the gaps in activities were filled.

scholarly journals Community-based management of severe acute malnutrition in India: new evidence from Bihar

2015 ◽  
Vol 101 (4) ◽  
pp. 847-859 ◽  
Author(s):  
Sakib Burza ◽  
Raman Mahajan ◽  
Elisa Marino ◽  
Temmy Sunyoto ◽  
Chandra Shandilya ◽  
...  
Keyword(s):  
Severe Acute Malnutrition ◽  
Acute Malnutrition ◽  
Community Based ◽  
New Evidence

scholarly journals Filling the Gaps for Community-Based Programs Managing Treatment and Prevention of Child Malnutrition in Non-Emergency Contexts: Results from the Rainbow Project 2015-17 in Zambia

2018 ◽  
Author(s):  
Stefania Moramarco ◽  
Giulia Amerio ◽  
Jean Kasengele Chipoma ◽  
Karin Nielsen-Saines ◽  
Leonardo Palombi ◽  
...  
Keyword(s):  
Severe Acute Malnutrition ◽  
International Standards ◽  
Acute Malnutrition ◽  
Child Malnutrition ◽  
Average Weight ◽  
Program Outcomes ◽  
Community Based ◽  
Predictors Of Mortality ◽  
Feeding Programs ◽  
Treatment And Prevention

Background: Evaluation of nutrition programs is essential to guarantee the effectiveness of community-based management of acute malnutrition (CMAM). Methods: The Rainbow Project Supplementary Feeding Programs (SFPs) in Zambia were evaluated between years 2015-17, following implementation of new recommendations based on previous evaluations (years 2012-14). Outcomes of the program were compared with International Standards and with those of 2012-14. Cox proportional risk regression analysis was performed to identify predictors of mortality and defaulting. Results: Data for 900 under age 5 years malnourished children (48.8% male; mean age 19.7months &plusmn;9.9) were analyzed. Rainbow 2015-17 program outcomes met International Standards, for general malnutrition or stratified moderate acute malnutrition (MAM) and severe acute malnutrition (SAM). When comparing with 2012-14 outcomes, better performance was noted: mortality rates were reduced by half (5.6% vs 3.1%, p = 0.01; for SAM: 12.4% vs 6.7%, p = 0.006), with significant improvement in average weight gain and mean length of stay (p&lt;0.001), and increased awareness of HIV status (+30%; p &lt; 0.001). HIV infection (5.5; 1.9&ndash;15.9), WAZ &lt; &minus;3 at baseline (4.6; 1.3&ndash;16.1) and kwashiorkor (3.5; 1.2&ndash;9.5) remained the major predictors of mortality. Conclusion: The effectiveness of the Rainbow SFPs for child malnutrition treatment and prevention in Zambia has significantly improved after evaluation and implementation activities, with impressive outcomes which resulted in a 50% reduction in mortality.

scholarly journals Prevalence and clinical manifestations of vitamin K deficiency in complicated severe acute malnutrition

2019 ◽  
Vol 7 (1) ◽  
pp. 57
Author(s):  
Suresh Kumar ◽  
Vibha Choudhary ◽  
Rameshwar Lal Suman ◽  
Pradeep Meena
Keyword(s):  
Vitamin K ◽  
Severe Acute Malnutrition ◽  
Clinical Manifestations ◽  
International Normalized Ratio ◽  
Acute Malnutrition ◽  
Average Weight ◽  
Average Height ◽  
Vitamin K Deficiency ◽  
K Deficiency ◽  
Standard Software

Background: In Severe Acute Malnutrition (SAM) clinical and biochemical abnormalities are commonly observed. In this institute author observed that many children of complicated SAM had bleeding manifestations but there is no defined prevalence of vitamin K deficiency in SAM that’s why author have planned this study.Methods: This was the hospital based prospective study conducted in 150 complicated SAM children. All children were treated according to WHO protocol for SAM management. Prothrombin Time (PT), International Normalized Ratio (INR), activated Partial Thromboplastin Time (aPTT) along with routine investigations were done on admission. All the collected data was managed and analyzed with standard software Biostatics (SPSS Version 20).Results: Total 150 complicated SAM children were studied for prevalence and clinical manifestations of vitamin K deficiency. Mean age of children was 17.03±11.0 months, 52.0% were male and 48.0% were female children. Average weight was 5.92±1.57 kg. Average height/length was 70.66±8.38 cm and mean MUAC was 10.47±1.31 cm. Out of 150, 42(28%) children had abnormal INR and 28(18.7%) had abnormal aPTT with abnormal INR. The mean INR was 2.11±1.1 and mean aPTT was 45.30±9.59 in children those had abnormal INR. Twelve out of 42(28.6%) had various bleeding manifestations and majority (66.6%) had gastrointestinal bleeding.Conclusions: More than one fourth children (28%) of complicated SAM children are having vitamin K deficiency and majority of children present with gastrointestinal bleeding.

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