Brain MRI and cognitive function seven years after surviving an episode of severe acute malnutrition in a cohort of Malawian children

AbstractObjectiveTo assess differences in cognition functions and gross brain structure in children seven years after an episode of severe acute malnutrition (SAM), compared with other Malawian children.DesignProspective longitudinal cohort assessing school grade achieved and results of five computer-based (CANTAB) tests, covering three cognitive domains. A subset underwent brain MRI scans which were reviewed using a standardized checklist of gross abnormalities and compared with a reference population of Malawian children.SettingBlantyre, Malawi.ParticipantsChildren discharged from SAM treatment in 2006 and 2007 (n 320; median age 9·3 years) were compared with controls: siblings closest in age to the SAM survivors and age/sex-matched community children.ResultsSAM survivors were significantly more likely to be in a lower grade at school than controls (adjusted OR = 0·4; 95 % CI 0·3, 0·6; P < 0·0001) and had consistently poorer scores in all CANTAB cognitive tests. Adjusting for HIV and socio-economic status diminished statistically significant differences. There were no significant differences in odds of brain abnormalities and sinusitis between SAM survivors (n 49) and reference children (OR = 1·11; 95 % CI 0·61, 2·03; P = 0·73).ConclusionsDespite apparent preservation in gross brain structure, persistent impaired school achievement is likely to be detrimental to individual attainment and economic well-being. Understanding the multifactorial causes of lower school achievement is therefore needed to design interventions for SAM survivors to thrive in adulthood. The cognitive and potential economic implications of SAM need further emphasis to better advocate for SAM prevention and early treatment.

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Assessment of the Nutritional Status of Under-Five Years (6–59 Months) Children Attending Dalhatu Araf Specialist Hospital Lafia, Nasarawa State, Nigeria

Current Developments in Nutrition ◽

10.1093/cdn/nzaa043_034 ◽

2020 ◽

Vol 4 (Supplement_2) ◽

pp. 183-183

Author(s):

Emmanuel Kigbu Francis ◽

Titilayo Bamidele ◽

Micheal Enemali

Keyword(s):

Nutritional Status ◽

Severe Acute Malnutrition ◽

Well Being ◽

Acute Malnutrition ◽

Nutritional Knowledge ◽

Normal Range ◽

Child Feeding ◽

Under Five ◽

Under Five Children ◽

Nutritional Status Of Children

Abstract Objectives Malnutrition is a major public health challenge in developing countries and as such the nutritional status of children serve as an indicator to rate the overall well-being of a society. In this study, we assessed the nutritional status of under-five children attending Dalhatu Araf Specialist Hospital, Lafia, Nigeria. Methods After ethical clearance, 165 under five children were randomly recruited into the study. The socio-demographic and nutritional information of the children and mother were obtained using structured questionnaires. Anthropometric assessment was done on each child and blood samples analyzed using standard biochemical techniques. The data obtained were statistically analyzed using the Statistical Package for Social Sciences (SPSS) version 20. Results Out of the 165 children recruited for this study, 51.5% were males. 41.2% of the children showed prevalence of Global Malnutrition, 15.8% and 25.5% indicated moderate acute malnutrition (MAM) and Severe Acute Malnutrition (SAM) respectively. 66.1% of the children had Mid-upper arm circumference (MUAC) measures in the normal range of 12.5–14.6 cm. There is a significant relationship between nutritional knowledge of the mother, socioeconomic status, child feeding practices, and the nutritional status of their children (P < 0.05). The biochemical parameters studied reported that average PCV (33.32 ± 4.49) and total protein (34.53 ± 13.26 g/L) were lower than the normal range, glucose (4.52 ± 0.97 mmol/L) and Calcium (2.14 ± 0.25 mmol/L) were within the normal range and Albumin (64.16 ± 16.87 g/L) was above the normal range. Conclusions This study has successfully revealed the nutritional status of under five years children in Nasarawa State, Nigeria. Our findings have critical implications for intervention initiatives among children in Nigeria. Funding Sources Self funded.

