Prevalence and predictors of hypocalcaemia in severe acute malnutrition

2020 ◽  
Vol 23 (17) ◽  
pp. 3181-3186
Author(s):  
Chabungbam Smilie ◽  
Dheeraj Shah ◽  
Prerna Batra ◽  
Rafat S Ahmed ◽  
Piyush Gupta
Keyword(s):  
Vitamin D ◽  
Severe Acute Malnutrition ◽  
Tertiary Care ◽  
Abdominal Distension ◽  
Cross Sectional Study ◽  
Acute Malnutrition ◽  
Care Hospital ◽  
Clinical Predictors ◽  
Cross Sectional ◽  
Malnourished Children

AbstractObjective:To determine the prevalence and predictors of hypocalcaemia in under-five children (1–59 months) hospitalised with severe acute malnutrition (SAM).Design:A cross-sectional study was designed to determine the prevalence of hypocalcaemia among children hospitalised with SAM. Serum Ca and 25-hydroxycholecalciferol (25-(OH)D) were estimated. Hypocalcaemia was defined as serum Ca (albumin-adjusted) <2·12 mmol/l. To identify the clinical predictors of hypocalcaemia, a logistic regression model was constructed taking hypocalcaemia as a dependent variable, and sociodemographic and clinical variables as independent variables.Setting:A tertiary care hospital in Delhi, between November 2017 and April 2019.Participants:One-hundred and fifty children (1–59 months) hospitalised with SAM were enrolled.Results:Hypocalcaemia was documented in thirty-nine (26 %) children hospitalised with SAM, the prevalence being comparable between children aged <6 months (11/41, 26·8 %) and those between 6 and 59 months (28/109, 25·7 %) (P = 0·887). Vitamin D deficiency (serum 25-(OH)D <30 nmol/l) and clinical rickets were observed in ninety-eight (65·3 %) and sixty-three (42 %) children, respectively. Hypocalcaemia occurred more frequently in severely malnourished children with clinical rickets (OR 6·6, 95 % CI 2·54, 17·15, P < 0·001), abdominal distension (OR 4·5, 95 % CI 1·39, 14·54, P = 0·012) and sepsis (OR 2·6, 95 % CI 1·00, 6·57, P = 0·050).Conclusion:Rickets and hypocalcaemia are common in children with SAM. Routine supplementation of vitamin D should be considered for severely malnourished children. Ca may be empirically prescribed to severely malnourished children with clinical rickets, abdominal distension and/or sepsis.

scholarly journals Morbidity patterns and outcome in children with severe acute malnutrition at a Tertiary Care Hospital.

2020 ◽  
Vol 27 (09) ◽  
pp. 1799-1803
Author(s):  
Waqas Ali ◽  
Asif Ali Khuhro ◽  
Sanam Bano Rajper ◽  
Fazal Ur Rehman
Keyword(s):  
Tertiary Care Hospital ◽  
Severe Acute Malnutrition ◽  
Tertiary Care ◽  
Cross Sectional Study ◽  
Bottle Feeding ◽  
Acute Malnutrition ◽  
Care Hospital ◽  
Laboratory Findings ◽  
Cross Sectional ◽  
Study Setting

Objectives: We planned this study to find out morbidity patterns as well as outcome of admitted children aged less than 5 years of age with severe acute malnutrition (SAM). Study Design: Cross Sectional study. Setting: Department of Pediatrics Medicine, Ghurki Trust Teaching Hospital, Lahore. Period: From 1st January 2018 to 30th June 2018. Material & Methods: A total of 80 children aged 1 to 59 months, of both genders, having SAM were considered. Physical examination, detailed clinical as well as laboratory findings related to nutritional status and comorbidities were noted. Outcome in terms of recovery/discharge, left against medical advice (LAMA) or death during the stay was noted in all the children. Results: Out of a total of 80 children, 20 (25.0%) were aged 1 to 6 months, 39 (48.8%) from 7 to 24 months and 21 (26.2%) from 25 to 59 months. Most of the patients, 39 (48.8%) were from 7 to 24 months of age, 62 (77.5%) were admitted through emergency, 52 (65.0%) had WHZ score-4SD and 27 (33.8%) using bottle feeding. Severe wasting without having edema was reported in 67 (83.8%) children. Diarrhea was the commonest comorbidity, found in 43 (53.8%) children, followed by sepsis 17 (21.3%) and pneumonia 15 (18.8%). There were 69 (86.3%) children noted having anemia. Hyponatremia was the commonest metabolic abnormality seen in 40 (25.0%) children. In terms of outcome, 71 (88.7%) children recovered well and got discharged while mortality was reported in 5 (6.3%) children. Conclusion: Diarrhea along with sepsis and pneumonia along with metabolic abnormalities were found to be more prevalent amongst children having SAM. Early identification of anemia as well as infections in children with SAM can contribute to better outcome.