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The Effectiveness of the Malnutrition eLearning Course for Global Capacity Building in the Management of Malnutrition: A Prospective Empirical Study (Preprint)

10.2196/preprints.10396 ◽

2018 ◽

Author(s):

Sunhea Choi ◽

Ho Ming Yuen ◽

Reginald Annan ◽

Trevor Pickup ◽

Andrew Pulman ◽

...

Keyword(s):

Clinical Practice ◽

Health Professionals ◽

Severe Acute Malnutrition ◽

Scale Up ◽

Health Sector ◽

Nutrition Intervention ◽

Acute Malnutrition ◽

World Health ◽

Knowledge Gain ◽

Prospective Longitudinal

BACKGROUND Scaling-up improved management of severe acute malnutrition has been identified as the nutrition intervention with the largest potential to reduce child mortality but lack of operational capacity at all levels of the health system constrains scale-up. We therefore developed an interactive Malnutrition eLearning course that is accessible at scale to build capacity of the health sector workforce to manage severely malnourished children according to guidelines of the World Health Organization (WHO). OBJECTIVE The study aim was to test whether the Malnutrition eLearning course improves knowledge and skills of in-service and pre-service health professionals in managing children with severe acute malnutrition. METHODS This 2-year prospective, longitudinal, empirical research study took place in Ghana, Guatemala, El Salvador and Colombia between January 2015 and February 2017. A subset of 354 in-service health personnel from 12 hospitals and 2 Ministries of Health, 703 pre-service trainees from 9 academic institutions, and 204 online users participated. Knowledge gain after training and retention over time were measured through pre- and post-assessments, comprising questions pertaining to screening, diagnosis, pathophysiology, and treatment and prevention of malnutrition. Comprehension, application and integration of knowledge were tested. Changes in perception, confidence, and clinical practice were assessed through questionnaires and interviews. RESULTS Before the course, awareness of the WHO guidelines was 36.7% (389/1059) overall and 26.3% (94/358) among in-service professionals. The mean score gain in knowledge after access to the course of 606 participants who had pre-and post-assessment data was 11.8 (95% CI 10.8, 12.9 P<.001) – a relative increase of 41.5%. The proportion who achieved above the pass mark post-training was 58.7% (356/606), compared with 18.2% (110/606) pre-training. Of the in-service professionals, 86% (128/149) reported applying their knowledge by changing their clinical practice in screening, assessment, diagnosis and/or management. This group demonstrated significantly increased, retained knowledge 6-months after training (mean difference (SD) from pre-assessment:12.1 (11.8)), retaining 65.8% (12.1/18.4) of gained knowledge from the training. Changes in the management of malnutrition were reported by trained participants, and institutional operational and policy changes were also found. CONCLUSIONS The Malnutrition eLearning course improved knowledge, understanding and skills of health professionals in the diagnosis and management of children with severe acute malnutrition, and changes in clinical practice and confidence were reported following completion of the course.

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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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Nutrition Assessment of Under-Five Children in Sudan: Tracking the Achievement of the Global Nutrition Targets

Children ◽

10.3390/children8050363 ◽

2021 ◽

Vol 8 (5) ◽

pp. 363

Author(s):

Mohamed Abu-Manga ◽

Ayoub Al-Jawaldeh ◽

Abdul Baseer Qureshi ◽

Amira M. Elmunier Ali ◽

Damiano Pizzol ◽

...

Keyword(s):