scholarly journals Evaluation of anthropometric indicators in malnourished children at Nutritional Rehabilitation Center, Gujarat, India

2019 ◽  
Vol 6 (4) ◽  
pp. 1410
Author(s):  
Dhara Patel ◽  
Nisha Upadhyay
Keyword(s):  
Severe Acute Malnutrition ◽  
Nutritional Intervention ◽  
Cross Sectional Study ◽  
Acute Malnutrition ◽  
Daily Weight Gain ◽  
Cross Sectional ◽  
Clinical Criteria ◽  
Anthropometric Indicators ◽  
Malnourished Children ◽  
Intervention Measures

Background: It is very difficult to recognize the cases with mild-to-moderate malnutrition because clinical criteria for their diagnosis are imprecise and are difficult to interpret accurately. The objective of the study was daily weight gain in gram/kg/day in severely malnourished children.Methods: This was a hospital based cross sectional study in which total of 114 consecutive patients of SAM less than 5 years treated for complications of severe acute malnutrition using WHO protocol. The study design included 114 children from the NRC and then followed up the period of 6 months to assess the nutritional status during the period of initial stage and the entire follow up period using available record of anthropometry indicators of the admitted children recruited in the study at the NRC.Results: Mean weight at admission was 6.4 Kg, 6.5 Kg and 6.2 Kg of overall, boys and girls respectively. Mean weight at discharge was 6.8 Kg, 6.7 Kg and 6.6 Kg of overall, boys and girls respectively. Mean MUAC at admission was 10.7 cm, 10.9 cm and 10.6 cm of overall, boys and girls respectively. Mean MUAC at discharge was 10.9 cm, 10.9 cm and 10.8 cm of overall, boys and girls respectively.Conclusions: For treatment of severe acute malnutrition, systematic guidelines required, thus this study indicates that following WHO guidelines, it has become easier to manage SAM in hospital settings, with least possible stay at hospital. The objective of the study was to know the effect of nutritional intervention measures on selected anthropometric indicators of severe acute malnourished children.

scholarly journals Vitamin D Deficiency among Patients Visiting a Tertiary Care Hospital: A Descriptive Cross-sectional Study

2020 ◽  
Vol 58 (231) ◽  
Author(s):  
Nimesh Poudel ◽  
Subodh Sagar Dhakal ◽  
Renu Sukhupayo ◽  
Dambar Bahadur Karki
Keyword(s):  
Vitamin D ◽  
Vitamin D Deficiency ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Serum Vitamin ◽  
Cross Sectional Study ◽  
Outpatient Department ◽  
Care Hospital ◽  
Sectional Study ◽  
Cross Sectional

Introduction: Vitamin D deficiency is a common condition prevalent among both developed and developing countries where it is seen mostly in females. It has been linked to various skeletal and non-skeletal diseases. This study was done to find out the prevalence of Vitamin D deficiency and clinical features of deficient patients attending the outpatient department of a tertiary care hospital. Methods: This descriptive cross-sectional study was done among the patients attending the outpatient department of a tertiary care hospital in Kathmandu, Nepal. The study was conducted from May 2019 to July 2019. The ethical approval was taken from the Institutional Review Committee (ref no. 310520113). Convenient sampling was done. The collected data was entered in Microsoft Excel and was analyzed in the Statistical Package for the Social Sciences (SPSS) version 26. Results: Out of 481 participants, the prevalence of vitamin D deficiency was 335 (69.6%). Severe vitamin D deficiency was seen in 78 (16.2%) and insufficient vitamin D in 77 (16%) of the patients. The mean serum vitamin D concentration by gender was 22.38±17.07 ng/ml in males and 18.89±15.25 ng/ml in females. A total of 263 (54.6%) females and 72 (14.97%) males had vitamin D deficiency. The most common symptoms found in vitamin D deficiency patients were fatigue 187(55.8%), muscle cramps 131(39.1%), generalized myalgia 125(37.31%), bone and joint pain 111(33.13%) Conclusions: Vitamin D deficiency was prevalent especially in females and elderly people. Fatigability was present in more than half of the vitamin D deficient patients.

scholarly journals Quality of healthcare for children with severe acute malnutrition in a refugee setting: cross-sectional study in West Nile Region, Uganda

BMJ Open ◽  
2020 ◽  
Vol 10 (6) ◽  
pp. e034738
Author(s):  
Marzia Lazzerini ◽  
Humphrey Wanzira ◽  
Peter Lochoro ◽  
Amos Ndunguste ◽  
Jerry Ictho ◽  
...  
Keyword(s):  
Health Outcomes ◽  
Severe Acute Malnutrition ◽  
Cross Sectional Study ◽  
Poor Quality ◽  
Acute Malnutrition ◽  
West Nile ◽  
Cross Sectional ◽  
Malnourished Children ◽  
Cure Rates