Severe Acute Malnutrition ◽

Secondary Data ◽

Well Being ◽

Acute Malnutrition ◽

Survey Method ◽

Micronutrient Deficiencies ◽

Severe Stunting ◽

Under Five ◽

The Government ◽

Global Nutrition

Background: Malnutrition places a heavy burden on the health, well-being, and sustainable development of populations in Sudan, especially a country affected by conflict, which continues to experience high levels of food insecurity, undernutrition, and micronutrient deficiencies; 3.3 million are acutely malnourished, with 522,000 children suffering from severe acute malnutrition and approximately 2.2 million children requiring treatment for moderate acute malnutrition. This study aims to describe the nutritional status of children under five years old and identify the progress toward the achievement of the Global Nutrition Targets. Methods: This is a secondary data analysis of a quantitative survey, using the second-round of the Simple Spatial Survey Method (S3M II) in Sudan in the period 2018–2019. The analysis used an area-based sampling methodology in all 18 Sudanese states. Data from the WHO Tracking Tools of the Global Nutrition Targets was used to reflect the progress in achieving the targets in Sudan. Results: Global stunting prevalence was at 36.35 percent including moderate stunting prevalence and severe stunting prevalence (21.25 percent and 15.06 percent respectively). Global wasting prevalence was 13.6 percent including moderate wasting prevalence and severe wasting prevalence (10.8 percent and 2.7 percent respectively). Sudan has made great progress in achieving the target of increasing exclusive breastfeeding. However, despite the welcome commitments by the Government and all stakeholders, Sudan is still struggling to implement strategies, policies, and regulatory measures to address malnutrition and achieve the Global Nutrition Targets in 2025 and the Sustainable Developmental Goals in 2030. Therefore, more than ever, there is a need for comprehensive, multi-sectoral action to address malnutrition in all its forms.

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Predictive Model for the Risk of Severe Acute Malnutrition in Children

Journal of Nutrition and Metabolism ◽

10.1155/2019/4740825 ◽

2019 ◽

Vol 2019 ◽

pp. 1-7 ◽

Cited By ~ 3

Author(s):

Olivier Mukuku ◽

Augustin Mulangu Mutombo ◽

Lewis Kipili Kamona ◽

Toni Kasole Lubala ◽

Paul Makan Mawaw ◽

...

Keyword(s):

Developing Countries ◽

Predictive Model ◽

Roc Curve ◽

Severe Acute Malnutrition ◽

Well Being ◽

Physical Growth ◽

Acute Malnutrition ◽

Predictive Score ◽

History Of ◽

Children Under 5

Background. The nutritional status is the best indicator of the well-being of the child. Inadequate feeding practices are the main factors that affect physical growth and mental development. The aim of this study was to develop a predictive score of severe acute malnutrition (SAM) in children under 5 years of age.Methods. It was a case-control study. The case group (n = 263) consisted of children aged 6 to 59 months admitted to hospital for SAM that was defined by az-score weight/height < −3 SD or presence of edema of malnutrition. We performed a univariate and multivariate analysis. Discrimination score was assessed using the ROC curve and the calibration of the score by Hosmer–Lemeshow test.Results. Low birth weight, history of recurrent or chronic diarrhea, daily meal’s number less than 3, age of breastfeeding’s cessation less than 6 months, age of introduction of complementary diets less than 6 months, maternal age below 25 years, parity less than 5, family history of malnutrition, and number of children under 5 over 2 were predictive factors of SAM. Presence of these nine criteria affects a certain number of points; a score <6 points defines children at low risk of SAM, a score between 6 and 8 points defines a moderate risk of SAM, and a score >8 points presents a high risk of SAM. The area under ROC curve of this score was 0.9685, its sensitivity was 93.5%, and its specificity was 93.1%.Conclusion. We propose a simple and efficient prediction model for the risk of occurrence of SAM in children under 5 years of age in developing countries. This predictive model of SAM would be a useful and simple clinical tool to identify people at risk, limit high rates of malnutrition, and reduce disease and child mortality registered in developing countries.

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Determinants of severe acute malnutrition in children between six months to five year of age enrolled in nutritional rehabilitation centre at a tertiary care level

International Journal of Contemporary Pediatrics ◽

10.18203/2349-3291.ijcp20194722 ◽

2019 ◽

Vol 6 (6) ◽

pp. 2489

Author(s):

Gargi H. Pathak ◽

Anuya V. Chauhan ◽

Sunita O. Beniwal

Keyword(s):

Nutritional Status ◽

Severe Acute Malnutrition ◽

Tertiary Care ◽

Feeding Practices ◽

Well Being ◽

Acute Malnutrition ◽

Nutritional Rehabilitation ◽

Rehabilitation Centre ◽

Under Five ◽

History Of

Background: Indicators showing levels of nutritional status in children are often regarded as representative of the health and general well-being of a society at large. Malnutrition stands as a consequence of several key social and economic factors such as lack of education, inadequate health care services and ill-informed cultural behaviors. In order to holistically address the issues surrounding malnutrition, a comprehensive understanding of the multi-dimensional complexities at play in society is crucial. Objective was to identify determinants of severe acute malnutrition among children with severe acute malnutrition under 5 years (between 6 months to 60 months) of age. Methods: A cross sectional study design involving 64 patients with severe acute malnutrition between 6 to 60 month of age was employed to identify the risk factors of severe acute malnutrition among children admitted in pediatric wards and nutritional rehabilitation centers, Civil hospital Ahmedabad, from April 2018 to march 2019. A detailed history of all the patients were taken and data collected using structured interviewer-administered questionnaire.Results: Thus, from the above study, it is clear that age of the child <2 years, female gender, bigger family size, poverty, illiteracy in mother, poor feeding practices, improper complementary feed introduction, poor nutritional status of mother whose child were breastfed, acute or chronic illness in child and narrow birth spacing were the chief determinants of SAM in under five children.Conclusions: Socio demographic characters, nutrition and child caring practices, infection and other childhood illness as well as obstetric history of mother are important determinants of severe acute malnutrition in children under five years of age. As a result, collaborative efforts should be organized to improve promotion of better child caring practices through appropriate age specific child and maternal feeding practices, prevention and early treatment of acute childhood illnesses and promotion of family planning.

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Dysglycemia in Critically Ill Children Admitted to Jimma Medical Centre, Southwest Ethiopia

Ethiopian Journal of Health Sciences ◽

10.4314/ejhs.v31i2.14 ◽

2021 ◽

Vol 31 (2) ◽

Author(s):

Habtamu Sime ◽

Melkamu Berhane ◽

Tsion Tilahun ◽

Temam Kedir ◽

Diriba Dereje ◽

...

Keyword(s):

Blood Glucose ◽

Blood Glucose Level ◽

Critically Ill ◽

Glucose Level ◽

Severe Acute Malnutrition ◽

Acute Malnutrition ◽

Critically Ill Children ◽

Prospective Longitudinal Study ◽

Southwest Ethiopia ◽

Prospective Longitudinal

BACKGROUND፡ Abnormal blood glucose level is one of the most frequently encountered problems in children with severe illnesses. However, its magnitude and outcome have rarely been determined in Ethiopia. We aimed to determine the magnitude, associated factors and outcome of dysglycemia in critically ill children admitted to Jimma Medical Center.METHODS: Prospective longitudinal study was conducted on children aged 28 days to 14 years admitted with critical illnesses at the different units of the Department of Pediatrics and Child Health of Jimma Medical Center, Southwest Ethiopia, from June to August 2019. Data were collected by trained medical personnel using structured questionnaire and analyzed using Statistical Package for Social Sciences (SPSS) windows version 20.0. Dysglycemia was considered whenever the child had a random blood sugar >150mg/dl or <45mg/dl.RESULT: Dysglycemia was seen at admission in 139/481, 28.9% children; 24 (5.0%) had hypoglycemia whereas 115 (23.9%) had hyperglycemia. The factors associated with dysglycemia at admission were severe acute malnutrition (p=002, AOR=3.09, CI=1.18,7.77), impaired mental status (p=0.003, AOR=4.63, CI=1.68, 12.71), place of residence (p=0.01, AOR=1.85, CI=1.15-2.96) and presence of diarrhea on date of admission. Among the children who had dysglycemia at admission, 16/139, 11.5% died.CONCLUSION: Dysglycemia is a common problem in critically ill children in the setting. Blood glucose level should be determined for all critically ill children, and routine empirical administration of dextrose should be minimized since most of the children with dysglycemia had hyperglycemia than hypoglycemia.

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