Objectives5.0 million annual deaths in low-income and middle-income countries are due to poor quality of care (QOC). We evaluated the QOC provided to malnourished children in West Nile Region in Uganda.DesignCross-sectional study.SettingWest Nile Region, an area hosting over one million refugees.ParticipantsAmong 148 facilities providing nutritional services, 30 randomly selected facilities (20%) and the records of 1467 children with severe acute malnutrition (100% of those attending the 30 facilities during last year) were assessed.OutcomesThe national Nutrition Service Delivery Assessment (NSDA) tool was used to assess capacity areas related to QOC. Case management, data quality and health outcomes were assessed from official health records. Multivariate analysis was performed to explore factors significantly associated with better cure rates.ResultsOf 305 NSDA scores allocated to 30 participating centres, 201 (65.9%) were ‘good’ or ‘excellent’. However, 20 (66.7%) facilities had ‘poor’ ‘quality improvement mechanisms’ and 13 (43.3%) had ‘poor’ ‘human resources’. Overall data quality in official records was poor, while recorded quality of case management was overall fair. Average cure rate was significantly lower than international Sphere standards (50.4% vs 75% p<0.001) with a higher default rate (23.2% vs 15% p<0.001). Large heterogeneity among facilities was detected for all indicators. Refugee-hosting and non-refugee-hosting facilities had a similar cure rate (47.1% vs 52.1%) though transfer rates were higher for those hosting refugees (21.5% vs 1.9%, p<0.001) despite better ‘equipment and supplies’. ‘Good/excellent’ ‘equipment’ and ‘store management’ were significantly associated with better cure rates in outpatient therapeutic centres (+55.9, p<0.001; +65.4, p=0.041, respectively) in multivariate analysis.ConclusionsThough most NSDA capacity areas were rated good or excellent, health outcomes of malnourished children in West Nile Region, both in refugee-hosting and non-refugee-hosting facilities, are significantly below international standards. Effective and sustainable approaches to improve malnourished child health outcomes are needed.

scholarly journals Incidence of vitamin D deficiency in pediatric neurology outpatient department of a tertiary care hospital

2018 ◽  
Vol 5 (4) ◽  
pp. 1414
Author(s):  
Purva Keni Karnavat ◽  
Anaita Udwadia Hegde ◽  
Fazal Nabi
Keyword(s):  
Vitamin D ◽  
Vitamin D Deficiency ◽  
Tertiary Care ◽  
Cross Sectional Study ◽  
Care Hospital ◽  
Cross Sectional ◽  
Pediatric Neurology ◽  
Economic Class ◽  
Vitamin D Levels ◽  
Chi Squared

Background: Pediatric neurology outpatient populations are a vulnerable subgroup for vitamin D deficiency. The aim was to study the incidence of vitamin D deficiency in pediatric neurology patients by studying relevant biochemical profile and to assess the contributory factors for the same.Methods: A hospital based cross sectional study was conducted at a tertiary care setup in Mumbai between 2011 and 2012. A total of 284 children aged 0.5-18 years, attending pediatric neurology OPD were enrolled. Statistical analysis was carried out with SPSS version 17.0 and included descriptive statistics; Chi squared and unpaired t-tests to investigate significance of proposed predictors for vitamin D status.Results: 89.1% of the children were deficient in vitamin D levels (≤30 ng/ml); out of these 11% were severely deficient. Factors significantly associated with vitamin D deficiency were increasing age (p=0.034), absence of intake of calcium supplements (p=0.00) and upper socio-economic class (p=0.001). Low serum calcium levels (p=0.01) and high PTH levels (p=0.00) were associated significantly. Prevalence was similar in children with higher BMI as compared to lower BMI. Duration of AEDs rather than number of drugs was more associated with deficiency.Conclusions: A high prevalence of vitamin D inadequacy in noted in pediatric neurology patients.

scholarly journals Vitamin D: prescription audit in tertiary health care centre

2017 ◽  
Vol 6 (9) ◽  
pp. 2163
Author(s):  
Amruta V. Dashputra ◽  
Rupesh T. Badwaik ◽  
Archana S. Borker ◽  
Amit P. Date ◽  
Priyanka Survase
Keyword(s):  
Vitamin D ◽  
Health Centre ◽  
Tertiary Care ◽  
Cross Sectional Study ◽  
Drug Dose ◽  
Care Hospital ◽  
Health Care Centre ◽  
Cross Sectional ◽  
Orthopedic Department ◽  
Ethical Approval

Background: Vitamin-D is critically important for development, growth and maintenance of health of human being. Many evidences show association between vit-D deficiency and several serious health conditions. Data collection on use of drugs is being obtained with the aim of optimizing drug therapy. So far till date only few studies about prescription pattern of vit-D have been found. Hence it is very important to do audit of prescriptions of vit-D. The aim of the study is to provide concise and updated information about the use of vit-D in tertiary care hospital and to record demographic details of patients.Methods: After ethical approval, this cross sectional study was conducted at tertiary health centre. Patient and drug data (name of drug, dose, dosage form and route of administration) was collected from the patient’s prescriptions in OPD.Results: Highest prescriptions of vit-D were found in orthopedic department (22% of total prescriptions of that department). Prescribing percentage of vit-D in medicine department was 4.6%, dermatology 1.5% and in psychiatry 0.8% of total prescriptions. Prescriptions of vit-D in combination with calcium were found in orthopedics (52%), medicine (7%) and obstetrics and gynecology (10%) departments.Conclusions: Highest prescriptions of vit-D alone and with calcium found in orthopedic department. Periodic therapeutic audit is necessary to rationalise the use of vit D.

scholarly journals Vitamin D Status and Associated Factors in Neonates in a Resource Constrained Setting

2018 ◽  
Vol 2018 ◽  
pp. 1-6 ◽  
Author(s):  
Khadija Murtaza Bhimji ◽  
Helga Naburi ◽  
Said Aboud ◽  
Karim Manji
Keyword(s):  
Vitamin D ◽  
Vitamin D Deficiency ◽  
Associated Factors ◽  
Tertiary Care ◽  
Public Health Problem ◽  
Cross Sectional Study ◽  
Care Hospital ◽  
Cross Sectional ◽  
Vitamin D Levels ◽  
Infant Birth

Vitamin D deficiency (VDD) is emerging as a serious public health problem globally; however due to lack of resources, vitamin D levels are not routinely measured among neonates. The study was conducted to determine vitamin D levels in neonates and factors associated with the same. A cross-sectional study was conducted among neonates admitted at neonatal ward of a tertiary care hospital. Means and proportions were calculated from summarized data in frequency tables. Chi square test was used to determine association between vitamin D and various associated factors such as sex, infant birth weight, gestation age, parity of the mother, maternal age, and HIV status of the mother. A total of 170 neonates were studied, out of which 80% had vitamin D deficiency. Neonates born to HIV-infected mothers were significantly less likely to have vitamin D deficiency (OR 0.21, 95% CI 0.06 – 0.77, p = 0.009). Subgroup analysis revealed the association to be stronger in terms neonates (p = 0.005). The association was not observed among preterm newborns. The prevalence of vitamin D deficiency in neonates was observed to be very high and needs more attention.

scholarly journals Impact of Socioeconomic Inequalities on Child Malnutrition

2020 ◽  
pp. 114-119
Author(s):  
Zamir Ahmed Qambrani ◽  
Asif Nadeem Jamali ◽  
Habibullah Siyal ◽  
Sarah Azhar ◽  
Hafiz Syed Imran-ul Haque ◽  
...  
Keyword(s):  
Socioeconomic Status ◽  
Tertiary Care Hospital ◽  
Severe Acute Malnutrition ◽  
Tertiary Care ◽  
Acute Malnutrition ◽  
Severe Malnutrition ◽  
P Value ◽  
Care Hospital ◽  
Cross Sectional ◽  
Chi Square Analysis

Socioeconomic status and the education of mother plays important role in providing better health care and nutrition to children. To the best of our knowledge the major population of Pakistan belongs to middle class and identification of malnutrition in our setups may help the policy makers to develop certain parameters to provide better nutrition to children under 5 years of age. The aims of current study were to analyze the prevalence of malnutrition and their association with different socioeconomic status in tertiary care hospital of Hyderabad. Study Design: Cross sectional. Place and Duration of Study: Study was performed at nutritional stabilization center of pediatric department of tertiary care hospital Hyderabad during the month of July 2019 to January 2020. Methodology: Preformed proforma was designed to record the data of participants. Hospital protocols using WHO guidelines (17) i.e. 10 steps for in-patient care of severe malnutrition were started & followed with feeding F-75 & F-100. Data was analyzed on SPSS-20. Results: The minimum age recorded was 8 months and maximum was found to be 45 months (3 years 9 months). 72% were females and 70% of participants had Weight to height ratio below normal. Prevalence of severe acute malnutrition was found to be 35.2%. After admission and management protocols 91.6% were recovered however, mortality was observed in 8.9% participants. Chi square analysis of all socioeconomic groups showed highly significant results with severe acute malnutrition (p-value= 0.001). Conclusion: Current study concluded a high prevalence of SAM in Pakistani population that is about 35.2%, out of which majority was from lower socioeconomic class.

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